Q. I am working as an MSW Intern at a hospice agency. One of patients has the borderline personality. I would like to know if you have any suggestions as to how to deal with her. Her anger at her recent terminal illness is understandable. She has been in this program for a short time and has, in a very short time, been able to cause internal havoc among the workers.
A. Borderlines see the world differently, and need to be dealt with differently for effective care. As a rule of thumb, I would assume that most, if not all, borderlines have black-white thinking. Things are wrong or right without much in between. There is no gray. If this is the case, I would be concrete in my approaches to problem solving. The best way of doing this is to use rational emotive therapy as delineated in any of the books by Albert Ellis, Ph.D. Ellis delineates an ABC method of viewing thinking. A is activating event, B is belief, and C the action or consequence of the individual. Most borderlines face an activating event, have a belief that causes an action, and often the action is wrong or done reflexively. Ellis gives concrete ways of correcting these aberrant thought processes.
Borderlines are energy vampires in the situation you describe. You have a psychiatrically ill patient that is terminally ill. The patient's drive to make major life changes are not going to be very strong, so her chance of responding to what you suggest are low. Therapy will be for short term mood and anxiety control, but not characterological changes. Without knowing the specifics of her terminal illness, social history, etc. it is difficult to make any meaningful suggestions. I would tell you to minimize the stress level the patient perceives, which will in turn minimize the opportunities for her to act out her frustrations. If you send a bit more data, or even specific situations, I will be glad to give you my 2 cents worth. Albert Ellis is still a good way to go, and any of his books are worth a read. The philosophy and theory in them is useful for anyone in any situation.