Estructura productiva. Descripción de las actividades

Rugge iro (2012, p.359) informs menta l hea lth professiona ls that the abilit y to contain as well as the “capacity to share prolonged states of suffering of the self without defe nsive recourse to interpretations that are premature and inevitab ly obstructive” are an important co mponent to a healthy therapeutic alliance with the clie nt wit h BPD. To this effect, it seems that appropriate ma nage ment of the clie nt wit h BPD is important, due to the emot iona l strain that it may place upon the therapist.

Further more, the therapist needs to pay careful attent ion, whe n fr ustrated, to their own propensit y to act in through a pre mature or cutting interpretation towards the client with BPD. Partic ipant 3 stated that:

there is a high dropout rate. There is… The management of t he borderline pat ient is oft en the t hing that get s t o t he clinician. It is the management thereof . How d o I deal with missed sessions? Because, they miss m ore sessions than other patient s.

The resulta nt effect of this is that :

you are not always lus[f eeling k een] t o deal wit h t he challenging, very demanding client. So, there it does t ake a bit more t ime management. You hav e t o work a bit smart er and you hav e t o be aware of your own capacity … do you have enough resources to deal with t he very, very challenging ones? So, you can mak e t he right calls and the right decisions.

71 therapist relat ions hip. Partic ipant 7 stated that when working wit h clients with BPD, therapists should, go the ext ra mile. Essentia lly, therapists are required to “do t hings that you normally wouldn‟t do for other patients...in the sense that you might

accompany t hem to somet hing import ant . You might writ e a lett er t o somebody, officially, t hat normally you would leave t o your pat ient t o do”.

Therefore, the higher investme nt with these clients leads to exhaust ion of the therapist. Perseius et al. (2007) indicates that clients with BPD are known to be more difficult in therapy as they make more emotional demands on the therapist. As a result, the therapist works harder and may feel pulled into doing things they would not normally do, such as contact with third parties as mentioned by participant 7.

Partic ipant 7 further elaborated that as per the symptoms that characterise BPD, the client fee ls as if:

they have got nobody in t heir corner. They have nev er had anybody really in their corner like their wingman. You must be their wingman. Of course, you st ay wit hin the bounds of

prof essional et hics, blah, blah, blah. But, if you draw that t oo narrow wit h t hem I think you lose out on a lot of t herapeut ic benef it. I have seen often, just the f act t hat you are willing t o pick up the phone and call the t eacher when in ot her therapies you would ref lect it back. You would say t o t he pat ient, “how come you want me to do it f or you?”, or you want t hem t o do it f or

themselv es; because you want t o help them indiv iduate. You k now, all of t hat . Wit h t hem it is about this thing, you either st ay wit h them in t heir regression, and then f rom the regression you slowly start helping t hem individuat e to a less regressed stat e.

From t his, the partic ipant reflects his active supportive role to the client. At times, this ma y become difficult as the boundaries of the therapeut ic relat ions hip need to be kept in mind. There is therefore a juggle of active involve ment wit h the clie nt, as well as being aware of the boundaries needed to be adhered to in order to protect oneself and the client.

72 As per the sympto ms that characterises BPD, clie nts ma y displa y suic idal tendenc ies. Regardless of whether this expressio n is ideatio n or not, the responsib ility to protect the clie nt‟s well-being rests upon the therapist. Here in, keeping in mind, that a client wit h BPD may shift and change his/her behavioura l stance to mainta in the role of victim, especia lly in insta nces where the therapeut ic alliance places the clie nt in a posit ion of facing his/ her own flaws.

To this effect, partic ipants ind icated that working in a hospita l setting is a lot more ma nageable whe n working wit h the clie nt with BPD :

I am luck y t hat most of t he borderlines that I see are in a hospit al setting. So, I don‟t see them generally in privat e pract ice. In a hospital setting you actually don‟t have to contain the suicide behaviour because t hey are already in t he hospit al (Partic ipant 3).

Bovens iepen (1994) makes reference to the instit ut ion as a container. Therefore, the hospital, for instance is seen as a container in which t he clie nt can be held. The staff as well as the phys ical structure of the building provides containment and structure for the clie nts, provid ing a feeling of being held. The focus is therefore on creating a structure in which the client feels contained, and not only a therapist - client

relations hip which does this. The funct ion therefore, relieves the clinic ian of so me responsib ility of containing the clie nt as the hospital and its staff (nurses and doctors for examp le) undertake this funct ion to some additio nal degree.