For some reason Dora was very talkative. It was surprising that she approached the Therapist to engage in a conversation; this is because she usually won’t say anything to anyone unless you are engaging in some type of activity with her. Dora started telling the Therapist about her experiences with some of the staff. She also, started to reminisce about some of her experience during the years that she spent in the Psych Ward. However, she did not want to say how many years she has been in the Psych Ward, perhaps because she holds on to the notion that she will eventually be discharged into her own apartment. Yet she is the one who needs to make the decision to leave. Her treatment team has already expressed that she can leave anytime she wants (https://truegeorge.com/2016/07/30/doras-incident/).
Then she started to speak about who she likes and who she doesn’t like. A couple of weeks ago Dora told the Therapist that she hated one of the Nurses (Neil). Now the Nurse that she hated before, she likes. The Therapist said to Dora, “I thought that you did not like Neil?” Dora did not acknowledge what she said in the past. She just said that he is all right. Dora also told the Therapist that that she thinks he is pretty cool. The Therapist couldn’t help but wonder when will he be on Dora’s hate list?
The Therapist understands that Dora is diagnosed with border line personality disorder. This type of disorder is associated with having intense mood swings, impulsive behavior and extreme reactions. Other symptoms include but not limited to: an unstable self-image or a distorted sense of self, feelings of isolation boredom and emptiness, difficulty feeling empathy for other people, a history of unstable relationships that can change drastically from intense love to intense hate, a persistent fear of abandonment and rejection and intense reaction to abandonment whether being abandoned is real or imaginary, intense highly changeable moods that can last for a few days or hours, impulsive risky behaviors, hostility and unstable career plans and goals. Now the term “border” means that those with this disorder is usually diagnosed with additional mental health disorders such as psychosis.
One can see why it is difficult to maintain a relationship with someone who has border line personality disorder. Look at Dora she hates her peers in the Psych Ward and does not want to have anything to do with them. Dora only wants to be associated with staff members, and the little activity that she sometimes engages in it is only with a staff member. However, it seems that the staff does not want to be bothered with Dora. So, you see Dora is surrounded by people but she is a lonely person. That is because she chooses to alienate herself from her peers. However, she has unrealistic expectations of developing a personal relationship with staff members. She does not understand that the staff are professionals who will not compromise the establish ethics of their profession.
Sometimes a staff member will play cards, or some other game with her, ask her how she feels and may engage in some small talk with her. But that is in the spirit of fostering good relations and have some genuine care of the patients that they are charged to look after. Other than that any other type of relationship will violate the Psych Ward standards of conduct and professional ethics. To compensate Dora engages in attention seeking behavior which includes everything from acting out, having arguments with other Psych Ward Patients to attempting suicide and even faking suicide attempts.
Now Dora who really needs to be in an assisted living facility is lingering and wasting away being locked up in the Psych Ward because she does not want to leave. She refuses to engage in therapy other than taking medication. She makes no plans for her future other then contemplating what behavior she will do to get attention from staff.
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