title: Patients with borderline personality disorder who are chronically suicidal: therapeutic alliance and therapeutic limits.
abstract: Therapeutic work with patients who are chronically suicidal and have borderline personality disorder (BPD) is challenging, and clinicians often resort to setting firm limits or excessively cautious interventions in efforts to prevent manipulation, regression, or over-dependence. Litigation and malpractice fears reinforce these stances, and reduced compensation for additional time and energy devoted to patients adds further disincentives to sole providers. However, elements of the working alliance and therapeutic limits are within the therapist's control. A case vignette illustrates an individual therapist's modification of usual therapeutic limits while working with a chronically suicidal patient with BPD within a dialectical behavior therapy (DBT) framework over a 16-week period. Discussions regarding the case, interventions used, DBT, and legality concerns follow.
authors.affiliation: Department of Psychiatry, Massachusetts General Hospital, Warren 605, 55 Fruit Street, Boston, MA 02114, USA. xjimenez@partners.org
authors.forename: Xavier F
authors.initials: XF
authors.lastname: Jimenez
mesh_terms: D000328:Adult; D001883:Borderline Personality Disorder / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000331:legislation & jurisprudence / Q000379:methods*; D005260:Female; D006801:Humans; D059020:Suicidal Ideation; D013405:Suicide / Q000523:psychology; D013406:Suicide, Attempted / Q000523:psychology; D016896:Treatment Outcome; D000092864:Suicide Prevention