PERSONALITY DISORDER/SELF ABUSE - page 3
Would anyone who has any insights or good resources on the internet, please respond. My facility has no policy on admission and treatment of borderline personality disordered clients who are... Read More
0Jul 28, '02 by psych_00_RNI work in a state hospital; we are the last stop for many of our patients. They have been through the local mental health centers and hospital psychiatric units before coming to us.
My unit houses up to 25 patients and now 9 of them have been diagnosed with BPD.
We use an adapted DBT program. We have had good success, considering the clients we are treating. Most of our clients do not return after completing the program. We do get some repeaters, but thier stays out of the hospital increase in legnth.
We have a 6 month inpatient program. The program is led by our Nurse Clinical Specialist and one other person (generally a psychologist, currently our unit director) and contains 5-6 BPD patients. The group meets for 1 hour twice a week. They also attend a 1 hour Women's issue group twice a week and receive 1 hour of individual therapy with one of the group leaders weekly.
As the dayshift nurse for the unit I have found the most important factor in successful treatment is Consistency. This is what our staff has the most trouble with and this leads our patients to act out. Consistancy between staff and between shifts is essential. If everyone is not consistant the Borderlines will split the staff and systematically suck all the life from everyone.
We have recently begun to use behavioral contracts. Before they can earn any privileges I have the patient write a contract. In it they have to outline thier responsibilities and expected conduct while on ward, as well as what they expect to gain from treatment. Then together we discuss and include the rewards and consequences for behaviors. Once the contract is completed and signed by the patient I present it to the Tx team where we all sign it, give a copy back to the pt. and place a copy in the chart.
Staff interactions can be a great a reward. If they are able to comply with no self abusive behavior and the rules of 1:1 supervision, they earn a set amount of 1:1 interaction with the nurse or staff member of thier choice. This really works if they crave staff attention.
Because patients with BPD can be so devious we have had to adapt our 1:1 policy for the self abusive/suicidal patients. They sit at a certain table in the dayroom. No other patients are allowed to sit with them ( to prevent giving them an item to hurt themself). They sit with thier hands on the table where they can be seen at all times. Every hour they are taken to the restroom and given a drink. This may seem cruel to some, but it does work because they are not getting the attention they are craving.