Patients lack self-knowledge about their inappropriate ways of thinking and behavior. On the contrary, they often think that their way of doing things is normal and correct. Because misconduct brings trouble to others, families and units have to send patients to psychiatric treatment. On the contrary, people with anxiety disorders often cause their own pain, not others. Personality disorder If they seek help from others-often because of setbacks-they often think that the problem is caused by others or a specific painful environment.
There are the following types of this disease: paranoia, schizophrenia, hysteria, narcissism, antisocial, borderline, avoidance, dependence, compulsion and passive aggression. Dissociative personality disorder used to be called multiple personality disorder, which is a general term for different personality disorders.
borderline-personality-disorder
Interpersonal relationship, self-image, emotional instability and obvious impulse; From early adulthood, there are various processes before and after, as follows:
(l) Crazy efforts to avoid real or imagined abandonment. Note: Suicide or self-injury mentioned in item 5 is not included;
(2) Unstable and tense interpersonal relationship, which is manifested in the transformation from extreme field conception to extreme degeneration;
(3) Identity obstacle: the self-image or self-feeling has undergone significant and lasting unstable changes;
(4) Impulsive and potential self-destruction in at least two fields, such as waste, sex, drug abuse, reckless driving and alcoholism. Note: Suicide or self-injury in item 5 is not included;
(5) Repeated suicidal behavior, suicidal posture, or threats, or self-injury;
(6) Emotional instability is due to obvious emotional response (such as a strong attack of emotional disorder, irritability, lasting for several hours, rarely more than a few days);
(7) long-term emptiness;
(8) Unjustly strong anger or uncontrollable anger (for example, frequent tantrums, anger and fights);
(9) Short-term paranoid thoughts related to stress or severe separation symptoms.
I. Clinical manifestations
The clinical manifestations of borderline personality disorder are mainly emotional instability, interpersonal relationship fluctuation and self-identity confusion.
Emotional instability is manifested in the impermanence of emotional transformation, especially when encountering setbacks, from normal emotions to excitement, anxiety or depression in an instant, ranging from a few hours to a few days, completely out of control. The behavior is also obviously impulsive, and there may be attempts to self-harm or commit suicide. The fluctuation of interpersonal relationship shows that the original interpersonal relationship is shaken under the condition of emotional instability. For example, you become bored with the person you love and alienated from the person you depend on, but at the same time you can't stand loneliness and often feel inexplicable emptiness.
The confusion of self-identity is manifested in the destruction of the integration and coordination between the internal state and the external environment, that is, the destruction of one's essence, belief and consistent consciousness in important aspects, resulting in self-image contradiction. For example, patients are obviously normal heterosexuals, but they often inexplicably suspect that they may have homosexual tendencies; I can handle some things that are not difficult to handle, but I am worried that I may not be able to solve them.
Second, the diagnosis points
First, the unstable changes in mood, interpersonal relationship and self-image are sudden and short-lived.
The second is that there are at least five indications in the following symptoms:
1, impulsive behavior harmful to oneself;
2. changeable emotions;
3. Unstable interpersonal relationship;
4. Excessive stimulation;
5. Doubt about one's identity;
6, unbearable loneliness;
7. There are attempts and behaviors of self-injury or suicide;
8. Long-term boredom.
Third, there may be manifestations of schizophrenia, behaviorism and antisocial personality disorder, but they can't be classified into corresponding types, and they have the borderline of various personality disorder types.
1, general principles of treatment
(1) Detailed evaluation interview. For those who are suspicious of borderline personality, a detailed initial interview should be conducted, especially to evaluate suicide concept and suicide risk. Suicide is the first consideration in treatment. At the beginning of treatment, it is necessary to have a clear treatment framework, including the contract of treatment objectives.
(2) Teamwork. In the whole treatment process, in addition to psychotherapy, patients need to consult psychiatric staff regularly. At this time, in addition to psychotherapy, psychiatric services also include several parts: crisis intervention and monitoring the safety of patients; Promoting therapeutic frameworks and therapeutic alliances; Provide knowledge education about borderline personality disorder; Coordinate the cooperation of the person in charge of various treatment methods; Evaluate the effectiveness of the treatment plan. Generally speaking, the treatment of borderline personality disorder needs the cooperation of a team, and the team leader needs to perform the above tasks. In addition, all members of the team agree that it is necessary to understand the patient's division and projection patterns and know how to deal with them.
(3) Psychotherapy is the main treatment, and drug therapy is supplemented by symptomatic treatment. No matter what kind of psychotherapy mode, it needs to be clear that this mode is bound to be long-term and may cause personality changes. Drug therapy is an important auxiliary and symptomatic treatment. At present, no high-quality evidence-based medical evidence (RCT research) has been found to prove that the combination of drugs and psychotherapy is more effective than a single treatment model, but clinical experience often supports the combination of the two treatment methods.
(4) Pay attention to the * * disease of Axis I and Axis II. And don't neglect the treatment of * * * disease.
(5) Flexibility of treatment plan. The treatment plan should not be fixed, but should be changed within a certain range according to the specific situation of patients to meet the needs of specific patients.
(6) Respect the patient's choice. The treatment of borderline personality disorder requires patients' high cooperation, and patients should not be forced to accept a certain treatment method or a therapist except in a crisis situation.
2 Summarize the characteristics of various treatment strategies.
2. 1 psychotherapy
Only two treatment modes are supported by the results of randomized controlled studies: (1) partial hospitalization mode with mental basic therapy (MBT) as the core in dynamic therapy, and (2) dialectical behavior therapy mode (DBT) in cognitive behavioral therapy. At present, there is no study to compare the advantages and disadvantages of these two therapies and what kind of patients use one of them. The same characteristics of the two therapies are: the treatment is carried out by the treatment team, patients receive various treatment methods, patients need to participate in individual psychotherapy and group activities every week, and the treatment team needs to hold regular supervision meetings or seminars. Although some people have invented a short-term treatment for patients with borderline personality disorder, most studies show that it takes at least 1 year to truly and continuously improve the patient's condition, and for most patients, the course of treatment is far more than 1 year.
Some effective strategies of various schools of psychotherapy include: (1) establishing a solid therapeutic alliance; (2) Monitor and set restrictions on suicide and self-injury; (3) While acknowledging patients' pain, encourage and help patients to be responsible for their actions; (4) The flexibility of treatment is limited; (5) Handling the feelings of patients and therapists; (6) eliminate patient division.
Individual dynamic therapy without group therapy and other hospitalization modes are also supported by some experimental evidence, but the degree of evidence is insufficient. The research evidence of group therapy and group skill training alone is limited, but it may help. The evidence of coupled therapy is also insufficient, but it may be useful, and in some cases, it may be an important adjuvant therapy model. Evidence-based medical evidence of family therapy is also insufficient, but some research hints may be helpful to family psychological education.
The principle that can be affirmed in psychotherapy is that no single treatment method is recommended for patients. This can also be seen from the fact that both MBT and DBT are comprehensive treatment modes.
2.2 Drug therapy
2.2. 1 Emotional disorder. The medication process is as follows:
Initial medication: SSRI or related antidepressants-effective: maintenance, ineffective or partially effective: switch to the second SSRI or related antidepressants-effective: maintenance, ineffective or partially effective: add low-dose nerve blockers (anger symptoms) and clonazepam (anxiety)-ineffective: switch to Maoi- effective: maintenance. Invalid: use lithium salt, carbamazepine or sodium valproate instead; Partially effective: add lithium salt, carbamazepine or sodium valproate.
2.2.2 Impulsive behavior. The medication process is as follows:
Initial medication: SSRI (such as fluoxetine, 20–80mg/day, sertraline,100–200mg/day)-Effective: maintained. Ineffective: switch to low-dose nerve blockers. Partially effective: low-dose nerve blockers were added. -Effective: maintained. Invalid: MAOI is still invalid, lithium salt is still invalid, and carbamazepine or sodium valproate is used instead. Partly effective: 1) adding lithium salt, it still doesn't work, so use carbamazepine or sodium valproate or 2) using MAOI, it still doesn't work, adding lithium salt, it still doesn't work, and use carbamazepine or sodium valproate as emotional stabilizer-effective: maintaining. Ineffective: atypical antipsychotics were added.
2.2.3 Cognitive perception disorder. The medication process is as follows:
Initial medication: low-dose nerve blockers (such as perphenazine, 4–12mg/day, trifluoperazine, 2–6mg/day, haloperidol,1–4mg/day, olanzapine, 2.5–10mg/day, risperidone. Ineffective or partially effective: increase the dose (such as perphenazine,12–16 mg/day).
Triflurazine, 5-15mg/day, haloperidol, 4-6mg/day)-Effective: maintained. Partially effective: SSRI or MAOI has been added. Ineffective: add SSRI or MAOI (those with persistent emotional symptoms) or switch to atypical antipsychotics or clonazepam (those with inconspicuous emotional symptoms).
2.3 Problems needing special attention in treatment
Attention should be paid to the following issues, some of which should be given priority:
1) Axis I and II diseases;
2) material dependence;
3) Violence and antisocial characteristics;
4) Chronic self-injury behavior;
5) Trauma-related syndrome, especially post-traumatic stress disorder.
6) symptoms of separation;
7) Psychosocial stress;
8) Age, gender and cultural factors
9) Crisis management: including ensuring that patients can find work team members or support resources in case of crisis; Pay attention to the timely handling of empathy and anti-communism; The end of treatment should be carried out according to standard procedures; Organize psychological education, etc.
3. Formulation of treatment plan
The introduction of treatment plan is divided into the following three aspects: 1) comprehensive and accurate initial diagnosis evaluation, establishment of treatment form and framework; 2) Team negotiation determines the key points of case management; 3) Choose specific treatment methods.
3. 1 First interview
3. 1. 1 Preliminary assessment (1)
The main purpose of the initial assessment of borderline personality disorder is to determine whether the patient needs hospitalization. Because the suicide rate of people with borderline personality disorder is very high, 8- 10%. Therefore, once the patient is suspected of borderline personality in the initial interview, it is necessary to evaluate the suicide situation immediately. Make a choice whether to be hospitalized or not. At this time, it is necessary to follow the ethical principle of "life first" instead of pursuing the accuracy of diagnosis or even the so-called therapeutic relationship. Only when there is life can there be treatment.
Patients need to pay attention to partial hospitalization (day or night hospitalization mode) when:
1) dangerous and impulsive behaviors that cannot be handled by outpatient treatment.
2) Failure to observe outpatient treatment leads to poor treatment effect.
3) Complex diseases need detailed and in-depth assessment.
4) Symptoms seriously affect social functions, and work and family life continue to be disturbed. Outpatient treatment is not effective.
In the following cases, short-term full-time hospitalization mode should be considered:
1) behavior that continues to harm others.
2) Uncontrollable suicidal impulses or serious suicidal thoughts.
3) Transient psychotic symptoms, impulse out of control or impaired judgment.
4) Symptoms seriously affect social functions, and work and family life continue to be disturbed. Outpatient treatment and partial hospitalization treatment modes are invalid.
Long-term hospitalization mode should be considered in the following situations:
1) persistent and serious self-injury behavior, outpatient and partial hospitalization mode is invalid.
2) Axis I disease is life-threatening. Such as eating disorders or mood disorders.
3) Incorporate material dependence.
4) Patients have serious dependence, and the treatment effect of outpatient service and partial hospitalization is not good.
5) The persistent aggressive behavior pattern towards others cannot be alleviated by short-term hospitalization.
6) Symptoms seriously affect social functions, and work and family life continue to be disturbed. Outpatient treatment, partial hospitalization and short-term hospitalization mode are invalid.
It should be noted that at present, hospitals in most areas of our country still lack some hospitalization models, and it is necessary to change the hospital model to meet the requirements of patients. In addition, the short-term or long-term hospitalization mode has higher requirements for psychiatric medical staff. If we just follow the traditional mode-locking patients in wards and feeding them some medicine-this hospitalization mode is harmful and useless, and it is "imprisonment" for people with borderline personality, on the contrary, it will destroy the original treatment effect. As mentioned above, the main treatment of borderline personality disorder is psychotherapy, so many psychotherapy activities need to be arranged when you are in hospital.
3. 1.2 evaluation interview (2-4 times)
After the initial interview, it is necessary to conduct a comprehensive evaluation interview, including the following parts: whether there is * * * disease, the degree and type of dysfunction, patients' needs and goals, inner conflicts and defenses, anterograde and fixation trends in psychological development, coping styles of adaptation and inadaptability, psychosocial stress events, and the intensity of these events. Doctors should try to understand the biological, interpersonal, family, social and cultural factors that affect patients.
Some axial diseases need priority treatment, such as substance dependence, major depression, PTSD and so on. At this time, doctors need to talk to their families and tell them that these diseases are difficult to treat. For example, PTSD, when combined with borderline personality, its course of treatment is much longer than that of ordinary PTSD.
3. 1.3 Establishment of treatment framework (4-5 times)
This is reflected in the treatment contract. It is best to sign a written contract, which mainly includes clear and definite treatment objectives (such as reducing the number of suicides), the role orientation of therapists and patients, the time and frequency of treatment, the plan of crisis intervention, the treatment method, expenses and payment methods when patients need to find a therapist during non-treatment time.
3.2 Team consultation to determine the focus of case management.
Crisis management and security monitoring
The team should have clear and unified standards for what kind of help patients can get from the treatment team in a crisis situation and to what extent they can meet patients' expectations of the treatment team. Moreover, all members of the treatment group should have the medical values of "life first". Otherwise, we can't cope with the crisis. Moreover, all team members need to closely monitor patients' thoughts of suicide and self-injury and communicate immediately, which seems to need to break through the principle of confidentiality.
This is especially difficult for dynamic therapists, because the main treatment of motivation is explanation. The model of crisis intervention is action-oriented. At this time, the principles of neutrality, explanation and reflection of dynamics are destroyed, which will cause great difficulties for future treatment.
This is indeed a contradictory situation. At present, whether to take tough measures against the crisis situation of borderline personality disorder is also controversial. If some therapists think that their suicide behavior is just "putting on airs" and threatening others to achieve their goals, they should not be taken seriously. In addition, some interventions by these therapists, such as encouraging patients to commit suicide, have indeed been reported successfully.
This is actually a position of choosing ethics, and there is not much room for discussion. The author's ethics is that no one is a suicide expert and clinicians should avoid any possibility of suicide. Even if this suicidal gesture has secondary benefits, the therapist himself should not despise it, because this contempt shows contempt for life. Moreover, the value of life will always exceed the value of theoretical purity of any school. The value of life always exceeds the value of smooth treatment. The existence of life is the premise of treatment. Clinical workers are faced with life, and should identify with and embody the mainstream values of life. Clinical work is not a theoretical debate between medical sociology and medical ethics.
3.2.2 Establish and maintain the treatment framework.
It is difficult for people with borderline personality to adhere to a stable treatment alliance. Especially when there is negative empathy. Moreover, they often evade treatment with various excuses, often flatter one therapist and then attack another. At this point, the members of the treatment group should be careful not to agree with the patient's point of view because of personal grievances. On the contrary, patients should be encouraged to continue treatment and not to draw conclusions easily. Especially when the drug therapy and psychotherapy of patients are carried out by different people, it is more likely to appear the above-mentioned phenomenon of division and projection identity. As the team leader, it is necessary to hold clinical seminars and supervision meetings at this time. As an individual psychotherapist, when encountering this situation, you need to learn to use the clarification and explanation skills in empathy focus therapy of psychodynamics. In addition, the knowledge level of the whole treatment team about borderline personality disorder needs to be consistent, otherwise everyone will say differently, which will induce more anxiety of patients. This is not a problem of treatment technology, but a problem of doctors' knowledge cultivation.
3.2.3 Providing psychological education
Psychological education is multi-level and diversified. It mainly includes the characteristics, prevalence, treatment, course of treatment and prognosis of borderline personality disorder, and the psychopathology of borderline personality disorder should be introduced when appropriate. Psychological education can be conducted by individual therapists, or by professionals who hold courses, speeches and seminars. At the same time, books or pamphlets written by hospitals can also be recommended for patients to read. At the same time, we should give psychological education to family members and important people, but we should grasp the opportunity of education.
There are several points to be noted in psychological education: 1) Psychological education should follow the principle of voluntariness, not coercion; 2) Psychological education should pay attention to the arduousness and long-term nature of treatment, and should not strengthen the unrealistic fantasies of patients and their families; 3) In psychological education, we should pay attention to the fluctuation in the treatment process, especially to point out the possible negative empathy transfer of patients in advance; 4) Psychological educators should not lie. If you don't understand something, you should tell the other party that you don't understand it and need to consult the literature, otherwise it will be completely abandoned. 5) Psychological education for families is not equal to family therapy, although educators can make education more effective by mastering the techniques of family therapy; 6) Pay attention to the understanding of family members in family education, and don't condemn them.
3.2.4 Division of roles of the team
Almost all the treatment modes of borderline personality disorder are carried out by the treatment team. It is also common for a therapist to treat patients with borderline personality disorder alone in China, but it is very dangerous. The easy problem is that the therapist will soon be exhausted and the patient's condition will get worse and worse. Single-person treatment mode is not recommended in the whole treatment field.
In addition to requiring all members of the team to have similar morality, values and knowledge background, the team therapy model also requires a clear role assignment. In particular, to designate one person to be responsible for the safety of patients, others must cooperate with this person. Report the patient's safety problems in time and obey and cooperate with this person's intervention measures.
Team management belongs to the category of management, which requires a lot of experience and team management skills. Management is a profound subject, and its knowledge category even exceeds psychology. Team managers should not be whimsical and let their temper and hobbies manage, but need to learn management skills seriously.
3.2.5 Monitoring and evaluating the treatment plan
Having a treatment plan does not mean it is effective. Therefore, it is necessary to evaluate the realization of treatment goals frequently. Adjust the treatment plan. Pay attention to four aspects.
1) stress event. If the treatment scheme is found to be ineffective, we should first look at whether there is a stress event. If there is a stress event, we should deal with it first, and don't rush to modify the treatment plan.
2) Functional degradation. People with borderline personality disorder are prone to retrogression at the initial stage of treatment, which is a common phenomenon and is not worthy of attention. However, if the patient has persistent regression, or gets better during treatment, and the degree of regression is serious, it needs attention. Especially when there are immature behaviors such as not working, suicide and forced eating. It may often suggest that patients are desperate for treatment but cannot express it. At this time, exploratory technology (such as dynamics technology) should be suspended and other encouraging technologies and skills training should be strengthened. At the same time, pay attention to maintaining the structure of treatment.
3) Recurrent symptoms under the condition of continuous drug treatment. At this time, we should first pay attention to strengthening the training of patients' coping styles. At the same time, don't indoctrinate patients with the idea that "medicine is everything" or "biology is everything", so that patients mistakenly think that their maladjustment to life is only due to the disorder of their neurotransmitters, without making any efforts.
4) supervision. The person in charge of patient safety (usually an individual psychotherapist) needs regular supervision. If the patient's symptoms cannot be relieved within 6- 12 months, it is suggested that he must accept supervision and consider changing the treatment plan. If the treatment plan is still invalid after the change, it needs to be submitted to the superior doctor for supervision again to determine the treatability of the patient.
3.3 Selection of treatment methods
As mentioned above, the treatment principle drawn from the current clinical experience is that long-term psychotherapy combined with drug therapy and other auxiliary treatments is effective in treating borderline personality disorder. At the same time, this clinical experience has not been confirmed by evidence-based medicine. The focus of treatment should first focus on the crisis. When there is no crisis, I and II axis diseases should be treated at the same time.
The flexibility of treatment is reflected in three aspects: 1) the treatment scheme should be flexible and personalized, and it is impossible for all schemes to be universal, because borderline personality disorder is essentially the sum of a group of heterogeneous diseases; 2) The treatment plan, including the treatment contract, should be appropriately adjusted according to the progress of the patient's condition; 3) Support, cognitive behavior and dynamic techniques will be used in different treatment periods.
Respecting patients' choice and implementing it in treatment means that doctors need to spend time introducing available treatment resources to patients, telling patients the principles of choosing these treatment resources and the advantages and disadvantages of various treatment resources. At the same time, the treatment plan needs to be negotiated with the patient, not the "unilateral action" of the doctor.
In the treatment mode, generally speaking, the team mode is more effective. If there is only one doctor, it means that the doctor needs to undertake a variety of tasks, including individual psychotherapy, group psychotherapy, drug therapy, psychological education, psychosocial skills training, family therapy and partner therapy, and even some hospitalization responsibilities. Single doctor treatment mode is generally the choice of independent practitioners. Moreover, doctors with this "superman" quality have not been discovered. At the same time, the team model also has disadvantages, that is, when the team is poorly managed, it may strengthen the "split" characteristics of patients. Therefore, the basis of team mode is effective team management.
3.3. 1 psychotherapy
2. Except as emphasized in1. One thing to add here.
MBT and DBT are the first choice for psychotherapy. However, DBT is the best choice at present because it has abundant supporting evidence. TFP (Empathy Focus Therapy) is the oldest treatment mode for borderline personality disorder, and RCT is being done at present, which is expected to become a first-line choice in the future.
This does not mean that the treatment methods currently studied by domestic therapists are meaningless. On the contrary, MBT and DBT are highly integrated treatment modes. For example, there is also an understanding board similar to dynamic therapy in DBT. For example, the traditional and single treatment model is like a single medicine in Chinese medicine, while many new and efficient psychotherapy models are like prescriptions for syndrome differentiation and treatment in Chinese medicine, which are prescribed by various single medicines according to the principle of "monarch, minister and assistant". If a doctor does not know the nature and taste of a single medicine, it is absolutely impossible to prescribe a truly effective prescription based on syndrome differentiation. Therefore, for the current therapists, not only can we not ignore the training of the current single treatment mode, but we should also receive more training in several therapies, all of which need to be mastered. Personally, I think a therapist should at least study cognitive behavior, dynamics, humanism and family therapy. If a single treatment model is a panacea for all diseases, then there should be only one treatment model left in the world. How can there be hundreds of psychotherapy schools?
In fact, what is emphasized here is the viewpoint of integration. I think integration is not a therapeutic school, but a principle of epistemology and methodology. On the technical level, in fact, the integration school has nothing, and all the technology comes from other schools.
This paper summarizes the characteristics of various schools of psychotherapy for borderline personality disorder from the perspective of integration.
1) The stability of the therapeutic alliance and the relatively clear boundary of the therapeutic relationship.
Treatment alliance is the focus of all treatment models. The quality of treatment alliance is reflected in two aspects: first, it is clear that both sides accept the treatment goal. For example, "promoting personality development" is not a clear treatment goal. The key is what will happen after the patient's personality develops? Who will judge whether the personality has developed? "Suicide behavior is reduced", "I can bear loneliness, and when I am lonely, I will no longer be dismissed by promiscuity, overeating and using exciting substances" and "expressing anger with words instead of hurting people and destroying things" are clear treatment goals. Second, patients can abide by the agreement and see a doctor regularly.
In terms of treatment boundary, it is necessary to clarify the time and place of treatment and the roles of both parties. In particular, the therapist must first determine what he can't do. Therapists need to be clear that patients often try to break through the boundaries of doctor-patient relationship. This kind of behavior is often a tentative behavior to treat safety. If the therapist often breaks through the relationship boundary to meet the patient's temporary needs, it will make the patient feel more insecure. In particular, patients with a history of sexual trauma often seduce therapists. What therapists need to know is that this vicious circle of temptation-success-anger-despair-further temptation or re-temptation of others appears repeatedly in patients' lives.
2) The change of treatment emphasis. The focus of treatment will inevitably change according to the changes of patients in different periods. This is to be prepared when making a treatment plan. And the focus has priority.
The transformation and priority of DBT treatment focus are generally:
Suicide behavior-behavior that interferes with treatment-behavior that interferes with the quality of life of patients.
The key points of dynamic therapy are:
The threat of suicide or murder-the threat of interrupting treatment-lying or deliberately keeping it-breach of contract-actions in treatment-actions outside treatment-lack of emotion or trivial matters in daily life.
Personally, I think we can also determine the key level of analysis from the perspective of defense mechanism:
Life-threatening actions-actions that endanger the therapeutic alliance-turn to their own attacks-splitting and projecting identity in therapeutic relationships-splitting and projecting identity that affects interpersonal relationships and work in daily life-isolation and reverse formation based on potential inhibition-sublimation and restraint.
In fact, the previous actions and attack rounds are also based on division and projection identification, and the treatment usually ends after the patient can understand the division and projection identification in all aspects of life. As a latent inhibition of neurosis, it is rarely analyzed, let alone mature defenses such as sublimation and restraint.
The multi-focus analysis model can refer to three sets of textbooks of the Department of Psychiatry and Psychosomatic Medicine in university of ulm, Germany, and can be downloaded in English for free in their official website.
3) Flexibility and diversity of therapists' attitudes. Therapists need to be active, emotional, equal and passive according to different stages of treatment. These gestures correspond to the focus levels mentioned above. It is worth noting that in the group model, this different attitude may be borne by different team members.
4) Therapists themselves need help and supervision. Supervision is not only the patent of dynamic therapists, but also dialectical behavior therapy emphasizes that therapists need to receive regular supervision. A steering group with a good group dynamics atmosphere is a necessary condition for borderline personality disorder.
5) Emphasize the reality and the responsibility to patients. This is the characteristic of all schools. Blindly loving can't solve the problem, and at the same time, it is emphasized that the responsibility of patients for their symptoms must be based on understanding of loving. I found that the common clinical problem is to confuse * * * with comfort. Comfort is a support skill, while caring is the attitude of the therapist. * * * Family ties are both comforting and exploratory.
6) Emphasize reflection and observation. This is mainly reflected in the dynamic model through the explanation provided by analysts, and in DBT through its understanding module and core strategy-mindfulness. Personally, I think that the technology of mindfulness may have more advantages than the explanatory model of dynamics. First, mindfulness technology can be operated by patients themselves, and it is very simple and can satisfy patients' sense of self-esteem and self-control. However, if the timing of analysis is not well grasped, it will often cause jealousy and inferiority of patients. Second, mindfulness technology can reach the body's reaction and deal with the problems before language, which is somewhat similar to EMDR and sand table therapy, but conversation technology can't; Third, there is a 2500-year Buddhist history behind mindfulness technology, which is a good belief resource. At the same time, because mindfulness technology is also the theory of inheriting Buddhism. There is no religious ceremony to spread Buddhism in the north, which is closer to the concept of people in the era of scientism. In fact, some teaching courses of mindfulness technology directly claim that their evidence is universal, and the truth verified by modern physics is a unique activity similar to scientific argumentation, not religion; Fourthly, mindfulness technology is the foundation and source of Zen Buddhism, which is almost a household name in China. The operation similar to mindfulness technology widely exists in various folk fitness technologies such as yoga and Qigong. China people are very familiar with its theoretical basis, in contrast, China people don't know much about the cultural basis of western dynamics. Besides, there are many misunderstandings about Freud. Another point may also be the advantage of mindfulness technology, that is, the relevant materials of mindfulness technology are completely free, and many Buddhist groups carry out mindfulness training for free.
3.3.2 Drug therapy
The process of drug treatment is shown in the previous 2.2, which comes from the evidence quality and clinical experience of evidence-based medicine. I won't go into details.