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Releasing Tensions
- The pleading, the anguish, and the expressed despair and resignation of borderlines serve to release their inner anxieties and to externalize and vent the fright and torment they sense within themselves.
- 우울이 다른 사람의 마음을 되돌리는 수단이 되기도 하지만 다른 사람에게 '교훈'을 가르쳐 주기 위한 분노 표출의 수단(그럼으로써 다른 사람에게 죄책감 느끼게 하는 수단)으로 활용될 수도 있음
- Impulsive borderlines: ...Thus, in the form of recalcitrant depression, they gain revenge, punish, sabotage, and defeat others who have failed to appreciate them.
- Petulant borderlines: Their frequent fatigue and minor somatic ailments force others not only to be attentive and kind but, by making them carry excess burdens, to suffer as well.
- In the same way, this borderline’s cold and stubborn silence may function as an instrument of punitive blackmail, a way of threatening others that further trouble is in the offing or a way of forcing them to make up for the inconsiderations they previously had shown.
- 장기적으로는 대인관계에 악영향을 미치는 정서조절 및 대인관계 전략
- 정도가 심해지면 기이한 사고와 정신병적 행동이 나타날 수 있음
- 자신의 fraility와 imperfections를 타인에게 투사하여 신랄하게 비난할 수 있음
Redemption Through Self-Derogation
- 자기비난(죄책감과 무가치감)을 통해 속죄하고 타인이 자신을 구원해주기를 바람
- Among petulant and impulsive borderlines, where hostile urges are more intense and enduring than in discouraged and self-destructive cyclophrenics, patients must counteract these feelings more forcefully.
- Instead of being merely self-effacing and contrite, they may turn on themselves viciously, as being despicable and hateful. Condemnatory selfaccusations may reach delusional proportions in these patients -> may lead to self-mutilation and destruction.
COUNSELING AND THERAPEUTIC INTERVENTIONS
- 반사회나 분열형 성격을 지닌 사람을 치료할 때보다는 변화의 가능성과 희망이 있음.
- 다른 성격 장애의 severe variants이기 때문에 다른 성격 장애에서보다 동질성이 적다(?).
- Some are well-compensated; most are not. Some are bolstered by supportive families, whereas others face destructive environmental conditions.
Strategic Goals
- The clinical picture represents a state of imbalance on all four of the pain-pleasure, passiveactive, other-self, and thinking-feeling polarities.
- Not only are the personality’s coping mechanisms ineffective and problem-perpetuating, but their lack of consistency leads to identity confusions as well.
- 분열형과 편집성만큼 moderately severe disorders of personality이지만 분열형과 달리 관계에서의 만족을 추구하고 편집성과 달리 성격 구조에서의 유연성을 지녔기 때문에 치료에서의 우위를 지닌다.Reestablishing Polarity Balances
- 어느 한 극성에 치우치는 경향이 있긴 하지만 기존의 대처가 통하지 않을 때 양 극단을 오갈 수 있음 -> 정체성의 혼란감이 더욱 커짐
- 현 상태를 조절하고 보다 적응적 대처 방식을 습득할 수 있게 도움Countering Perpetuating Tendencies
- Once patients grasp the counterproductive nature of their strategies, a major therapeutic goal is to help the UBC patient tolerate the anxiety that causes the switching from one extreme behavior to another.
- These extremes represent a frantic desire to discharge anxiety. Learning to contain these feelings long enough to delay responses will provide the time to evaluate whether the perceived threat is real, and to choose a healthier response.Modifying Domain Dysfunctions
- The three most salient domain dysfunctions of UBC personalities are their paradoxical interpersonal conduct, split intrapsychic architecture, and uncertain self-image.
- Therapeutic interventions that aim to solidify the patient’s identity can indirectly lead to decreases in the anxiety produced by the threat of abandonment, and thus can serve to undermine maladaptive behaviors at their source.
- One consequence of helping the patient tolerate anxiety long enough to explore inner conflicts and to experiment with moderate behaviors can be to initiate the integration of the many splits within the architectural structure of the personality. Tolerance for unpleasant reactions can also diminish the tendency to regress to earlier modes of coping and anxiety-reduction.
- Extreme and categorical behavior is thus built on the foundation of extreme categorical thinking. The patient’s incompatible intrapsychic objects are an example of such thinking -> 흑백사고를 알아차림으로써 극단적으로 행동하게 될 가능성을 낮춤
- Examining early memories can lead to insight into antithetical emotions, contradictory needs, and readily aborted schemas about others.
Tactical Modalities
- 강한 역전이를 야기함
- 리네한의 DBT가 self-injurious behaviors 개선하는 데 도움이 됨
- Benjamin(1993a)에 따르면
- It is when the patient realizes that the therapist will never be able to provide enough nurturance, that desperate and extreme behaviors, such as suicidal gestures, cause the therapist to begin to withdraw.
- Another possible pattern is one in which the patient starts to get better but fears that improvements will lead to being ‘‘kicked out’’ of therapy. The patient will therefore preemptively regress.
- 치료자-환자 경계가 흐려지고 치료자의 사적 영역이 침범당하기 쉬움
- These difficulties should be avoided as much as possible by making it clear at the beginning of therapy that the goal of treatment is to foster independence, and that limits must be set to aid its achievement.
- 상담 초기 몇 회기에 명확한 한계와 규칙이 설정되어야 함
- If the patient accepts the therapist’s terms, the two can begin working on building an alliance. A good therapeutic relationship can take quite some time to develop. Much can be gained therapeutically as the UBC patient realizes that not all individuals are dangerous
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