Self-nurturing: A cognitive behavioral treatment approach for the borderline client

Self-nurturing is a cognitive behavioral treatment approach specifically developed and used in clinical work with borderline clients. The client is taught to recognize and differentiate both the underdeveloped reality ego and developmentally arrested child components of the spilt-ego structure by their affective and behavioral characteristics. The therapist systematically lends ego strengths to the underdeveloped reality ego which is utilized as the good enough parent to re-parent the child ego state. The reality ego is strengthened in the process and the client's maladaptive behaviors dramatically decrease.     

The treatment of borderline neurocognitively impaired children: A perspective from self psychology

The applicability of the definition of the borderline syndrome to children is questioned, as is the traditional view that its etiology lies in the type of interaction the child had with its parents. The redefinition of the syndrome of borderline proposed in prior publications using the conceptual framework of self psychology opens the door to new treatment approaches. This article addresses some of the issues related to these treatment approaches.     

The common-sense model of illness representation: Theoretical and practical considerations

This article focuses on several areas. After reviewing the most commonly used approaches in the study of health behaviors, (e.g., the medical model, the health belief model, and the theory of reasoned action) the common-sense model is presented as an alternative. By presenting evidence across a wide range of illness domains, we demonstrate the usefulness of the common-sense, self-regulatory approach. We then discuss the importance of the common-sense model for health research among minorities. We conclude the article with examples of the operationalization of illness representations in past research and directions for future research.     

Family treatment of a borderline personality

This article discusses family therapy as a complementary treatment modality with the adult borderline patient. According to theory, the separation-individuation process is the underlying conflict of the pathological adaptation of the adult borderline patient and the goal of therapy is often considered to be separation of the patient from the family. Family treatment can facilitate the process of separation-individuation as it allows for the concomitant enhancement of the separateness of the parents. Family treatment can also reduce anxiety about separation, minimize the development of a premature intense transference, and prevent the battle for control between the therapist and the parents. Moreover, the process of the family treatment itself, described in this article, reflects the developmental phase of symbiosis, followed by the subphases of the separation-individuation process, i.e., differentiation, practicing and rapprochement, with the groundwork being laid for moving into object constancy. The ego functioning of all family members has the potential of being enhanced and strengthened through this process.     

The social economics of ethical consumption: Theoretical considerations and empirical evidence

Recent years have seen rising discussion of ethical consumption as a means of stemming global warming, challenging unsavory business practices, and promoting other pro-social goals. This paper first lays out a conceptual framework for understanding the spread of ethical consumption, in which heterogeneous preferences and sensitivity to social norms feature centrally. It then presents empirical evidence from a well-known nationally representative survey on factors associated with tendencies to ‘buy ethically’. It is found that, ceteris paribus, people are more likely to buy ethically when others around them do too, consistent with a role of social norms in promoting ethical-consumption behaviors.     

Theoretical and research considerations of burnout

As in any new area of investigation, the study of the phenomenon of burnout contains much potential benefit, especially to workers in helping/service professions; and it contains sources of error which may delay or distort understandings that are sorely needed. This paper identifies and explains many pitfalls and sources of error in developing theory and research about burnout. After discussing the limitations of the current definitions of burnout, the authors explore the ramifications of the most well supported definition. Specific suggestions are made for further investigation, especially in the area of individual characteristics and their interaction with the burnout phenomenon. Finally, methodologies most likely to yield solid, usable information for practitioners are discussed.     

Making the most of your time: Clinical social work with a borderline patient

If the therapist is to avoid feeling helpless bewildered, and disorganized in response to patients with Borderline Personality Disorder, it is essential that he or she understand as fully as possible the behavior, defenses, and developmental history commonly associated with this syndrome. This paper examines both the diagnostic and the treatment issues from an object relations perspective, including the contributions of social work concepts. A case example is offered.This paper was delivered at the 23rd Annual Meeting of the International Conference for the Advancement of Private Practice, August 1984, in Banff, Alberta, Canada.     

The developmental phasing of internalization: Implications for diagnosis and treatment

This article proposes that the concepts of internalization and mental representation are the theoretical linkages capable of bridging most if not all of the developmental theories despite the formulation of these theories at varying levels of abstraction. Previously unresolvable theoretical dilemmas fade away before the integrative power of these concepts. A brief review of levels of brain function acknowledges the biological substrate from which all developmental and adaptive processes unfold. As with a single developmental line, normative patterns and deviations are of equal significance to preliminary efforts toward integration. Utilizing the concepts of mental representation and internalization, points of intersection of major developmental theories are illustrated. Application to the therapeutic arena via more developmentally informed diagnosis and specificity of attunement and therapeutic use of self is briefly demonstrated.     

Diagnosis and treatment of borderline personality organization

This paper describes the diagnostic and therapeutic approach to borderline personality organization proposed by Otto Kernberg. Diagnosis is based primarily on the characteristic ego pathology which includes the mechanism of splitting, defined as the defensive separation of good and bad self and object representations. The therapeutic strategy emphasizes systematic exploration of the negative transference and the pathological defenses. A case is presented to illustrate the applicability of Kernberg's concepts to the therapy of a borderline client treated by a clinical social worker on a once-a-week outpatient basis.     

The goal-oriented approach to evaluation: Critique and case study from drug abuse treatment

The specification and measurement of program goals remains central to most evaluation research strategies, yet procedures for implementing this approach are not well-articulated. It is the purpose of this discussion to describe a stepwise procedure for programmatic goal setting and monitoring used in a demonstration drug treatment program for women. Three implementation steps are described: (a) goal setting, (b) checking for consistency, (c) monitoring and feedback. The advantages and limitations of this approach are discussed and useful complementary measurement strategies are suggested.     

Sense of community: Issues and considerations from a cross-cultural perspective

Behaviour settings such as work, family, church and community are primary settings in which we participate, they provide us with meaningful roles, relationships, and social identities. In fact, these are settings that provide us with a sense of community (SOC). SOC has been heralded as the guiding value for community research and action. It reflects the integration of people into networks and structures that provide feelings of belonging, identification and meaning. The concept has received much attention since the introduction of McMillan and Chavis' initial formulation. It is argued that research into SOC has been hampered by relying on the Sense of Community Index at the expense of the SOC model. Insights are drawn from cross-cultural psychology and research to highlight conceptual issues and to encourage exploration and the utilisation of alternative modes of investigation. Contex-tualist approaches including substantive theorising and narrative psychology, which have their roots in pragmatism, are promoted as frameworks for bringing community and SOC into focus as central to social and community development.     

The uninterpreted rage: Protecting the therapeutic alliance in the treatment of borderline patients

After reviewing differing approaches to the treatment of the borderline patient, this paper describes the treatment of a patient whose negative transferences are not interpreted by the therapist; rather, the focus is on maintaining the therapeutic alliance via the awareness of the kinship selfobject function of the therapist and merger with the idealized selfobject.There is no end unless the bottom of the trough has been reached, unless the thing feared has been experienced. (Winnicott in Casement, 1991, pp. 129–130). As a matter of fact in these cases it is of decisive importance for the psychotherapist to remain clearly differentiated from the core of psychopathology—if he cannot achieve this separation and becomes drawn into the patient's delusions, he loses his tie to the healthy remainder of the patient's psyche and thus his therapeutic leverage. The maintenance of a realistic, friendly relationship with the psychotherapist is thus of crucial importance in the treatment of the psychoses and borderline states ... (Kohut, 1971, p. 30).     

The borderline/schizoid marriage: the holding environment as an essential treatment construct

The borderline/schizoid marital constellation is the prominent constellation among borderline patients on a long-term inpatient unit. Treatment of this marital constellation, in which each spouse has a severe personality disorder, requires application of the concept of the holding environment as an essential treatment construct, with the therapist as manager of the holding environment. This paper explicates the means of management. With the proposed treatment approach and a long-term treatment orientation, seemingly hopeless cases can improve.     

The trainee and the borderline client: Countertransference pitfalls

Acknowledging and overcoming hostile countertransference is a major problem in treating borderline personalities, especially for clinicians in training. Borderline personality dynamics and transference/countertransference phenomena are described, and a compendium of trainess' negative countertransference reactions is offered, following Maltsberger's and Buie's (1974) schema. Myths of omnipotence, seen as antecedents to countertransference reactions, are discussed briefly. A case example illustrates some of the ways that a trainee may inadvertently foster a negative transference/countertransference experience; it also discusses the roles of supervision and consultation in explicating the particular difficulties that the therapist and patient created. The necessity for and nature of limit-setting with borderline patients is noted.     

Ergonomic considerations for a systemic approach: the millenium maize mills project in northern Mozambique

Malnutrition is a major problem for rural areas of Sub-Saharan Africa. Technology such as the maize mill, which alleviates the burden of pounding grain, also introduces opportunities and new challenges for improved nutrition. While there have been many technical studies of grain mills, and maize mills are in operation in hundreds of locations throughout Sub-Saharan Africa, the maize mill has not been studied from a socio-technical system perspective. This paper reports on the first phase of a study grounded on the hypothesis that mills can improve nutrition by exploiting their function as a social gathering point and providing both instruction and enjoyable healthful products. The objective was to identify those products that could be made available that customers at the mill would be willing to buy. Following observation of food availability, preparation, and consumption preferences within daily work routines, sample products were prepared and presented for cooking and consumption, along with some discussion at a district center mill owned by a local woman. The responses of customers and the mill owner were positive. Strategies for local manufacture and distribution of these products for sale and roles of the mill owner and the mothers are questions for future study.