MHApps BPD – Caution Take Care – BPD EUPD GP Health Professional – Dangers Of Working With Patients
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It would not be unfair to say that individuals with BPD / EUPD are over-represented in the group of patients who place health professionals in personal, professional and ethical dilemmas. It is important that you be aware of the risks and protect yourself.
Boundary issues are a particularly challenging issue with people with BPD / EUPD and are a function of their tendency to regress, misread emotional situations, idealise/devalue relationships and their sensitivity to perceived rejection. Health professionals are responsible for the maintenance of boundaries and are usually legally responsible. Your responsibility is to maintain the independence of the patient, and not be too helpful. The patient should maintain responsibility for their own behaviours and actions, including self harm.
An important problem sign to watch for is if you are treating them as ‘special’ and not like a usual patient. Recognise your own emotional reaction to the patient. It is almost impossible to maintain an emotionally neutral stance all of the time and the clinical imperative to display neutrality with this group is draining and needs to be dealt with. Commonly this group will lead you to feel frustration, anger, sympathy and a sense of helplessness. You are not immune. It is important to validate your reactions and discuss them with your appropriate network of peers. When not addressed, these reactions can result in you withdrawing from good professional practice and blaming the patient, or attempting to do more and becoming enmeshed. If you think you are working in an enmeshed way discuss the issue with someone else – they might see that you are nudging a boundary you shouldn’t. Share the load in these situations and refer to a psychiatrist or psychologist if possible.
Be careful not to be drawn into the human instinct to give physical comfort when someone is helpless, distressed or childlike. It is not unusual for this group to request breaches of boundaries by asking for a hug or some other form of physical soothing. Sometimes you will feel the urge to comfort in this way to alleviate your own sense of helplessness. Remember, touching any patient in any way apart from appropriate physical examination can place you at risk of allegations of professional misconduct. That risk inevitably increases where the patient has the sensitivities and characteristics of BPD / EUPD.
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- Care, but not too much.
- Get close, but don’t get enmeshed.
- Empathise, but protect your own boundaries.
- Hear about human evil, but don’t lose optimism.
- Witness intense emotion, but maintain focus.
Finally, remember that with a good program of management, people with BPD / EUPD are able to improve over time.