UNIVERSITY OF THE SOUTHERN CARIBBEAN ANDREWS UNIVERSITY AFFILIATION AND EXTENSION PROGRAMS

Essay: Comparison of Kernberg and Linehans Theories on Borderline Personality Disorder

An Assignment Prepared in Partial Fulfillment For the Requirements of the Course PSYC460: Psychology of Abnormal Behaviour

INSTRUCTOR Mrs. Vanessa Samlalsingh

By Rochelle Matthews

29 November 2012

Approval______________

Borderline Personality Disorder: Therapies Borderline Personality Disorder Borderline personality was a term coined by Adolf Stern in 1938 to describe persons with mental health problems who did not meet the criteria for either psychotic or neurotic disorders. It has also been used to describe the borderline states of consciousness these patients sometimes feel when they experience dissociative symptoms (a feeling of disconnection from oneself). Individuals with BPD have a history of unstable interpersonal relationships. They have difficulty interpreting reality and view significant people in their lives as either completely flawless or extremely unfair and uncaring (a phenomenon known as "splitting"). These alternating feelings of idealization and devaluation are the hallmark feature of borderline personality disorder. Because borderline patients set up such excessive and unrealistic expectations for others, they are inevitably disappointed when their expectations aren't realized. Etiology As with many other psychiatric disorders, Borderline Personality Disorder (BPD) is regarded as the product interactions among multiple factors, including genetic, neurochemical, neuroanatomical, and psychological factors. Adults with borderline personalities often have a history of significant childhood traumas such as emotional, physical, and/or sexual abuse and parental neglect or loss. Feelings of inadequacy and self-loathing that arise from these situations may be key in developing the borderline personality. It has also been theorized that these patients try to compensate for the care they were denied in childhood through the idealized demands they now make on themselves and on others as adults. Some studies suggests that this disorder is associated with mood or impulse control problems, others implicate malfunctioning

Borderline Personality Disorder: Therapies neurotransmitters (the chemicals that send messages to nerve cells). The disorder has a genetic correlation since it occurs more commonly among first-degree relatives. Kernberg Kernberg believes that borderlines are distinguished from neurotics by the presence of "primitive defenses." Chief among these is splitting, in which a person or thing is seen as all good or all bad. Something which is all good one day can be all bad the next, which is related to another symptom: borderlines have problems with object constancy in people -- they read each action of people in their lives as if there were no prior context; they don't have a sense of continuity and consistency about people and things in their lives. They have a hard time experiencing an absent loved one as a loving presence in their minds. They also have difficulty seeing all of the actions taken by a person over a period of time as part of an integrated whole, and tend instead to analyze individual actions in an attempt to divine their individual meanings. People are defined by how they lasted interacted with the borderline. Other primitive defenses include magical thinking (beliefs that thoughts can cause events), omnipotence, projection of unpleasant characteristics in the self onto others and projective identification, a process where the borderline tries to elicit in others the feelings s/he is having. Kernberg also includes as signs of BPO chaotic, extreme relationships with others; an inability to retain the soothing memory of a loved one; transient psychotic episodes; denial; and emotional amnesia. Linehan Linehan theorizes that borderlines are born with an innate biological tendency to react more intensely to lower levels of stress than others and to take longer to recover. They peak "higher" 3

Borderline Personality Disorder: Therapies emotionally on less provocation and take longer coming down. In addition, they were raised in environments in which their beliefs about themselves and their environment were continually devalued and invalidated. These factors combine to create adults who are uncertain of the truth of their own feelings and who are confronted by three basic dialectics they have failed to master (and thus rush frantically from pole to pole of): Vulnerability vs. invalidation Active passivity (tendency to be passive when confronted with a problem and actively seek a rescuer) vs. apparent competence (appearing to be capable when in reality internally things are falling apart) Unremitting crises vs. inhibited grief.

Linehan Dialectical Behaviour Therapy Dialectical behavior therapy (DBT), a cognitive-behavioral technique, has emerged as an effective therapy for borderline personalities with suicidal tendencies (Ford-Martin, 2001). The treatment focuses on giving the borderline patient self-confidence and coping tools for life outside of treatment through a combination of social skill training, mood awareness and meditative exercises, and education on the disorder. Group therapy is also an option for some borderline patients, although some may feel threatened by the idea of "sharing" a therapist with others. Kernberg Transference-Focused Psychotherapy The techniques of transference focused therapy (TFP) serve to delineate the disjointed representations of self and other that the patient has. The therapist helps the patient understand the reasons, the fears and anxieties, which maintain the continued separation of these fragmented 4

Borderline Personality Disorder: Therapies senses of self and other. This understanding is accompanied by the experiencing of strong affects within the therapeutic relationship. The combination of understanding and affective experience can lead to the integration of the split-off representations and the creation of an integrated sense of the patient's identity and experience of others. This integrated psychological state translates into a decrease in affective liability, impulsivity and interpersonal disorder, and the ability to proceed with effective choices in work and relationships. The goal of TFP is the integration of the psychological structure with the intent to resolve the borderline condition. Differences Linehan and Kernbergs theories on the etiology of borderline personality disorder differ significantly, and so do the respective treatments they devised for it. Linehans dialectical behavior therapy focuses on teaching the patients appropriate behaviors for coping with everyday life and governing their interactions with others. Since her theory is based on the idea that borderline personalities have different reactions to stimuli in their environment than other people, her form of therapy teaches the patient techniques to modulate their reactions. The foundation of Kernbergs transference focused therapy is that borderline patients engage is primitive defenses against the anxieties they face, and chief among these defenses is splitting. This method focuses on integrating the disjointed images that the patients has created by encouraging them to attain a higher level of rationalization and better object relations through the therapeutic relationship. The difference between the two types of therapy lies in the fact that the focus of transference-focused psychotherapy is on the integration of polarized images of self and others while dialectical behavior therapy teaches emotion regulation skills in a validating environment (Clarkin, Levy, Lenzenweger & Kernberg) (2007).

Borderline Personality Disorder: Therapies References Clarkin, J. F; Levy, K, N; Lenzenweger M. F. & Kernberg, O. F. (2007) Evaluating three treatments for borderline personality disorder: a multiwave study. American Journal of Psychiatry;164, pp 922-928. Retrieved from: http://dsm.psychiatryonline.org/article.aspx?articleid=98504&RelatedWidgetArticles=tru e Ford-Martin, P. (2001). Borderline Personality. In B. Strickland (Ed.), The Gale Encyclopedia of Psychology (2nd ed., pp. 88-89). Detroit: Gale. Retrieved from http://go.galegroup.com.ezproxy.uosc.edu/ps/i.do?id=GALE%7CCX3406000093&v=2.1 &u=caribuc&it=r&p=GPS&sw=w Levy, K. N., Clarkin, J. F., Yeomans, F. E., Scott, L. N., Wasserman, R. H., & Kernberg, O. F. (2006). The mechanisms of change in the treatment of borderline personality disorder with transference focused psychotherapy. Journal Of Clinical Psychology, 62(4), 481- 501. doi:10.1002/jclp.20239 Oliver, D. Concepts behind borderline personality disorder. Retrieved from: http://www.borderlinecentral.com/articles/conceptsbehindbpd.php Salsman, N. L. & Linehan, M. M. (2006). Dialectical-Behavioral Therapy for Borderline Personality Disorder. Primary Psychiatry. 13(5) pp 51-58. Retrieved from: http://mbldownloads.com/0506PP_Salsman_CME.pdf