Mental health articles

OF mental health care and mentally ill

Development of a therapeutic relationship with a patient with a borderline personality disorder

 Background Tina is a 26-year-old woman with a diagnosis of borderline personality disorder. She was admitted to a regional secure unit six months ago under Section 37 of the Mental Health Act, following a conviction for arson with intent to cause harm. Tina has a history of self-harming behaviours since the age of 12 when she took an overdose of her mother’s antidepressants. On that occasion her next-door neighbour took her to hospital, after Tina told her what had happened. Since this time Tina has taken many further overdoses, cut her arms, stomach and legs repeatedly, and has burned her arms with cigarettes and lighters. Tina has had many short-term sexual relationships but relates that she felt a great deal for each of her previous partners. She is in regular contact with her mother who continues to have mental health problems. Tina was first in trouble with the police when she was 11-years-old following her stealing from local shops. Since this time she has had many convictions for minor offences but has never been previously incarcerated. In hospital Tina was allocated Sheila as her named nurse. Sheila is a charge nurse on the admissions ward with many years’ experience of nursing acutely mentally ill people. Tina quickly warmed to Sheila stating that she found talking with her ‘comforting’. During the first three months of Tina’s admission she found it increasingly difficult to maintain control over her impulses to self-harm and in fact was burning herself on an almost daily basis. During this time Sheila found she was spending increasing amounts of time with Tina offering support, reassurance and distraction from thoughts of self-harm. Gradually, it was observed that Tina reduced the frequency of self-harming behaviour, particularly when Sheila was on duty. Tina felt less able to control her impulsive behaviour at other times, reporting that she did not feel she could approach other staff as she could Sheila.

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