Lingam Ravi
Regional Department of Psychotherapy, Claremont House, Newcastle upon Tyne, England.
J Nerv Ment Dis. 2013 Feb;201(2):136-42. doi: 10.1097/NMD.0b013e31827f649d.
Debate about suitability or clinicians' low expectations has led to patients with personality disorders being labeled as difficult and being socially excluded from pathways of care. Traditional psychotherapeutic treatments in borderline personality disorder demand too much of these patients' fractured ego structures for meaningful (long-term) therapeutic engagement. However, these patients cause clinicians anxiety and are a burden in health care systems. This article describes the challenge for clinical care teams working in partnership arrangements-psychotherapy and psychiatry services-to provide a containing framework of care. Early access to a pragmatic psychoanalytically oriented group treatment in borderline personality disorder is aimed at offering these patients an opportunity to make transitions in borderline treatment and thus alter the trajectory of their (self-) destructive pathway. A clinical and theoretical case is made for clinicians and health strategists to re-engage in the process of making meaningful early contact with borderline vulnerability. The group-based treatment model in borderline disturbance described in this article has helped forge partnerships between psychotherapy and psychiatric teams in providing in-depth diagnostic and prognostic information early in the patients' journey.
关于适用性的争论或临床医生的低期望导致人格障碍患者被贴上“难相处”的标签，并在社会层面被排除在护理途径之外。边缘型人格障碍的传统心理治疗方法对这些患者破碎的自我结构要求过高，以至于难以进行有意义的（长期）治疗。然而，这些患者给临床医生带来焦虑，并且在医疗保健系统中成为负担。本文描述了临床护理团队在合作安排（心理治疗和精神病学服务）中面临的挑战，即提供一个包容性的护理框架。早期获得针对边缘型人格障碍的实用精神分析导向的团体治疗，旨在为这些患者提供在边缘型人格障碍治疗中实现转变的机会，从而改变他们（自我）毁灭路径的轨迹。本文为临床医生和健康策略制定者提供了一个临床和理论案例，促使他们重新参与到与边缘型人格障碍易感性进行有意义的早期接触的过程中。本文所描述的边缘型障碍的团体治疗模式有助于心理治疗团队和精神科团队建立合作关系，以便在患者就医早期就提供深入的诊断和预后信息。
