Q. I am a psych nurse working on an ACT Team. Several of our clients are diagnosed with borderline personality disorder. Most of these folks are fairly acute and one very dynamic lady is currently at the state hospital after she became suicidal and overdosed. This was after a hanging attempt and a week in the hospital. She couldn't recover in the local acute care in-patient unit. Her depression is so overwhelming that she will crawl in the corner and bang her head and sob uncontrollably. This lady is highly educated and very intelligent but she presents as someone with zero insight. For example, she believes that there was absolutely no reason to hospitalize her, and that all of her rights have been violated. I know that we have a good repore. 

I would like perspective on how to help her find that insight and maintain her respect at the same time. I wish I understood what is the determining factor in a person wanting to begin the arduous task of healing and understanding what is really going on with them. Because I suffer from depression I know what it feels like to feel as though you are in a black hole. However, I have learned warning signs and I hate to spend time in depression. When I feel the worst I know it will pass and I may allow myself a few hours on the couch and fantasize about dying but then I get up and get busy. I know that my depression is not as deep as the lady I have referred to, I only mention this to suggest that I have empathy. But getting better and staying better requires a lot of work! I am new to your website but look forward to more information.

 A. From your description, it appears that your client may be experiencing such severe depression that insight alone may not be enough to help with her symptoms. As you spoke of, when depression becomes severe and debilitating, it may feel like you're in a "black hole." As you know, when people experience that level of depression, it is very difficult to maintain clear and directed thinking. All a caregiver can do at that time is help the client get through that difficult time, reminding them of the cyclical nature of their illness, that they have worked through similar episodes in the past, and help keep them safe. As a psych nurse I'm sure you are well aware of the importance of those interventions. It is during the recovery and maintenance phase of the illness that therapy is most useful and effective in helping a client develop insight. When they feel their best is when they think the clearest. It is then that they can work on insight and symptom management approaches. Encourage your client to stay in therapy when her symptoms improve so she can increase her skills at detecting and responding to her symptoms.

          

[ Home ] [ BPD Bookstore ] [ Search BPD Today ] [ DSM IV Diagnosis ] [ Ask the Therapist ] [ Ask the Dr. Archives ] [ Therapist's Archives ] [ What's New? ] [ Articles ] [ BPD Research ] [ BPD Advocacy Program ] [ Borderlines Speak Out ] [ BPD Stories ] [ BPD Chat ] [ BPD Family Chat ] [ BPD Bulletin Board ] [ BPD Open Forum ] [ BPD Christian Board ] [ BPD Parents Board ] [ BPD Teenager Board ] [ Self Injury Board ] [ DBT Board ] [ Family Board ] [ Parents of BPD Board ] [ Children of BPD Board ] [ BPD Communities ] [ Family Section ] [ Membership Section ] [ Author Interviews ] [ Older BPDs  ] [ BPD Rages  ] [ Clinicians That Treat BPD ] [ Resources ] [ Links ] [ Email Volunteers ] [ Spiritual Support  ] [ Consumer Resources ] [ Clinicians ] [ Awards ] [ Webrings ] [ Contact Us ]