Setting Objectives for Borderline Personality Disorder

Six Cool Ask David Questions from Carlos and Greg Carlos asks: 1. Are your tools available in Spanish? 2. Is there any evidence that TEAM can help patients with Borderline Personality Disorder (BPD)? 3. How do you get patients with BDP to stop jumping from problem to problem? 4. How do you get them to stop endless venting during therapy sessions? Greg asks: 5. What comes first, thoughts or feelings? 6. Can't a genuinely negative or tragic event directly cause negative feelings, without having to have negative thoughts?   Dear Dr. Burns: 1. I would like to use your BMS but I mostly work with patients in Mexico. Has there been any standardization of your tests in any Spanish speaking country? David and Rhonda address this.  You can email Victoria Chicural, who is one of the TEAM-CBT leaders in Mexico (along with Silvina Carla Bucci), at victoriachl@yahoo.com and ask her about access to TEAM-CBT forms that have been translated into Spanish. 2. I am wondering if TEAM has proven to be effective in the treatment of BPD (Borderline Personality Disorder). I use it a lot, but I have found quite a few challenging elements. David describes his published work, indicating an excellent response to TEAM-CBT in patients with BPD. 3. People suffering from BPD usually have trouble prioritizing tasks and activities. The same happens when it comes to setting objectives. Because of their emotion dysregulation, they usually decide to work on one objective, and later on, they sometimes say: "Well, this objective is not THAT important anymore. Let's do another." For them, doing the specificity part can be really challenging because their perspective changes very quickly and they usually go back to the former objective when they're being challenged by a similar situation!!! How do you get them to prioritize objectives and not to switch from one to another so quickly? Or, do you think I could be making a mistake when setting objectives? David describes the strategies he has developed for coping with this type of clinical problem, including the development of his Concept of Self-Help Memo that he required every new patient to fill out prior to their first therapy session. 4. BPD usually come up with a lot of material to the session. They may be facing complex PTSD but also dysfunctionality at work, at school, etc. They want to say everything in a single session even if we have agreed to follow one single objective. Many sessions turn into endless talking without getting anywhere - some of them argue they need to vent out what they feel - but as time goes by, they complain that therapy is not working! How do you deal with a patient who is overwhelmed with numerous factors in a session where you have a previously set objective? David describes the strategies he has developed for coping with this type of clinical problem, Carlos S Bouchanm, Clinical Psychologist David’s Response Hi Carlos, I think these would make for excellent Ask David podcast questions. If so, can we use your name and read your questions? I reported on the effectiveness of the forerunner of TEAM in the treatment of BPD is the Journal of Clinical and Consulting Psychology in the 1990s. TEAM was specifically developed for this population, since 28% of my patients in Philadelphia had BPD. In the live podcast, I will address the excellent questions you asked about treating individuals with BPD. Thanks! David From: Greg Hi David, Thanks for everything you do and for the great podcast! I have another couple questions possibly for the “Ask David” segment of the podcast. 5. Can you say some more about automatic thoughts? CBT is based on the idea that we’re thinking things that produce feelings, but with an automatic thought it just kind of pops up and is there. It’s not like actively, intentionally thinking it. Other schools of thought (for example Somatic Experiencing) posit that feelings from the nervous system occur first and that the thoughts are actually the product of that, which seems to run counter to the CBT view. This has been a little challenging and confusing. David and Rhonda discuss this, including new research on the causal links between emotions and thoughts. 6. How do you apply TEAM CBT to worries about real and true things, like a real diagnosis or a tragic event? It would seem that it’s not just one’s thoughts about it, but an actual threat or upsetting event causing feelings because that is simply how one would feel about. Maybe the thinking is accurate? This, too, has been particularly challenging and confusing, so I’d love to hear more on this. David and Rhonda discuss how thoughts trigger all of your feelings, even after a genuinely tragic event. Thank You, Greg L. David’s Response Thanks, Gary. These are great questions, and perhaps we can address them om an Ask David podcast! There are strong, clear answers that might be interesting or helpful, as nearly everyone has these questions! Best, david Thanks for joining us today! Rhonda, and David