In our case of the week, the author firstly explains and subsequently demonstrates the therapeutic value of communicating the diagnosis “borderline personality disorder”. He illustrates its usefulness with a brief outline of the therapy with the 22-year old Kathy who was struggling with feelings of loneliness and depression.
The author perceives the diagnosis as a type of interpretation and hence therapeutic communication offered by the therapist to the client with borderline related symptoms. The author discusses the possible harmful effects of the diagnosis such as the raise of feelings of shame or abandonment and the strengthening of the depression in the already vulnerable client. The author provides an important rule of thumb here: “initially, discuss diagnosis only when things are going well”. He adds the importance of an extensive period of time where the therapist builds on an empathic relationship with the client before the diagnosis can be offered. When eventually offering the diagnosis to Kathy, the therapist tries to respect her individuality (e.g., noticing her sense of humour) while pinpointing a pattern underlying her separate symptoms.
The possible advantages of offering the diagnosis are discussed in depth. Firstly, communicating the diagnosis might create a necessary distance and hence introduce the separation phase with the client. Secondly, clients receive the opportunity to promote their self-observation as there is now an external, objectifying label for what they are experiencing (e.g., Kathy starts to read books about borderline). As the borderline diagnosis includes a diverse range of symptoms, the client is also invited to self-reflection (e.g., Kathy starts a journal to write about her feelings). All of this might lead to a more thorough development of the self (e.g., Kathy changing her college major into an area of greater interest).
The paper is interesting for those who want to know more about the value and risks of offering a diagnosis as well as for those who are working with borderline pathology in practice.
Here you can find the link to the case in our Archive (registration is required):
To find our previous cases of the week, go to http://www.singlecasearchive.com/blog.
The SCA team
Borderline , diagnosis, ego, separation, personality disorder,
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