Acceptance and Commitment Therapy for a Lady with Personality Disorder and Depression

The study focuses on a 35-year-old lady with personality disorder and severe depression resulting from anxiety. The lady has a history of child emotional abuse and poor tolerance at work. The therapeutic intervention used was Acceptance and Commitment Therapy, which aligns with mindfulness skills in teaching people different methods applicable to living with their values. The ACT model exists as a psychological flexibility approach based on six primary therapeutic processes including acceptance, defusing, contact with the present moment, Self-as context, values and committed action.

Case Study Saved On 4:23 on 8th August
Synopsis of the Case Study
The study aimed at focusing on the health concerns of a 35-year-old lady with a 12-year-
old diagnosis of personality disorder. The medical staffs have placed her on the disability support
pension. From further determination, she has been found to have a personality disorder, as well
as severe depression resulting from anxiety. She has a record of child emotional abuse because,
when she was growing up, her parents got involved in domestic violence. The lady lives with her
grandmother since the age of 12 years, the reason being her mother committed suicide due to
divorce. The lady had developed critical symptoms of depression associated with her childhood
traumatic experiences, social discrimination as well as lack of family support. These factors
negated her school performance, social stigma, inadequate support at a little age led to the
development of borderline personality traits.
She was an employee in the customer service sector, but her tolerance in the workplace
was very low. After a verbal altercation with her former employer, she lost her job. Her mental
condition is to a large extent affected by diabetes and unemployment. She lives with a negative
perception of the world. Her life has a history of admissions in mental health hospitals with her
recent entry being in 2017, which was due to mirtazapine overdose. I majorly looked at her past
traumatic experiences, social stigma due to depression and anxiety associated with borderline
personality traits, poor tolerance at work, and wanting to cope to work skills in the job
environment. According to Batten (2011), acceptance and commitment therapy is the best
therapeutic interventions for her, because the treatment is a pioneering behavioral therapy
considered to optimize the stance to value their lives. While using my nursing professionalism,

the best decision was to come up with an idea of establishing a therapeutic relationship by
ensuring the maintenance of professional boundaries.
An ACT is instrumental in controlling anxiety disorder and depression, and it's used it as
the primary factor of consideration. It is evident that most patients with Personality Disorder and
depression are at higher risk of self-harm (Versaevel & Lajugie, 2013). The lady requires much
counseling services which could be the best to help her relax. Group activities and massage
therapies are the most useful options for improving her condition. I made use of the acceptance
model and commitment therapy as per A-tjak et al. (2015), which proved to be positive for her
recovery. It meant that occupational therapists and psychologists needed to be involved in
helping find an alternative solution to her rescue.
Synopsis of evidence base for the use of the intervention:
The acceptance and commitment theory exists towards skills’ development occurs a
multi-step process that creates skilled nurses like I have become having completed the training
into being not only qualified but also competent. My decision to study the ATC model was
motivated by the zeal of having a deeper understanding of the theoretical and practice-based
subject. I had to focus on the poor coping skills of one of the female patients in association with
her erratic manners in a mental. The study focus on coping skills was done in a working
atmosphere characterized by occupational challenges (Maclean, Webber & French, 2015).
Focus on the current happenings is one of the methods applicable to sharpening nurse’s
clinical skills since leadership skills, as well as principles, are required in dealing with medical
clients. Being in a position to understand patients’ expressions in line with the specific context
was the initial but the most important step (Russ, 2009). As a nurse, focusing on the behavioral

issues facing patients in their life was vital for therapeutic processes and working on the specific
client’s needs. In fact, the need to have a deeper understanding of the therapeutic model was
critical in the process. As well, cultivating my compassionate skills was of importance in
building therapeutic relationships with the patient since building rapport and trust remained vital.
As I was taking care of the patient, my therapeutic communication skills were enhanced
by having a sense of humanity characterized by active listening and non-judgemental attitudes in
every professional approach. Managing her stress levels as well as developing compassion and
mindfulness approach in my practice helped me in the process of realizing the behavioral change
in the patient. According to Rubb (2014), the methods I applied were in line with the stress-
reduction efforts as provided through the clinical healthcare sector. Having learned the
mindfulness strategies, I had to use them in line with the acceptance and commitment therapy
including leaves on the stream and breathing exercises. Observe, breath, expand, allow,
objectify, normalize, show self-compassion and expand awareness make up the eight techniques
of the mindfulness exercise (Russ, 2009).
For the acceptance and commitment theory to have its core competencies in place, it
needs specific skills that in turn shape the dependability capacity of a nurse. On my side, I would
look at the patient’s behavior like the cognitive fusion as well as avoidance with the aim of better
discrimination of the therapeutic practices relevant to each patient. According to Jameson (2015),
the Borderline Personality Disorder has unique connections with self-harming behavioral risks.
Having adequate skills on defusion and acceptance is essential in therapeutic practices as helping
others involves the articulation of client’s values in the process of giving solutions.
In the process of handling my clients, it had no option other than demonstrating various
techniques on acceptance and commitment and their relative relationship with each other as well

as with the basic therapeutic principles. The impact of counselling in alleviating emotional stress
relative to traumatic childhood encounters and the positive psychoeducation impact on
acceptance were some of the issues I learnt (Russ, 2009). Although the approaches needed some
form of education and research, my therapeutic skills were enhanced by the participation in the
inpatient trauma care unit. In fact, the experience I had was of benefit to both me and the clients I
served. According to Geller (2012), patient care during the healing processes has the capacity to
help clients towards their full acceptance as they understand their suffering.
Geller (2012), defines some of the essentialities considered in establishing a therapeutic
presence for clinicians as well as the pause moment concepts helpful in boosting clinicians’
refreshments and skills. In one of the patients, I recognized that involvement with stressful
moments has an impact of making me recall some of the past experiences I had in time. Geller
(2012), explains bracketing as a process through which clinicians abandon some of their
thoughts. Bracketing was practical and useful to me in developing my mental health skills in the
nursing field to high capacities. The approach was, in fact, relevant to the case of the patient I
was handling since it helped them have an atmosphere to focus on their goals. According to
Dahl, Lariviere & Corbiere (2017), through therapeutic interventions, a patient is revealed by
depression and the lack of purpose. In this case, my client has poor coping skills thus she would
be depressed as well as have no purpose in her work environment.
The acceptance and commitment therapy exists as a practical approach that gives patients
the opportunity to have a deep understanding of the processes that would give them hope in life.
As well, it gives them the capacity to manage their livelihood as well as show interest in
participating in all they do. According to McCracken & Vowles, (2014), Acceptance and
Commitment therapy leads stress and ache. The lady, in this case, needs purposeful attention to

have a deep understanding of herself and the situation at hand. The Internet Acceptance and
Commitment therapy can be quite effective in reducing depression among people with Mental-
related health issues as it applied various therapeutic techniques to bring patients into acceptance
(Lappalainen et al, 2015).
In the process of accepting oneself, under the Acceptance and Commitment therapy this
lady needs to allow her feelings as well as thoughts to flow having no action on them. Failing to
act on the thoughts and opinions on the patient will translate into an approach where only the
strengths are enhanced with no concern on the flaws thus overrule them. According to Geller &
Greenberg (2012), the therapeutic process gives a patient the opportunity to see everything
positively while negating the dangerous issues that a situation might bring. The acceptance and
commitment theory requires one to set great skills followed by enough experience headed on the
cognitive defusion of other psychologically heightened situations. The ACT is seen to inspire the
affected people in resolving issues on their own by enhancing their ability to adopt different
patterns of thinking through the cognitive diffusion process. The process empowers the
individual over the situational challenges and gives them control over some unnecessary
reactions.
Overview of the therapeutic intervention used while working with the consumer and the
rationale of using the therapy
The Acceptance and Commitment Therapy aligns with the mindfulness skills in teaching
people different methods applicable to living with their values, generally referred to as positivity.
Positivity is a pragmatic process involving therapeutic counseling in addition to acceptance and
other mindfulness approaches in enhancing increased flexibility in the positive, practical aspects
(Russ, 2009). The ACT model exists as a psychological flexibility approach based on six primary

therapeutic processes including acceptance, defusing, contact with the present moment, Self-as -
context, values and committed action (Batten, 2011). The six procedures exist as the functional
components of the Acceptance and Defusion model where positive emotional thoughts and
experiences are contained (Russ, 2009).
Having to focus on the current moments as well as the self-as-context capacity would
become a positive aspect of the ACT therapy. As well considering the present moments with no
consideration of some of the other point of one’s life makes human a multitasked focus with full
ambitions having the capacity to develop the lack of concentration. It as well brings self-
awareness self-as context and communicating present moment both involves in contact with our
mind and observance of our mind with self-awareness (Russ, 2009) and the third part is
recognising personal values and commitment to action are essential to motivate ourselves to be
committed to reach our goal with our values (Batten, 2011).
The ACT model as presented to the customer happens to be both simple and convenient.
When Abbreviations are used as Accepting thoughts and feelings by being present, choosing the
valued pathway and acting becomes easy (Russ, 2009). Suicidal thoughts have been troubling the
client as one of the traits of her poor coping skills. Our internal thoughts of experiences are used
in developing the cognitive fusion approach involving more attachment to past encounters such
as her traumatic childhood. All the negative thoughts make her unable to focus on the real issues
that would somehow be the reason for her poor coping capacities characterized by low tolerance,
depression, self-harm thoughts, anxiety and other forms of negativity. ACT interventions are
seen to be not only creative but also resourceful as they aim at promoting cognitive diffusion and
acceptance.

Friendliness exists between the Christianism faith and the ACT interventions as they have
been compared to reading the bible (Rosales, A., & Tan, S. Y. 2016). Since the therapy’s basis,
reins in considering a patient’s character, reducing avoidance as one of the coping styles exist in
it while the person’s behavior is investigated. On account of this approach, the patient was
optimized of her values, and the quality of life since the therapy was useful in confronting the
psychological rigidities related to the negative thoughts, painful emotions, and even her
traumatic experiences. The face to face conversations characterizing the therapy helped in
addressing her problems.
Clinical issues and concerns encountered
The process encountered some challenges where the first one was the certainty to retain
the client. The past family life of the patient traced associated with substance and emotional
abuse. The client had a higher chance of leaving the process than staying to undergo it. It took a
longer time than usual to establish a good relationship with the client. Also, the lady made a long
duration before being free with the environment.
The client would lose focus and concentration during the intervention process hence
hindering its continuity. The process made the client to go back to the past thoughts and to lose
her attention on the process. Her character developed to fear, and anger and freedom diminished
slowly. It made her process get more prolonged than usual as well as raising concerns on the
health status of the client and future endeavors after the procedure. What was faced as the most
significant issue was on how to develop an environment that would reduce despair and
untrustworthy while conversing.

Group work sessions shared pats experiences and concerns among the members, but it
didn't seem helpful to the lady as she only increased her discomfort. It did not link well with the
case of the patient. They just took her back to the feelings of depression and indicated to the
patient the disregard to show her change. She only got misplaced. The challenges showed
themselves in most parts of the process, but they didn't exist permanently. They just indicated
environmental threats to the client and prompted that could enable the success of the
intervention. Lastly, a positive result got presented by the case.

References
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