According to the DSM IV TR, Borderline Personality Disorder is a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity by early adulthood and present in a variety of contexts.
Per the DSM IV TR, To fit the criteria for this PD, one must fit in five or more of the following criterion
1. frantic efforts to avoid real or imagined abandonment 2.a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluations. 3. Identity disturbance: markedly and persistently unstable self-image or sense of self 4.impulsivity in at least tow areas that are potentially self damaging for example, spending, sex, substance abuse, reckless driving or binge eating 5.re-current suicidal behavior, gestures, or threats, or self mutilating behavior. 6. Affective instability due to a marked reactivity mood for example intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and rarely more than a few days 7. Chronic feelings of emptiness 8. Inappropriate, intense anger or difficulty controlling anger for example, frequent displays of temper, constant anger and recurrent physical fights 9. transient, stress-related paranoid ideation or severe dissociative symptoms.
Team, Margaret Mahler's theory on child development is very important for you to know for this test..... My hope is that we can use this discussion to learn about Margaret Mahler and see how relatable her theory is to the the attachment issues in BPD so that you can get skillful at the application of these theories.
Per Wikipedia, Mahlers's childhood development takes place in phases and there are sub groups within these phases.
Normal Autistic Phase. This is the first few weeks of life. The infant is detached and self absorbed and spends most of his/her time sleeping (hahaha I don't know about that)
Normal Symbiotic Phase- this phases lasts until about 5 months. The child is now aware of her mother but there isn't a sense of individuality. The infant and mother are one, and there is a barrier between them and the rest of the world.
Seperation-Individuation Phase. This marks the end of the Symbiotic phase and refers to the development of limits, the differentiation between the infant and mother. This process is divided into subphases, each with its own onset, outcomes and risks Hatching- first months. The infant ceases to be ignorant of differentiation between her and the mother. Increased alertness and Interest for the outside world. Practicing 9 to 16 months, infant begins to crawl and then walk freely, the infant begins to explore actively and becomes more distant from the mother but still experiences himself as one with his mother. Reapprochement 1 -24 months, the infant once again becomes close to the mother. the child may realize that his physical mobility demonstrates psychic separation form his mother so he may become tentative about explore but keep his mother within sight when he does explore.
Mahler calls Object Constancy the phase when the child understands that the mother has a separate identity and is truly separate individual. This leads to the formulation of Internalization, which is the internal representation that the child has formed of the mother. This internalization is what provides the child with an image that helps supply them with an unconscious level of support and comfort from their mothers. Deficiencies in positive internalization could possibly lead to a sense of insecurity and low self esteem issues in adulthood.
Team, now that we have a look at both BPD and Margaret Mahler's theory, I really want to see how the two fit together in a theoretical way and in an applicable way.
As you do, more extensive reading on Margaret Mahler you will find that health child development is really moving through these phases with nurturing, supporting, loving parenting. In the early phases playing mostly the role of the nurturer and as you move down into the individuation phases really moving into a supporting your child's healthy exploration and but always remaining supportive and constant so that eventually they have a health internalization of their mother and ultimately support.
When I started really learning about mahler, I think it gave me new perspective on BPD and the lack of attachment to their own mothers and an absence of a object of constancy that they have. It reminds me of how important it is to provide consistent boundaries with BPD clients and for the test "Setting Boundaries" is the number one most effective treatment and when you think about it from this frame of reference it makes sense when you think about their fear of abandonment and the clinician providing that sort of "Clinical Holding" so to speak by providing those constant boundaries. It makes them feel safe, a feeling that they are deficient in. So, when as a clinician you are second guessing yourself because you are having to roll with the resistance and set good boundaries with some of these extremely difficult axis 11 behaviors, I want you to remind yourself of the above concept.
I also want you to think about it when, the BPD is splitting and they are devaluing you and idealizing another staff and other team members are quick to judge you for being the "heavy". I would like you to educate them about some of the things that are going on developmentally so that they can learn about the behaviors and their own countertransference about the behaviors and the importance of all presenting in a cohesive manner and in doing so they will also be able to see your compassion which will intern allow them to move through their transference issues and maximize their support to you which will ultimately benefit the client
Team, At some point in our discussion next week, I also want to spend some time on the power of the "Labeling theory" and cultural implications with BPD, AXIS II or cluster B traits
Google just deleted my whole post. So, I'm trying again.
Having experience with kids with RAD, ODD, and other attachment-related mental illnesses, I think a lot of Mahler's theories. I also know that many kids with such issues grow into teens and adults who meet criteria for BPD, other axis II diagnoses, and conduct disorder.
As I continue to learn at my new job, I gain more experience working with adults with attachment issues. I agree that in order to treat our patients to the best of our ability, having knowledge about Mahler's theories and BPD is important. It's also important to share knowledge with co-workers (whether social workers or not).
Having worked with one such patient this week, I noticed that I also need to continue to be aware of my own countertransferrence, as a patient's acceptance or rejection can bring up other issues for me that would impact my work if I were not aware of what was going on.
When I was reading the Margaret Mahler Wikipedia page that you referenced, it almost sounded like the most critical period for good separation-individuation is rapproachment (15-24 months), because "a basic 'mood predisposition' may be established at this point." I wonder if the writer is referring to a link to axis 2 disorders like BPD, and whether 15-24 months IS a critical period, or whether all the subphases of separation-individuation are equally important. My inner nerd just came out, but now it's retreating again.
I don't have kids, and have a BA in Elementary Education but didn't learn these early phase developmental milestones there. It's a good time for me to be thinking about these milestones now when working with homeless adults and their kids.
This is a great reference post for me, as I often work with mothers just as much as with children in our clinic. We routinely screen for post partum depression because it can be so detrimental to a child when his or her mother/primary caregiver is not able to provide that consistent supportive presence that the child needs. A woman who is depressed may have a difficult time engaging with her child, and the doctors in our practice become especially concerned in these cases.
The rapprochement stage reminds me of a video I saw in a presentation by an Infant Mental Health specialist. She showed us videos of children playing and how they often look back to their mother for affirmation of what they are doing or just to make sure she is there. When the mother engaged with the child he or she would continue playing and exploring. Then the mother was instructed to be stone faced and not respond to her baby. It amazed me how quickly the child became upset and stopped trying to play or initiate anything on her own. This showed me how important it is for the mother/primary caregiver to be available to the child and responsive to him or her.
According to the DSM IV TR, Borderline Personality Disorder is a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity by early adulthood and present in a variety of contexts.
ReplyDeletePer the DSM IV TR, To fit the criteria for this PD, one must fit in five or more of the following criterion
1. frantic efforts to avoid real or imagined abandonment
2.a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluations.
3. Identity disturbance: markedly and persistently unstable self-image or sense of self
4.impulsivity in at least tow areas that are potentially self damaging for example, spending, sex, substance abuse, reckless driving or binge eating
5.re-current suicidal behavior, gestures, or threats, or self mutilating behavior.
6. Affective instability due to a marked reactivity mood for example intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and rarely more than a few days
7. Chronic feelings of emptiness
8. Inappropriate, intense anger or difficulty controlling anger for example, frequent displays of temper, constant anger and recurrent physical fights
9. transient, stress-related paranoid ideation or severe dissociative symptoms.
Team, Margaret Mahler's theory on child development is very important for you to know for this test..... My hope is that we can use this discussion to learn about Margaret Mahler and see how relatable her theory is to the the attachment issues in BPD so that you can get skillful at the application of these theories.
ReplyDeletePer Wikipedia, Mahlers's childhood development takes place in phases and there are sub groups within these phases.
Normal Autistic Phase. This is the first few weeks of life. The infant is detached and self absorbed and spends most of his/her time sleeping (hahaha I don't know about that)
Normal Symbiotic Phase- this phases lasts until about 5 months. The child is now aware of her mother but there isn't a sense of individuality. The infant and mother are one, and there is a barrier between them and the rest of the world.
Seperation-Individuation Phase. This marks the end of the Symbiotic phase and refers to the development of limits, the differentiation between the infant and mother. This process is divided into subphases, each with its own onset, outcomes and risks
Hatching- first months. The infant ceases to be ignorant of differentiation between her and the mother. Increased alertness and Interest for the outside world.
Practicing 9 to 16 months, infant begins to crawl and then walk freely, the infant begins to explore actively and becomes more distant from the mother but still experiences himself as one with his mother.
Reapprochement 1 -24 months, the infant once again becomes close to the mother. the child may realize that his physical mobility demonstrates psychic separation form his mother so he may become tentative about explore but keep his mother within sight when he does explore.
Mahler calls Object Constancy the phase when the child understands that the mother has a separate identity and is truly separate individual. This leads to the formulation of Internalization, which is the internal representation that the child has formed of the mother. This internalization is what provides the child with an image that helps supply them with an unconscious level of support and comfort from their mothers. Deficiencies in positive internalization could possibly lead to a sense of insecurity and low self esteem issues in adulthood.
Team, now that we have a look at both BPD and Margaret Mahler's theory, I really want to see how the two fit together in a theoretical way and in an applicable way.
ReplyDeleteAs you do, more extensive reading on Margaret Mahler you will find that health child development is really moving through these phases with nurturing, supporting, loving parenting. In the early phases playing mostly the role of the nurturer and as you move down into the individuation phases really moving into a supporting your child's healthy exploration and but always remaining supportive and constant so that eventually they have a health internalization of their mother and ultimately support.
When I started really learning about mahler, I think it gave me new perspective on BPD and the lack of attachment to their own mothers and an absence of a object of constancy that they have. It reminds me of how important it is to provide consistent boundaries with BPD clients and for the test "Setting Boundaries" is the number one most effective treatment and when you think about it from this frame of reference it makes sense when you think about their fear of abandonment and the clinician providing that sort of "Clinical Holding" so to speak by providing those constant boundaries. It makes them feel safe, a feeling that they are deficient in. So, when as a clinician you are second guessing yourself because you are having to roll with the resistance and set good boundaries with some of these extremely difficult axis 11 behaviors, I want you to remind yourself of the above concept.
I also want you to think about it when, the BPD is splitting and they are devaluing you and idealizing another staff and other team members are quick to judge you for being the "heavy". I would like you to educate them about some of the things that are going on developmentally so that they can learn about the behaviors and their own countertransference about the behaviors and the importance of all presenting in a cohesive manner and in doing so they will also be able to see your compassion which will intern allow them to move through their transference issues and maximize their support to you which will ultimately benefit the client
Team, At some point in our discussion next week, I also want to spend some time on the power of the "Labeling theory" and cultural implications with BPD, AXIS II or cluster B traits
ReplyDeleteGoogle just deleted my whole post. So, I'm trying again.
ReplyDeleteHaving experience with kids with RAD, ODD, and other attachment-related mental illnesses, I think a lot of Mahler's theories. I also know that many kids with such issues grow into teens and adults who meet criteria for BPD, other axis II diagnoses, and conduct disorder.
As I continue to learn at my new job, I gain more experience working with adults with attachment issues. I agree that in order to treat our patients to the best of our ability, having knowledge about Mahler's theories and BPD is important. It's also important to share knowledge with co-workers (whether social workers or not).
Having worked with one such patient this week, I noticed that I also need to continue to be aware of my own countertransferrence, as a patient's acceptance or rejection can bring up other issues for me that would impact my work if I were not aware of what was going on.
When I was reading the Margaret Mahler Wikipedia page that you referenced, it almost sounded like the most critical period for good separation-individuation is rapproachment (15-24 months), because "a basic 'mood predisposition' may be established at this point." I wonder if the writer is referring to a link to axis 2 disorders like BPD, and whether 15-24 months IS a critical period, or whether all the subphases of separation-individuation are equally important. My inner nerd just came out, but now it's retreating again.
ReplyDeleteI don't have kids, and have a BA in Elementary Education but didn't learn these early phase developmental milestones there. It's a good time for me to be thinking about these milestones now when working with homeless adults and their kids.
This is a great reference post for me, as I often work with mothers just as much as with children in our clinic. We routinely screen for post partum depression because it can be so detrimental to a child when his or her mother/primary caregiver is not able to provide that consistent supportive presence that the child needs. A woman who is depressed may have a difficult time engaging with her child, and the doctors in our practice become especially concerned in these cases.
ReplyDeleteThe rapprochement stage reminds me of a video I saw in a presentation by an Infant Mental Health specialist. She showed us videos of children playing and how they often look back to their mother for affirmation of what they are doing or just to make sure she is there. When the mother engaged with the child he or she would continue playing and exploring. Then the mother was instructed to be stone faced and not respond to her baby. It amazed me how quickly the child became upset and stopped trying to play or initiate anything on her own. This showed me how important it is for the mother/primary caregiver to be available to the child and responsive to him or her.