- Borderline Personality Disorder: A Clinical Guide - John G. Gunderson - Google книги
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- Borderline Personality Disorder – NICE Clinical Guideline 78
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- Clinical practice guideline for the management of borderline personality disorder.
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If this book were a new opera composed by John Gunderson and conducted by him at a worldwide premiere performance at one of the famed houses in Milan, Paris, London, or New York, everyone in the audience, including this critic, would stand up impulsively and cheer. Indeed, stand up and cheer we must. John Gunderson became interested in borderline patients during his psychiatric residency at the Massachusetts Mental Health Center in Boston. In he went to the National Institute of Mental Health and, together with William Carpenter and John Strauss within the framework of the International Pilot Study of Schizophrenia, compared a sample of 29 patients with schizophrenia and a group of 24 borderline patients who had all recently been admitted for hospitalization on the severity of 27 psychopathological dimensions ranging from anxiety to withdrawal 1.
They demonstrated that in regard to symptoms, these severely ill borderline people, until then often diagnosed and lumped together with patients with schizophrenia, were clearly distinct from the group with schizophrenia.
Borderline Personality Disorder: A Clinical Guide - John G. Gunderson - Google книги
In the course of this work, Gunderson also reviewed the then existing descriptive accounts, theories, psychodynamic formulations, psychological testing results, and treatment recommendations of borderline patients, some 25—50 papers in all, including important and seminal contributions by Adolph Stern 2 , Roy Grinker 3 , Otto Kernberg 4 , James Masterson 5 , and Gerald Adler 6. Some of the publications were semantically confusing, discrepant, or simply a jumble of words describing behavior, dynamic formulations, or symptoms.
In an audacious, vigorous, youthful, and memorable article, Gunderson and Singer 7 distilled this material and identified six coherent factors they judged characteristic of most borderline patients according to most of the publications. I well remember reading that article with astonishment and saying to myself that this essay would change the world of borderline patients. It did. There were usable responses, and these ultimately resulted in the first formulation of criteria for borderline personality disorder and schizotypal personality disorder This in turn brought this large group of very ill and difficult patients, once the subject mostly of theorizing and treatment in the psychoanalytic community, into mainstream general psychiatric thought and investigation.
And a large group of patients it is. As Michael Stone 11 has pointed out, estimates of the prevalence of borderline personality disorder in the United States are in the range of 2. Borderline Personality Disorder: A Clinical Guide is an utterly distinguished and unerringly honest book, a meticulously crafted state-of-the-art summary of our knowledge about the diagnosis, the levels of treatment, and modalities of psychotherapy for this illness.
Unfortunately, at present, a disquieting and unbridgeable moat separates the estimated 7—8 million people in our nation with borderline personality disorder from the resources necessary for its successful treatment, so graphically illustrated—with evidence from about publications—in this work. Our society has made the anachronistic decisions to provide vigorous financial support for research on neuroscience and mental illnesses but to withhold the funds necessary for the implementation of the practical conclusions of these projects for the benefit and treatment of mentally ill people—thus abandoning them.
Two early chapters of the book provide background on diagnosis and differential diagnosis. Gunderson goes over in great detail the provenance of the diagnostic criteria for borderline personality disorder from the research of the major contributors to the field and the subjective suffering patients experience living life with borderline disorder.
He makes the point that borderline personality disorder, by far the most important type of personality disorder, is such a major disorder of the self that it requires priority in planning meaningful rehabilitative treatments and therefore deserves categorical status of equal weight with axis I disorders.
This then leads to dilemmas in differential diagnosis thoughtful psychiatrists can encounter in having to decide on a primary diagnosis of borderline personality disorder versus one of bipolar disorder, major depression, posttraumatic stress disorder, narcissistic personality disorder, or antisocial personality disorder. The ensuing three chapters provide an overview for the treatment of borderline patients. These include therapeutic processes and the functions they serve; a potential sequence and timetable of expectable changes in behavior, affect, social functioning, and object relations; three sequential levels of alliance; case management and the responsibilities of the primary clinician; assessing and responding to recurrent suicidality; boundary violations; and various modalities of care, i.
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The second edition includes new research about BPD's relationship to other disorders and up-to-date descriptions of empirically validated treatments, including cognitive-behavioral and psychodynamic approaches. Compelling new research also indicates a much better prognosis for BPD than previously known. A pioneer in the field, author John Gunderson, M. The guide begins with a clear and specific definition of BPD, informed by a nuanced overview of the historical evolution of the diagnosis and a thoughtful discussion of misdiagnosis.
Offering a complete evaluation of treatment approaches, Dr.http://wordpress-11600-25562-61096.cloudwaysapps.com/15574.php
Borderline Personality Disorder – NICE Clinical Guideline 78
Gunderson provides an authoritative overview of the treatment options and describes in-depth each modality of treatment, including pharmacotherapy, family therapy, individual and group therapy, and cognitive-behavioral therapies. Unlike other works, this book guides clinicians in using multiple modalities, including the sequence of treatments and the types of changes that can be expected from each mode. The discussion of each treatment emphasizes empirically validated therapies, helping clinicians choose modalities that work best for specific patients. In addition, Borderline Personality Disorder: A Clinical Guide, Second Edition, also outlines therapeutic approaches for multiple settings, such as hospitalization, partial hospitalization or day hospital programs, and levels of outpatient care.
Complementing the well-organized treatment guide are a series of informative and intriguing sidebars, providing insight into the subjective experience of BPD, addressing myths about therapeutic alliances in BPD, and questioning the efficacy of contracting for safety. Throughout the book, Dr. Gunderson recommends specific do's and don'ts for disclosing the diagnosis, discussing medications, meeting with families, starting psychotherapy, and managing suicidality. John G. Gunderson, M. This information does not constitute medical advice.
B orderline D isorders. Deftly combining contemporary theory with clinical practice, an invaluable resource for any clinician seeking a coherent model of personality functioning and pathology, classification, assessment, and treatment. This insightful guide introduces Transference-Focused Psychotherapy—Extended TFP-E , a specialized but accessible approach for any clinician interested in the skillful treatment of personality disorders.
Treatment of Severe Personality Disorders: Resolution of Aggression and Recovery of Eroticism , the influential psychoanalyst and psychiatrist Otto Kernberg presents an integrated update of the current knowledge of personality disorders, their neurobiological and psychodynamic determinants, and a specific psychodynamic psychotherapy geared to resolve the psychopathology of these conditions—namely, the syndrome of identity diffusion and its influence on the capacity for emotional wellbeing and gratifying relationships with significant others.
Transference-Focused Psychotherapy for Borderline Personality Disorder: A Clinical Guide first provides clinicians with a model of borderline pathology that is essential for expert assessment and treatment planning and then addresses the empirical underpinnings and specific therapeutic strategies of transference-focused psychotherapy TFP.
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