Supervising Trainees Who Counsel Clients with Borderline Personality Characteristics: Implications for Training and Practice
Fazio-Griffith, Laura, Curry, Jennifer R., Journal of Mental Health Counseling
This article presents findings from an exploration of clinical supervisors "perspectives of the process of supervising trainees who counsel clients with borderline personality characteristics. Six supervisors, from private practice settings, nonprofit agencies, and counseling and training centers, participated in three rounds of interviews. They explored the supervision process with trainees who counsel clients who exhibit these characteristics and the influence these characteristics had on the supervision process. Recommendations based on these findings are offered for supervision in clinical practice, counselor education, and training.
Current literature on the process of supervising trainees supports the general notion that supervision is required for development as a counselor (Bernard & Goodyear, 2004); however, the literature is very limited in addressing supervision of trainees who counsel clients with specific personality characteristics. Holloway (1995) noted "the relevance of these characteristics has not been studied within the context of supervision, training or both" (p. 94). While myriad mental health issues may be addressed in counseling and supervision processes, one that may be particularly difficult for preservice counselors to deal with is borderline personality disorder (BPD). Also, clinicians in training may find clients with BPD characteristics more challenging than those actually identified as having BPD. Characteristics associated with BPD are exhibited by clients who do not meet all five DSM-IV-TR diagnostic criteria (American Psychiatric Association, 2000). An individual with borderline characteristics will vacillate among the behaviors characteristic of clients with BPD. The characteristics exhibited may be less intense than those of clients diagnosed with BPD and thus much more difficult for a clinician in training to recognize. The client with borderline characteristics may present as clingy, helpless, resentful, and stubborn, with hostile outbursts, expressions of self-pity, and self-denigrating guilt (Millon, 1981).
The National Institute of Mental Health (NIMH; 2007) described BPD as a pervasive instability of interpersonal relationships and emotional regulation leading to a high risk of suicidal ideation and self-injurious behavior. Ebner-Priemer, Welch, Grossman, Reisch, Linehan, and Bohus (2007) indicated that the "emotion dysregulation in BPD comprises increased sensitivity to emotional stimuli, unusually strong reactions, the occurrence of complex emotions, and problems identifying emotions" (p. 266). While its exact cause or source is not known, Mayo Clinic staff (2006) suggested that BPD may be the result of harmful childhood experiences; other researchers have alluded to potential genetic or neuro-biological causal factors (Lieb, Zanarini, Schmahl, Linehan, & Bohus, 2004).
According to Lawson (2000), BPD is the most common personality disorder, affecting nearly six million individuals in the United States; supporting data suggests that it reportedly affects over 2 percent of adults (NIMH, 2007). The Mayo Clinic staff(2006) contended that as many as one out of every 33 women suffers from BPD. Complications affect the individual's life by straining relationships with significant others; causing instability in employment, school, or work life; hampering social activities; and fostering negative self-image and self-worth (Mayo Clinic staff). Moreover, individuals with BPD reported greater internal aversive states of tension that those considered mentally healthy (Stiglmayr, Grathwol, Linehan, Ihorst, Fahrenherg, & Bohus, 2005). Symptoms that may affect the counseling process include volatile behavior, self-destructiveness, manipulation, impulsivity, and fear of abandonment. Moreover, therapists may not at first recognize BPD, especially when suicidal ideation and depression are not manifesting (Lawson). However, in spite of the inherent difficulties faced by individuals with BPD, including the challenges for clinical trainees who counsel them, effective intervention can promote positive growth and change in these clients (Mayo Clinic staff; NIMH; Lawson). …