Case Study
Patient Demographic: Client Age: 30 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Agency Type of Counseling: Outpatient Presenting Problem: Recent Hospital Discharge Diagnosis: Borderline Personality Disorder (BPD) 301.83 (F60.3)
Mental Status Exam: Mental Status Exam: The client is wearing a low-cut blouse and short shorts. Her affect and mood are labile, and her speech is pressured. She is fidgety at times and sits with her arms crossed. The client states that she has had three previous suicide attempts and has been cutting since her late twenties. Her last suicide attempt was an overdose, which resulted in her recent hospitalization. She stated that this was the result of her last boyfriend “ghosting” her. The client denies audiovisual hallucinations but states that she often feels that others are conspiring against her. She says that she continues to have suicidal thoughts but denies having a current plan. Fam
Presenting Problem: You are a mental health counselor in an outpatient setting. Your client is a 30-year-old white female who was released from the hospital 48 hours ago. The client presents today for a postdischarge follow-up appointment. The hospital clinician diagnosed the client with borderline personality disorder(BPD) and substance use disorder. The client has a history of suicidality, impulsivity, and relational instability. She explains that she has a “quick temper,” which occurs when she is feeling rejected. She explains that she has a long history of being treated poorly by others, including her last boyfriend, former employers, and family members. During these times, the client admits to substance misuse and self-mutilation (i.e., cutting). She states that there are times when she drinks to black out and that she is more inclined to do so when her feelings become intolerable. The client has had multiple hospital admissions and has been in the care of several counselors. She questions your credentials and your ability to “work with someone like (her).”
Other Contexts: You and the client develop a clear and explicit treatment contract to provide a foundation for informed consent. Through this collaborative process, you establish an agreement outlining treatment roles, responsibilities, and expectations for you and the client. The client agrees with your suggested goals but does not want to include safety issues as part of her treatment plan. You provide psychoeducation on BPD, and she relates to experiences of abandonment. She would like to learn how to navigate romantic relationships and requests interventions targeting this area.  To address the client’s desire for successful intimate relationships, you select an approach that uses a process known as “limited reparenting” as a means for helping the client form more secure attachments

Question: To address the client’s desire for successful intimate relationships, you select an approach that uses a process known as “limited reparenting” as a means for helping the client form more secure attachments. Which of the following interventions makes use of limited reparenting?
(A): Dialectical behavioral therapy
(B): Mentalization-based treatment
(C): Transference-focused psychotherapy
(D): Schema-focused therapy

Correct Answer: Schema-focused therapy
Explanation: Schema-focused therapy is an EBP for BPD. It uses a process known as limited reparenting to help clients establish a secure attachment with counselors within the confines of their professional relationship. The goal of schema-focused therapy is to help the client replace maladaptive schemas or negative patterns of behaving, thinking, and feeling with healthier experiences and interactions. Transference-focused psychotherapy is also an EBP for BPD. Transference-focused psychotherapy is a psychoanalytic therapy based, in part, on the assumption that primary defense mechanisms (eg, “splitting” and “all-or-nothing” thinking) stem from identity defusion that fuels intense emotional states, transference, and strained interpersonal relationships. Dialectical behavior therapy, another EBP for BPD, is a combination of cognitive therapy, behavioral shaping, and mindfulness practices to overcome erratic patterns of emotions and behaviors. Lastly, mentalization-based treatment is an EBP that uses a psychodynamic approach to examine one’s capacity to understand oneself in relation to others. The counselor identifies and addresses certain mental states that contribute to impulsivity and unstable interpersonal relationships. Therefore, the correct answer is (B)
Competency: treatment planning