Personality Disorders

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Therapy for Clients with Personality Disorders

        Being able to treat a client with a personality disorder requires finesse on the part of the practitioner which includes and understanding of the client and his or her stage of acceptance. Depending on the disorder being treated and the age and stage of the client, one can utilized a customized therapeutic approach which can include psychotropic medication as well as psychotherapy. In some cases, one can attempt psychotherapy alone and then if necessary, add medication. For someone who is new in the field of psychotherapy such as a nurse practitioner student or advanced practice nurse, CBT can be simple and straightforward to utilize. However, there are some studies of the effects of CBT performed by therapist candidates with limited theoretical education, and the conclusions made in these studies seems to be that CBT performed by therapist candidates can be effective (Stark, 2016).

        I selected Bipolar II Disorder which according to the DSM-5 (2013), there has to be a hypomanic episode with specific criteria and a minimum of three (inflated self-esteem or grandiosity, decreased need for sleep, more talkative than usual, flight of ideas), as well as a Major Depressive Episode which includes depressed mood or loss of interest, lack of energy, feelings of worthlessness, etc.…among other things. The difference between this disorder and a Bipolar I disorder is that the moods never reach full blown mania. This type of disorder is very common and can be very difficult to treat. Many times, clients stop taking medications thinking that they are better and that they no longer need them. The hardest phase to treat in this disorder is depression. Although pharmacotherapy is the recommended first-line therapy for manic, depressive and residual states, medication adherence is typically poor, relapse rates are high, and full remission is rare (Chatterton, 2017). The combination of psychoeducation and CBT was also associated with significant decreases in the risk of medication non-adherence, reduced mania symptoms and improved global functioning and should be considered as an additional offering to people with bipolar disorder, particularly since it can be offered online (Chatterton, 2017).

        In this case I will have to utilize psychotropic medication and depending on the client I can utilize a mood stabilizer like Depakote or lithium along with CBT. The approach I would utilize to share this diagnosis with a client is to start with an explanation of the symptoms and how they affect the person and their ability to function without mentioning the specific disorder initially. Once the client understands the definition of the disorder and realizes that he or she has this in common, then I will mention the disorder as well as the approach to treatment which will include customized CBT based on the client’s phase.

References

American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental disorders. Washinton, DC: Author: American Psyhciatric Association.

Chatterton, M. L. (2017). Psychosocial therapies for the adjunctive treatment of bipolar disorder in adults: network meta-analysis. British Journal of Psychiatry, 210(5), 333–341. https://doi-org.ezp.waldenulibrary.org/10.1192/bjp.bp.116.195321.

Stark, V. &. (2016). Affect at the different phases of cognitive behavioral therapy: An evaluation of psychotherapy provided by candidates. Scandinavian Journal of Psychology, 57(1), 36.