Psych 380 1nd Edition Lecture 20 Outline of Current Lecture I. Therapy Challenges associated with Borderline Personality DisorderCurrent LectureI. This Thursday is the final lectureII. Next Tuesday – Final examIII. Optional classes the week after ThanksgivingIV. Therapy Challenges: Borderline Personality Disordera. Initial warning signsi. History of abuseii. Problems with previous therapistiii. Refuses to give permission to contact previous therapistiv. Litigation with previous therapistv. History of sex with authority figuresb. Example; Janei. Work related stressesii. Signed the informed consent form1. Specifies secrecy, etc.iii. Dr. Halgin asked for permission to contact her previous therapist and she declined because she was going to sue himiv. Dr. Halgin is on the MA board for psychologists – reviews the actions of psychologists practicing in the state.v. There are therapists who misbehavevi. Options:1. Probation2. Mandated therapy for themselves3. Take away license4. Others…vii. Although sometimes it is the client and not the therapist. Example of a therapist who was sued for sexual assault – the client was lying the whole time, proved it by asking her about a body mark on the therapist’s body that she couldn’t identifyviii. There is a law that therapists cannot have sex with clients that they have had in the previous 2 years.1. Easy for people to lie and wait 2 years and 1 dayc. Back to Jane…i. He sees her a second time with no issueii. The third session she comes in practically naked (bikini?) and hammerediii. She could barely standThese notes represent a detailed interpretation of the professor’s lecture. GradeBuddy is best used as a supplement to your own notes, not as a substitute.iv. She says “I’m here to do some favors for you.” When Dr. Halgin says he doesn’t understand what she means she says “We both need to relieve from stress, I’m going to have sex with you”v. She had driven to the appointment intoxicated, is a danger to herself and societyvi. She went towards Dr. Halgin physicallyvii. This was extremely awkward for Dr. Halgin – didn’t know what to do. He couldn’t let her leave but he could also get himself in trouble. There are nowitnesses there and she could sue him (he said she said). viii. When he denies her advances she says, “Fine if you don’t want to fuck me I’ll leave.”ix. He decides he has to call either her husband or the police.x. Because she is a danger to the public he may want her arrested.xi. After practically wrestling her, he gets her keys and calls her husband who comes and picks her up.xii. After that he calls her and tells her that he can’t treat her anymore.V. Later warning signs:a. Expresses excessive satisfaction “best therapist I’ve ever had”i. Splitting1. Idealization/devaluationb. Seeks physical contact (hug, kiss)c. Brings gifts, enraged if they aren’t acceptedd. Tried to take control of the time and place of therapyVI. What to do?a. Talk to colleaguesi. Consult and documentii. What do you think about your reaction to your patient?iii. Example; before his son was borniv. Dr. Halgin always felt extremely anxious and uncomfortable when he was with an 18-year old college student who was his patientv. It had to do with he himself having a kidvi. Thinking – will my son have to deal with this in 18 years?vii. 90% attention to client 10% thinking about selfb. Adhere to framei. No I can’t meet you at ABC for our sessionc. Avoid friendshipi. I’m not your friend, I’m your therapistii. I’ll be friendly at times but I have to tell you things you don’t always want to heard. Avoid touchingi. May be interpreted as sexualii. Touching is violation of boundariese. Let client solve practical problems of lifef. Hospitalize if necessaryi. This is the not so fun part of being a therapistii. You essentially take away their rightsiii. They are in the hospital for 72 hours without releaseiv. You take away their autonomyv. What if it were me in there? How would I feel?VII. Video; Jesse from the show In Treatmenta. Previously watched another episode in which he went to therapy with his adoptive mother. He had just gotten kicked out of school, had gotten in contact with his birth mother.b. In this episode, he shows up at Paul’s home late at night. Paul is making pancakes with his son.c. Jesse says he got kicked out of his birth parents’ homed. He was invited there and went early to scope out the housee. Saw children using chalk in the driveway – was upset by thisf. Left and got highg. Went back to the house later, ate nearly all of the oreo cookies they put out – said he felt patronized by the fact they put cookies outh. He doesn’t really remember what they said, just noticed that they held hands the whole time, he noticed that all signs of their children were hidden except for safety covers on the outletsi. When he went to the bathroom he noticed a bar for disabled people – remembered a child in a wheel chair earlierj. They had washed all of the chalk off the drivewayk. Paul confronts Jesse for purposefully sabotaging himself so that he can blame things on other peoplel. Jesse leaves very angry from the sessionVIII. Ethical/Legal issuesa. Understand yourselfi. Dr. Halgin talks about the doctoral psychologist program at Umassii. They only accept 4 students each yeariii. He always asks the applicants what was the most important influence in them wanting to become a psychologist.iv. Gives example of person who says Karatev. Another person recalls when he was 13 and stole his parents’ car with his friends and ran away. They spent a week down there before they were caught.vi. You need self understanding in order to treat othersb. Know ethics and standardsi. Is it ethical to have sexual relationship with former client?ii. sex (violation of power)?iii. 2002 code – within 2 years of treatment is considered unethicalc. Be competent in what you doi. Complaints about incompetence - didn’t solve problemii. Child custody evaluations – who should get custody?iii. One parent is always going to be enragedd. Balance business and clinical issuesi. Collection agencies can lead to clients filing a complaint or spreading the word that the person is a bad therapistii. Better to expect that about 10% won’t paye. Confidentialityi. HIPAAii. Health insurance Portability & Accountability Actiii. Promoted by Senator Kennedy in 1990’siv. It protects people’s privacyv. Example of alcoholic –