How will you know (long-term client) is in crisis
1) Behavior is not typical (appear not to care about appearance)
2) Irrational thoughts/behavior/black and white thinking/absolutes
3) New serious topic (that you need to dive into)
4) Transcrisis state
5) Home/work patterns change
6) High/Low affective response/emotional stability
Not working on longterm goals, just trying to get back to homeostasis
long term vs crisis counseling (satisfaction now)
Long term counseling
- talking about the process of counseling and putting boundaries in place about what its supposed to look like
- Crisis counseling = get into it, no time to explain process and boundaries
Mental Health Crisis Services
24-hour service
Mobile crisis teams
Crisis resolution teams (or CITs)
The way you introduce yourself and explain what your role is important to “get them on your team”
when services are going to be terminated, or regression happens, it can put people into transcrisis or crisis
Setting boundaries with BPD clients
- Treatment noncompliance is common; therapists should address it openly and acknowledge the client’s right to refuse tasks.
- Clients with BPD may try to externalize problems; therapists should avoid being manipulated into fixing their issues.
- Therapists need to stay calm, not treat every crisis as an emergency, and ensure the client does the majority of the therapeutic work.
- When clients push for inappropriate therapist involvement in external matters, therapists should reinforce therapy and life as separate domains.
- Therapists working with BPD clients should constantly evaluate their own emotional responses and boundaries to avoid manipulation and burnout.
