Utilizing cognitive-behavioral techniques in psychodynamic practice with clients diagnosed as borderline

Many factors, including theoretical controversies, treatment constraints, and an increasing awareness of the high incidence of childhood trauma, compel practitioners to reevaluate both theory and practice in the treatment of clients diagnosed as borderline. Our purpose in this paper is to encourage clinicians who practice primarily from a psychodynamic perspective to reconsider the judicious use of relevant cognitive/behavioral techniques with this population. We focus on the rationale of utilizing relevant cognitive/behavioral techniques in out-patient settings, and discuss specific problem areas where these techniques might be useful. These problem areas include (1) cognitive and affective splitting, (2) affective dysregulation, and (3) faulty attributions. Each problem area is discussed with clinical illustrations of appropriate cognitive/behavioral interventions. The vignettes also illustrate the essential role the therapeutic relationship plays in order for cognitive/behavioral interventions to be effective.     

A Case Study of a Maltreated Thirteen-Year-Old Boy: Using Attachment Theory to Inform Treatment in a Residential Program

This paper presents therapeutic interventions from an attachment perspective with a thirteen-year-old boy with a history of maltreatment, living in a residential treatment facility. Attachment theory holds that accumulated memories of experiences with caregivers become organized into representational structures called internal working models. The guiding principles of the therapy begin with the critical role played by the individual therapist as an attachment figure. The central purposes of the therapy are conceived as promoting the restructuring of the internal working models of others to reflect expectations of trustworthiness and reliability, and models of the self as worthy to receive care. The approach described is contrasted with common approaches to residential treatment that rely on environmental behavioral contingencies, modeled on social learning theory.     

Self‐Help Groups in the Welfare State: Treatment Program or Voluntary Action?

This article identifies two different perspectives used when studying self‐help groups: the professional treatment perspective and the voluntary action perspective. An outline of the perspectives leads to a discussion of their consequences for self‐help group research. The authors categorize about five hundred scientific publications from all over the world on the basis of the perspectives they present on self‐help groups; the results indicate that different perspectives seem to be preferred in different countries and when discussing different subjects. Finally, the authors suggest questions and concepts that the perspectives generate, and they emphasize the importance of being aware of which perspective is used in the study of self‐help groups.     

Attachment and Self‐Efficacy in Career Search Activities: A Structural Model

The author integrated attachment theory with social cognitive career theory (SCCT) to examine how attachment styles influence the career search self‐efficacy activities of interviewing, networking, job searching, and personal exploration. Using an undergraduate sample (N = 275, 81% women), the author tested a structural model. Results indicated that anxious attachment style was negatively related to interviewing self‐efficacy, whereas avoidant attachment style was negatively related to networking, job searching, and personal exploration self‐efficacy. Theoretical implications based on these findings provide support for an integrative model of attachment theory with SCCT. Career counselors are encouraged to consider clients’ attachment styles when working with individuals who are searching for employment. To help address the limitations of the study, future researchers could test the applicability of the current model with a more diverse sample.     

A feminist critique of rational-choice theories: Implications for sociology

I consider the relationship between two currents affecting sociology, rational-choice theory and interdisciplinary feminist theory. In particular, I consider how the feminist critique of the separative model of self applies to one version of rational-choice theory, neoclassical economics. In discussing this I identify four assumptions of neoclassical economics: selfishness; interpersonal utility comparisons are impossible; tastes are exogenous and unchanging; and individuals are rational. I argue that each of these harmonizes best with a view of separate rather than connected selves, and that this imbalance distorts theories, particularly those that claim to understand women’s experience. These distorting assumptions are less prevalent in sociology than in economics, but some of them are implicit in some versions of sociological rational-choice and exchange theories. I conclude by using research on marital power to illustrate how removing distorting assumptions and bringing questions about separation/connection to center stage can help illuminate sociological research. Her forthcoming book,Comparable Worth: Theories and Evidence (New York: Aldine deGruyter), discusses this controversial policy issue from a perspective that draws upon sociology, economics, and feminist theory.     

Using psychodynamic interventions to engage in trauma-informed practice

In recent years, trauma-informed practice has received increased attention in the social work literature. Although the adoption of trauma-informed practice is necessary for preparing social workers to practice effectively with clients, these frameworks do not necessarily provide social workers with the specific skills for doing so. Therefore, we argue that using interventions grounded in contemporary psychodynamic theory can help transform them into trauma-informed practitioners. Psychodynamic psychotherapy interventions, especially from object relations and self psychology, align with many of the principles of trauma-informed practice (e.g. establishing an atmosphere of safety and acceptance, relying upon relational collaboration). We begin by discussing trauma-informed practice and then discuss how the use of psychodynamic psychotherapy interventions (holding environment, containment, and selfobject transferences) can facilitate the application of trauma-informed principles. We conclude with a case illustration of how to incorporate psychodynamic interventions into trauma-informed practice.     

Borderline personality disorder: nursing interventions using dialectical behavioral therapy

Psychotherapeutic treatment of people with borderline personality disorder (BPD) is one of the greatest challenges confronting mental health professionals today. Clients with BPD are often difficult for nurses to work with, perhaps due to a lack of understanding of the underlying dynamics of the disorder. This article describes effective treatment strategies for BPD with a central focus on dialectical behavioral therapy (DBT). In typical mental health settings, nurses can effectively implement interventions using the concepts of DBT to help people with BPD build effective coping strategies and skillful behavioral responses for improved quality of life.     

Specialization and the Survival of Self‐Help Organizations

This article examines the survival rates of 589 self‐help organizations in order to understand how self‐help niches, organizations specializing in biomedical, human services, and behavioral health, differentially impact longevity. Drawing on a study of the self‐help movement, we examine how the various mechanisms by which specialization impacts self‐help movement organizations' chances of survival. Extending the concepts of embeddedness, countervailing powers, and organizational specialization to self‐help organizations, we investigate how formal structures and professional alliances differentially promote longevity. Results show how formalization enhances self‐help organizations' longevity, and serves as a mechanism by which specialization impacts organizational viability. While formalization has a robust and beneficial impact on longevity, some professional linkages are negatively associated with survival and others are positively associated with it.     

The Relationship Between Nonsuicidal Self‐Injury and Family Functioning: Adolescent and Parent Perspectives

We explored parent and adolescent reports of family functioning, how this differed if the parent was aware that their child self‐injured, and how parental awareness of self‐injury was related to self‐injury frequency, self‐injury severity, and help seeking. Participants were 117 parent–adolescent dyads, in 23 of which the adolescent self‐injured. Adolescents who self‐injured reported poorer family functioning than their parents, but parents who did not know about their child's self‐injury reported similar functioning to parents whose children did not self‐injure. Parents were more likely to know that their child self‐injured when the behavior was severe and frequent. Help‐seeking was more likely when parents knew about self‐injury. Family‐based interventions which emphasize perspective‐taking could be used to effectively treat self‐injury.     

An Integrated Human Behavior Theory

Abstract

In this article, the behavioral exchange model as derived from the work of Emerson, is presented to help the practitioner more adequately conceptualize the interaction between the clinician and the client. This model can help the clinician develop and further his/her understanding of how power differentials between the clinician and the client affect the therapeutic relationship. This model describes how clients use a cost-benefit framework to determine if treatment is worthwhile-meaning that if the client perceives the rewards of an interaction as not outweighing the costs, then the client may terminate treatment. Finally, this model can assist the clinician in constructing an integrative framework for the diverse variables reviewed in the text, and with this framework will be better equipped to influence them.     

Computerized Behavioral Interventions: Current Products and Recommendations for Substance Use Disorder Treatment

Unlike traditional methods of delivering substance use disorder (SUD) and mental health treatment, computerized behavioral interventions deliver services via computers, smartphones, and other electronic devices. In recent years, there has been a proliferation of Web-based treatment programs designed for certain target populations. Studies have shown that many of these programs are evidence-based, and some are just as effective as traditional in-person interventions. This article reviews current computerized behavioral interventions and makes recommendations for how these tools can be incorporated into SUD treatment services.     

A Systems-Crisis Approach to Family Treatment

This paper presents a model which integrates a wide range of possible interventions using family treatment and provides a method of differential decision making with regard to the intervention to be used in a given case. The model uses an ecological perspective and draws on concepts from general systems theory and crisis theory. A number of case examples are provided to demonstrate how the model has been applied in a clinical setting.     

Self‐Help Career Services: A Case Report

Self‐help career services represent an important form of career intervention rarely described in the literature. Using a case‐report approach, the author describes this type of career intervention, which was guided by cognitive information processing theory and Holland's ( 1997 ) typological theory. The report offers an example of appropriately identifying client readiness to engage in career counseling using a 3‐tier model for service delivery composed of direct, brief, and self‐help interventions. It also demonstrates an effective method for translating theory to practice, a particularly critical need in the career development field. The outcome of the intervention supports a differentiated model of career services that increases client accessibility to those services.     

“I” and Self-Consciousness in the Japanese Language and in Sociology

Abstract It is often said that the Japanese lack the firm consciousness of “self” namely, they yield to groups and are absorbed in an anonymous state. Some ascribe this to the Japanese language, in which the first and the second person are expressed by various pronouns (or, in many cases, are even omitted) in accordance with the relationships between persons. By contrast the Westerner's “I,” which is usually the only pronoun for the first-person, is rarely omitted. They conclude from this that the Japanese individual does not possess as clearly defined a conception of “self” as does the Westerner. Underlying this issue are the fundamental, interwoven questions of language and self-consciousness: does “self” really exist, and does the analysis of the I in language pertain to the first question? This paper discusses these questions by considering Wittgenstein's argument that “I” does not refer to self-consciousness: rather, “self” is a metaphysical reification of “I.” These problems concern sociology, in which the “subject” of action has been the focal point of methodological arguments. I will show that Meadian interactionism and critical theory are deeply rooted in the metaphysical, subjectivist understanding of “I,” while ethnomethodology offers a perspective which overcomes both subjectivism and objectivism for studying communication.     

Behavior Management Principles: Incorporating a Biopsychosocial Perspective

This article identifies ten principles for developing, establishing, and maintaining behavioral interventions in work with children. Employing a biopsychosocial perspective, it offers a framework for utilizing such interventions in ways that are consistent with social work's historical contribution to the mental health disciplines. With a primary focus on school settings, it describes both theoretical considerations and practical applications. A relational, feedback-oriented approach to implementing behavioral interventions is advanced.     

Teaching Students to Perform Assessments

In recent years, assessment methods and skills have been increasingly emphasized in the social work literature. Little information, however, has been provided about how to teach students assessment skills in a classroom setting. This article addresses that gap in the literature and presents an integrative skills assessment approach for teaching students to perform assessments. This approach is based on technical eclecticism and combines assessment methods and skills from three practice models: (1) psychosocial, (2) cognitive—behavioral, and (3) systems. Knowledge and skills about measurement, computerized assessment models and expert systems also are included in this approach to teaching assessment skills. The authors provide suggestions and tools for teaching assessment skills in a classroom, including an integrative skills assessment protocol and several techniques that may be used to teach students to gather assessment data. In teaching assessment skills, possible links may be developed with the field practicum and the classroom experience of students. In addition, the authors suggest that students benefit from the integrative skills approach. The approach is comprehensive, flexible, competency based, technological, and empirically based. However, shortcomings are that the approach is a clinical practice approach that excludes other forms of practice and that the integrative skills assessment approach does not help students develop skills for performing the rapid assessments frequently required for brief interventions.     

Career Theory From an International Perspective

The Career Theory in an International Perspective group highlighted 7 approaches: action theory, self‐construction model, transition model, dynamics of entering the workforce, narrative in career guidance, dilemma approach, and interactive identity construction. Three main characteristics appear to be common to these different contributions: (a) emphasis on contexts and cultural diversities, (b) self‐construction or development emphasis, and (c) a constructivist perspective. Such conceptualizations are quite distinct from the methods and tools most often used by career and school counselors in their daily activities. A proliferation of models was noted. The need for new models, methods, and materials probably originates (a) in the diversity of societal questions emerging in the field of career development and self‐construction and (b) in some differing points of view regarding goals of personal and career development interventions.     

Contextual Factors Related to African American Adolescent Career Development

African American adolescents’ career development has gained increased attention in light of various barriers affecting their educational and career development goals. The author examined relationships among career decision self‐efficacy, ethnic identity, and academic self‐concept of 104 African American high school students enrolled in Upward Bound programs. Participants responded to measures of career decision self‐efficacy, ethnic identity, and academic self‐concept. Results indicated that career decision self‐efficacy was significantly and positively correlated with ethnic identity and academic self‐concept. In addition, academic self‐concept was found to be a stronger predictor of career decision self‐efficacy than was ethnic identity. The results of this study may assist counselors, teachers, administrators, and parents to understand career decision self‐efficacy as it relates to ethnic identity, academic self‐concept, and demographic variables. This research supports the need for continued career‐related interventions within the schools designed to focus on factors related to ethnic minorities to help foster their career development.     

THE INTEGRATIVE AND PHYSIOLOGICAL EFFECTS OF SPORT PARTICIPATION: A Study of Adolescents

The integrative and physiological effects of sport participation are investigated using data from a national survey of Icelandic adolescents. Focusing on mental health and health related behavior, the study shows more benefit from club sport than informal group sport, and, in turn, individual sport. As the physiological perspective suggests, beneficial effects are largely due to strenuousness of exercise. However, findings also suggest that club sport has an integrative effect when predicting positive aspects of mental health, an effect limited to urban communities, as comports with social integration theory.