Psychodynamic Case Study of a Client with Borderline Personality Disorder

TABLE OF CONTENTS
INTRODUCTION....................................................................................................................3
The Client’s Presentation
Client’s Disability
Client’s Eye Contact and Communication
The Client’s Body Language
Referral
Problem Presentation
Diagnosis/Medication/ General health
Background
History of the Family
Relationships History
Work history/ Education
FORMULATION.......................................................................................8
CONTRACT WITH THE PATIENT .............................................................14
Rationale
THERAPEUTIC OBJECTIVES.......................
..............................................16
THERAPEUTICAL PROCESS.....................................................................18
ABSTRACTS LIST
Abstract A
Abstract B
Abstract C
Abstract D
OUTCOMES...........................................................................................38

Counter transference
OBJECTIVES
REFERENCE .................................................................................51
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NTRODUCTION
I started working at a charity organization known as H.I.M.H in March 2017. I was
truly enthused or inspired by the tremendous as well as inimitable work the charity
organization was doing. The work supported men and women from different ethnic groups
which are victims of human trafficking, domestic violence as well as persons suffering from
chronic mental health and physical needs. The London’s H.I.M.H is sub-divided between
twofold centres; one unequivocally encompasses ethnic minorities’ including Arab
communities, African, and Afro-Caribbean and the other section involved everyone. The care
provided in the two situations appeared to stem from a basis of inspired hope and caring. The
Centre is full of life and colour, and I affectionately recall the feelings of wonderment the
first spell I walked into the organization. It is important to note that it explicitly deals with
ethnic minorities groups and cubicle emanates culture, a setting I have never experienced in
any place.
I encountered my first customer (Jane) while working at the H.I.M.H. Jane’s
devastating needs as well as a history of substance abuse touched me in a way which I never
projected. Jane is a 42-year-old woman and has mostly lived in London. She fluently speaks
Italian and English, therefore, identifying her as heterosexual. Jane elucidates that her mother
was very spiritual in front of other people. As a result, many people had a perception or
insight that Jane’s mother was putting on a false persona to the Italian group associated with
religion. In reality, Jane did not feel as however, her mother lived by what she discoursed or
was being truthful to church. This consternation and realization appear to have resulted in
Jane neglecting religion and developing a negative attitude toward religion.
In contrast to Jane, I am a 25-year-old female of African descent but Asian appearance. I live
by religious and spiritual values and attend church services so often, therefore, very distinct
from Jane. I have considered the comparison in the entire therapeutic relationship.
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The Client’s Presentation
I first impressed of Jane because she was an exceptionally spectacular young woman
who never looked upon her age but took inordinate pride in her physical physique or
appearance. She was tall and curvy and dressed her figure with skirts and high heels. She at
all times had face make-ups and never left her household without the application of a bright
red or purple lipstick. I conjectured how she could perceive me who was dull dressed plain
therapist sitting in her opposite. Generally, I remember Jane had a very fascinating or
appealing presence from my initial session with her.
Client’s Disability
During my first session with Jane, I thought that her outward appearance didn’t match
her communication skills. As a result, I reported this observation to my superintendent and it
clear that she had a learning disability that was perceived by the supervisor to have resulted
from strong medication. Surprisingly, Jane had not been diagnosed for the disability. It is
important to note that in several instances, the prowess of a society to spot and address an
individual’s disabilities and shortcomings may significantly change that individual’s life,
resulting in serious concerns such as relationship issues. Furthermore, this particular concern
came up during the therapy when Jane talked about online dating. She narrated how some
men relish writing to her messages online however immediately she talk to them in person or
through the phone the men put off and precipitously drift and adjourn chatting. She was
distressed that a prospective online suitor told her that there is something wrong with her.
This stuck in her mind and always feels highly judged by other people due to her disability.
She thinks that she is not wanted and would never get a potential suitor.
Client’s Eye Contact and Communication
During the first session, I realized Jane generally keeps eye contact. I failed to notice
her struggling with keeping eye contact. However, as she kept on talking I noticed that she
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experiences difficulty in maintaining eye particularly when she felt vulnerable, that is when
she said that she would never find a potential suitor. At the same time, it becomes hard for
her to understand particular concepts and interpretations and so I had to patient with her. She
occasionally uses this as a ploy or trick to shun some topics which she is not comfortable
with and quickly goes ahead to speak other things. This form of ricochet appeared to make
other persons feel as if Jane is not considering their position on a matter under discussion or
not listening resulting in a need to get another individual who communicates for her. In
several instances, I had to be firm and careful to identify and understand what she found
difficult to talk about. I was always mindful not to force her to follow my agendas or ask her
particular things she might not be ready to offer an answer.
The Client’s Body Language
Jane’s body language was at times fidgety. She would sometimes take large water gulps and
sporadically moved the chairs around if they appeared or seemed distinct from what she is
used to seeing before. Jane visits me on a Sunday morning and since we were the first people
to use the counseling room, it seemed left dull, with the lights off and the blinds low
nevertheless the large windows allowed sufficient day-light to shine via the windows. Jane
would still stand up and switch on the light on noticing it appeared darker than usual. Her
body language reveals that she experiences some problems. She needs to feel as nevertheless
she has had an impact on her instant setting even if the effect isn’t completely anticipated or
implicit.
Referral
Jane first visited a therapist when she reached at the facility. Nevertheless, Jane says
that she never got the first conferences beneficial and finally ended go to the sessions. She
made up her mind to come back to a therapy after receiving shocking news of the death of her
foster mother. It is Jane’s outreach worker who spoke to my supervisor about in regards to
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the need for Jane to get therapy. Notably, this was after she became extremely bruised, and
scarred about the kinds of treacherous sexual activity Jane was taking part in.
My supervisor at the facility was very honest. He always encouraged us to do work in
a manner which most suited us. It is easy and I felt free to work at H.I.M.H in such a setting
because before coming to the organization I counselled people at Maudsley hospital for one
year. I adored the notion of not looking at past notes or assessments written about my
customers. I simply ask the patients to let me whatever they are most contented with.
Remarkably, this tactic worked for me in that particular locale as I it provided I much time
with the customers.
On my initial slated session with Jane, she got into the room and began looking for
my manager. I recall waiting in the room pondering whether to simply wait or collect her.
After limited minutes my manager brought her in counseling room and I presented myself to
her. Jane was well dressed having her hair, make-up as well as face done. Jane sat down on
the chair looking perchance a little unsure and uncomfortable with me. She tightly held her
glass of water during the session. Nonetheless, as the meeting went on, I felt that the
supervisor was testing me whether I was worth for Jane’s case. I felt that I had to win the
supervisor and therefore I had not to disappoint her.
The Presenting Problem
H.I.M.H is a health organization that provides customers therapy depending on the
clients’ needs. Due to Jane’s evaluation, my manager and I established that an open-ended
psychodynamic psychotherapy was appropriate for Jane because of her nature issues
presenting issues explained under.
General Health/Medication/Diagnosis
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Jane has a lengthy psychiatric history. Many drugs have prescribed for her including
Lorazepam (1mg), Zopiclone (7.5mg), Omeprazole (20 mg), and Valproate Sodium and she
is presently under Lithium medication.
Jane was in 2007diagnosed with Borderline Personality Disorder (BPD) and clinical
depression up to 2016, June. She attended a clinical evaluation or assessment in the year 2010
which stated that, “since moving to the municipality, there have been no incidences of
depressive or hypomania. Nonetheless, Jane has shown some symptoms or behaviours which
indicate on-going personality difficulties. Jane experiences problems in impulse control,
maintaining positive interpersonal relationship as well as regulating her emotion.”
Jane has been referred to several health services since her first diagnosis comprising
Hospitals, social services, and charities. She has received a lot of support from H.I.M.H since
her arrival in the institution in 2008. The institution provides her with professional workforce
who supports her in the management of finances and housing. She is also provided with an
outreach worker who supports her with social needs such as encouragement and counselling.
She is satisfied with the H.I.M.H‘s services and love the staff.
Current Background
Jane told me that she was having relationships with four men during our initial
session. I challenged this because she said that she always engages with them in only sexual
activities for a maximum of two hours per weekly. Most of these men are in relationships or
married. However, Jane said that she did not want real relationships with them. She admitted
that never had never had real relationships with any man, and would like to have one,
however, men only want her for sex. Jane has lived alone since she left her foster mothers’
homestead.
Family History
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Jane comes from a large family; however, it was hard to understand what part of the
family she meant. Jane made a drawing of a family-tree on a paper during the session. This
was enormously helpful to me.
Jane’s father divorced her mother before she was born. As such, she had not seen the
father until she was 15 years old. After the divorce, Jane’s mother got into another
relationship and gave birth to two children; a girl and a boy. Jane was physically raped by the
stepfather and due to that ran away from her mother. She joined foster carer at 13 years. The
foster mother took care of her until she was18 years after which got her own residence while
studying. Jane flew to the U.S. at 16 years to meet her father for the very first time. Jane
found that the biological father had entered into a second relationship and had sired two
children.
The biological father didn’t want to know her and admitted he was embarrassed to
refer to her as his biological daughter due to her disability and outlook. She came back to
London and got another chance to meet her biological father once more due to her thirties.
She tried to maintain a relationship with him however the father was not interested, making
her give up.
Jane never mentioned her mother until a few weeks into therapy. It seemed hard for her to
talk about her relationship with the mother. She noticed that the mother never thought of her
even after the father’s open abandonment. The mother currently resides in Italy with her
stepfather and she sometimes visits. She says that she hardly visits her because she found it
difficult to deal with her mother due to her anger.
Relationship History
Jane has a history of men who she slept with. She says that her initial boyfriend at the
age of 19 was very obnoxious and would sometimes sexually assault her. She had several
foul relationships and her behavior tended to get her out of one and hand her over to another
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