CASE PRESENTATION
Case Presentation: Borderline Personality Disorder
Tayler Mathew Tryon
Department of Counselor Education and Family Studies, Liberty University
Author Note
Tayler Mathew Tryon
I have no known conflicts of interest to disclose.
Correspondence concerning this article should be addressed to Student M. Name
Email: tmtryon@liberty.edu
CASE PRESENTATION
Case Presentation: Borderline Personality Disorder
Part I: Intake Information
Identifying Data
This section needs to include the following information exactly as listed here:
Date of Initial Assessment: 3/05/2025 Sexual Orientation: Heterosexual
Pseudo Name: Lisa Moon Race & Ethnicity: White and Asian (Korean)
Age: 37 Marital/Relationship Status: Never Married
Gender: Female
Employment Status/Grade Level: Unemployed/Some College
Reason for Referral/Presenting Problem
Lisa is a 37-year-old female coming in today for assessment. Over the past several years
Lisa talked about having issues with her moods and with people in her life. She states, “I just
have had this back-and-forth thing going on. One minute I seem like I’m okay and then
something happens, and I’m so upset, and I get mad at people, and we get into it.” When
discussing her relationships she informed that she has had several friendships that did not last
with other females her age and she has had trouble with maintaining relationships and states, “I
just kept jumping from one guy to another. I didn’t even let myself have any time, but I don’t
know it was like I couldn’t deal with being alone. Ever since I was younger, I just fell for every
guy who came into my life and was good to me but then it never stayed good.”
Lisa was just asked to leave the last place she was staying, and she is in need of housing
and reports she and her roommates got into arguments a lot and they always tried to blame her,
and it would lead to fights. She has tried to stay with family but there have been past issues with
both her mother and brother when they have taken her in to stay. She is currently unemployed
after being terminated from a long-time job. Lisa talked about how after she has these issues or
CASE PRESENTATION
fights with people she tends to go and cry and isolate and because of issues with not being able
to keep friends or partners she criticizes herself and her looks.
Part II: Client’s Biopsychosocialspiritual Assessment
Biological Assessment
Lisa is 37 years old, identifies as white and Asian heterosexual cisgender female. She has
never been married but just recently separated from a long-term partner and has no children. Lisa
reports she is somewhat of a “night owl” and gets around four to five hours of sleep a night. She
reports she stays up late watching some crime shows and journaling about things from her daily
life to past relationships and friendships. Lisa reports her diet is somewhat consistent but not
necessarily what she would identify as healthy. She informed that she eats more than she used to
and is around 75 pounds heavier than she was in her twenties. She discussed her past diet issues
and said from about age of 15 to 25, she had an unreported and undiagnosed eating disorder of
bulimia. She reports she tries to get a little exercise a few times a week, usually this was doing
some time on the stationary bike at the gym of the apartment complex she was at for the last six
months.
Lisa discussed her medical history including a bad wrist from a couple past injuries
including a car accident and a volleyball injury as a teenager. She informed that she fractured it
both times and there tends to be some arthritic pain and stiffness. She reports that around 9
months ago she was diagnosed with Pre-diabetes and has been taking Metformin to help stabilize
her glucose levels. Lisa reports that she used to have an issue with pain pills after a car accident
and for a couple years she was taking pain pills prescribed by her doctor. She states, “I did
Tramadol and Mobic and I maybe got a little too overzealous sometimes with taking them and
yeah I guess I can say it’s my fault and I didn’t take them like I was supposed to. But now I don’t
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do anything like that. It’s just Tylenol or Advil for me.” Lisa reports the car accident was when
she was 30 and for the past five years, she has not had any opioid pain relievers.
Psychological Assessment
Lisa discussed her past mental health history that included going to counseling as a
teenager after having multiple ongoing issues at home including arguments and anger outbursts
with her family and her mother “forcing” her to go. Lisa reports that she didn’t think she had
anything wrong with her and she was not acting differently than a typical teenage girl. She states,
“Yeah so I talked to this lady for like a few months but it was all bullshit. She just wanted to get
in my business and then go report back to my mom what I’m doing. I honestly lost trust in
counselors because this bitch, she was just a snake, and I confided in her that I had lost my
virginity to this boy from the neighboring high school, and she flipped and told my mom.” Lisa
reports that she did have a history of rebelling in high school including skipping classes, having
underage sex, and underage drinking. Lisa reports that she had two instances when she tried to
attempt suicide by taking pills. She states, “I mean I wasn’t really like trying to kill myself, but I
was just upset, and I wanted them to know that they hurt me and maybe I’d win them back if
they saw how serious I was about them.” Lisa informed that both of these self-harms as she
categorized them were due to having a breakup or severe altercation with an ex-boyfriend. She
reports that over the years she has done many things to try and avoid a breakup with a guy she is
dating. She has locked herself in a guy’s bathroom and even went to the emergency room
claiming she was having panic attacks to avoid the boyfriend breaking up with her. She states,
“Oh yes, I have pages and pages of my journals of all the things I’ve done to try and get someone
to stay and not leave. I could write a book on all of the ways I’ve tried by now!”
CASE PRESENTATION
Lisa reports that on one occasion she was sent to a girl’s reform camp after taking pills
and her mother finding her and having her puke up the pills she had taken which were Tylenol.
She states, “The other time this happened, I went to this smelly old psych ward for adults. I was
19 at the time and I just had quit college and was living back at home and my mom made me
go.” Lisa reports that she never seriously wanted to die but she does talk about it when people
upset her or she has a relationship that is in jeopardy or that is ending and the two times she took
pills, she took less than 10 pills when attempting an overdose. Lisa reports she does not
remember what diagnoses she was possibly given during her time in counseling or during her
inpatient stay.
Regarding trauma, Lisa talked about two instances where she was molested by her
brother and her brother’s friend on separate occasions. She reports this happened when she was
12 years old and starting to develop during puberty and reports that her brother and his friend
were 16 years old at the time. She states, “I mean it kinda just was what it was. Nothing I haven’t
had to deal with as an adult too. Guys copping a feel, trying to do something when you’re not in
the mood.” Lisa reports that neither time with the brother or her friend was there digital or
genital penetration, but there was inappropriate touching underneath clothes, and she performed
oral sex on the brother’s friend. She states, “I guess they were just curious or whatever. It really
sucked though because I was so into my brother’s friend Jason. I guess I kinda loved him and he
didn’t love me back and that was the first time I felt that since my dad had left.”
Lisa reports that when she was around five years old, her dad left and went to work
overseas as a pilot and then started a new family. She reports that he would come to California
where they lived a couple times a year to spend time with them and he took care of her
financially but was never around much as a father from what she could remember. She reports
CASE PRESENTATION
that she enjoyed her dad more because he seemed generous and adventurous, and she did not get
along with her mother and would clash with her starting as a teenager. She reports that she
sometimes would blame her mother for the dad leaving because of her demeanor and alcohol
use.
Lisa reports that for her substance use history she has not done that many things more
than a few times. She states, “After seeing my mother drink like a fish and be crazy toward me
and my brother, I never wanted to act like that, so I drank sometimes at parties but just like social
drinking.” Lisa reports she tried marijuana and cocaine when she was a teen and in college and
reports it was less than 10 times that she used either substance. She drinks maybe three to four
times a month when she goes out to the bars. She states, “I just go have a good time with the
girls at happy hour. Sometimes that’s where I have met some guys I end up dating. I am kind of a
lightweight so two or three drinks is all I need.” Lisa reports that besides alcohol, marijuana,
cocaine, and prescription opioids, she has not tried another other illicit drugs or narcotics.
Lisa’s risk was assessed using the Columbia or C-SSRS. The lifetime section was
completed with Lisa’s past two suicide attempts which she rates as not that severe. Lisa was also
given a PHQ-9 that scored as a 9 and she had no thoughts of wanting to die or harm herself. She
reports that her only form of self-harm used to be bulimia and eating and then throwing up later.
She reports since started as a teen, she kept it as her secret and did not admit it back then and
therefore was not treated for it. She reports that she has not had issues with bulimia since around
25 years old. She reports that being with several boyfriends that liked skinny girls, she felt the
pressure to try and look slim for them but then after dating guys that did not seem to care, she
stopped bingeing and purging. She reports that now she has just accepted her weight and is
categorized as overweight.
CASE PRESENTATION
Lisa informed that she comes from a line of complicated and “hard to deal with” women.
Her mother she reports had issues with men after the divorce between her and Lisa’s father. She
states, “It was always drinking or men and I came third to that and she forgot to go to things for
me and I hated her because she made my dad leave with her way she was.” Lisa reports she talks
to her mother sometimes, but they have not seen each other in several months and have a distant
relationship now. Lisa reports her maternal grandmother also had issues maintaining a marriage
and had three different husbands whom she all divorced from. She reports that her father’s
parents died when she was young and does not know any major health issues on that side of the
family. She states, “I mean I have a relationship with my dad. He sends me money sometimes but
he’s in a home now and I don’t see him that much. But I don’t know if there’s been any mental
issues with him other than maybe having dementia now.” Lisa reports her father is in his late
sixties and retired several years ago from his airline job and that coincided with being put in a
retirement village that is monitored by staff.
Social Assessment
Lisa discussed briefly her cultural background. She reports her mother is white and her
father was third generation Korean/American. She discussed how her connection to that side of
her ethnicity was not something she really identified with or looked into until later in adulthood.
She states, “I now talk more about my Asian background, and I enjoy certain aspects of the
culture but a lot of people I think maybe don’t realize that I’m part Asian when they meet me.”
Lisa informed that one thing that she has done is keep quiet about her volatile lifestyle from her
teenage years until now when talking with her father. She reports that she feels his culture is
more serious about being respectful, rational, and not doing impulsive things that could shame
the family. She states, “Oh believe me, my dad does not know about this stuff. If I get mad at
CASE PRESENTATION
him over something like not sending me money, I just don’t come around for a while. He doesn’t
know about my relationships or my issues with friends and family and how they’re kind of not
speaking to me right now.” Lisa reports that she has referred to all the men in her life as “Ted” to
her father and he is under the impression that she has had one stable partner during her adult life.
She states, “My dad never seems to want to meet them just wants to make sure they treat me
okay. I’m not gonna talk to my dad about getting picked up by guys at the bar, which was just be
stupid to do and get him mad at me.”
Lisa reports that her mother was quite a bit younger than her father when they got
together. She states, “My dad is about 10 years older than my mom. They were together for about
10 years and then after that it was just my brother, me, and my mom at home. And then some of
my mom’s boyfriends that came and went over the years.” Lisa informed that her brother is a
warehouse worker now and is 41 years old and they are not on speaking terms right now. She
reports that before living with friends, she had stayed at her brother’s house for about a year. She
states, “I mean sometimes I lived with boyfriends, or they moved in with me.”
Lisa talked about her home environment growing up and reports it was chaotic with the
different men being around and her mother being mean and verbally abusive over the years. She
states, “I mean, I didn’t live in some nice household. I didn’t live in a dump; it was a nice house
and my dad always made sure we had what we needed and my mom was able to work just part-
time as a saleslady over the years because my dad supported us pretty well even with having a
new family.” Lisa talked about how she at times would want to go live with her dad when her
and her mom would fight. She reports her brother would be gone or just stay out of it and is not
very social and just hung out with his friends, smoked pot, and stayed out of any trouble. Lisa
reports that she and her mom would go from being so loving and nice with each other to ignoring
CASE PRESENTATION
each other and Lisa disappearing for days to go stay with friends or a boyfriend to get away from
her mom. She states, “one minute we were all good and sweet to each other and then she’d say
something I didn’t like or I’d say or do something and she’d tried to reprimand me but I wasn’t
gonna be told no. I was never told no growing up and I made sure to let my mom know that she
was the reason I didn’t have a dad around, so basically I got to get away with stuff over time. I
learned how to talk her into stuff and my brother would sometimes lie for me so I could go do
what I wanted.”
Regarding Lisa’s romantic partners, she reports that she lost her virginity as a teenager
and dated several men over the subsequent years. She states, “I have had a few long-time
boyfriends who I thought were my true love.” She reports that she has had about five
relationships she considers long-term lasting a year or more. She reports she has had another ten
boyfriends that she had for a couple of months up to a year. She states, “I mean I guess I have a
type. Good looking guys who kind of command the room. I want to be the apple of their eye and
also show them off to my friends.” She reports that she usually enjoys the beginning of all her
relationships and then over time things change and they begin to resent her and her moods and
her picking fights and arguments and then she resents them when they stop treating her in the
ideal romantic way. She states, “I want to be treated like a princess and then when they don’t
really give me that ideal love I always picture, yeah I kind of get mad and maybe I go into petty
stuff and start fights. But we would always make up and go back to being in love after.”
Lisa talked about her last romantic partner she separated from within the last year. She
reports that they dated for around three years but never lived together because he lived with
family and was in between jobs a lot. Lisa reports that she sometimes found herself in situations
where she was paying for things in the relationship and doing things to try and keep her partner
CASE PRESENTATION
happy like paying his car payment and letting him stay at her place. Lisa and the partner had a
big blowup fight she reports and that was due to him spending all their rent money and her being
forced to move in with family and then roommates during this last year and also coincided with
her getting fired from her job for being gone often and taking hospitality items from the hotel
and giving them to friends and her boyfriend. Lisa reports that currently she has just been seeing
a couple guys casually and hangs out with them on nights she goes to the bar around one time
per week.
Lisa informed that she was a B and C average student in high school and got her diploma
and completed about 18 months of college before dropping out. She went on to get a food and
beverage hospitality certification and became a hotel concierge at a nice hotel in San Diego. She
reports that before getting this job about seven years ago, she mostly did office temp work and
waiting tables. Lisa reports that she loved her job at the hotel because she enjoyed being in a nice
fancy hotel and talking with clients who lived a nice lifestyle like her father did and like she felt
like she did when she would spend time with him during his vacations. She states, “I guess hotel
work became a thing I liked because we would go stay at nice resorts when my dad would take
us on a vacation to nice places like the Bahamas and Cancun.”
Lisa reports she has been living on her trust fund she has from her dad and has had a few
food service jobs recently but is currently not employed and not sure what she wants to do next.
She states, “I mean I took pride in my job and I enjoyed that job at the hotel but I’m worried that
maybe what happened at the hotel will come out if I try to get another similar job. It wasn’t even
really my fault. They tried to say I did all this stuff but honestly, the previous owner always let us
take free stuff when guests would leave and I just don’t get why these new owners were so weird
about stuff and didn’t just let us staff have nice stuff and freebies. I don’t see the harm in that.”
CASE PRESENTATION
Lisa reports she tried really hard to convince her bosses to let her keep her job and she had two
warning write-ups before ultimately being let go. She states, “I mean I didn’t want to lose this
thing that meant the world to me and it’s like they took it away and wouldn’t just give me
another chance to show I could change.”
Spiritual Assessment
Lisa discussed her spiritual history and the religious activities she attended sometimes.
She reports that she sometimes will take her father to church now at the one near his retirement
community. She states, “I mean I would say I’m spiritual but I don’t attend church that often but
I do read my bible and journal about it sometimes. Mostly I do this when I have had a fight with
someone in my life and I’m journaling about them. I’ll try to find some healing quotes or words
to help me with how I’m feeling.” Lisa informed that she does pray sometimes but it is mostly
when she’s in a time of trouble or stress. She reports she should pray more and attend church
more often but sometimes she just can’t commit to it and she will go to brunch with friends or go
to the casino with a casual fling guy and blow off church. Lisa reports that she places more
importance on God in her life than what it was as she grew up as they did not go to church in her
house and she would only go if she was staying overnight at a friend’s house on a weekend. Lisa
talked about her spiritual awareness and talked about how she tries to be a reasonably good
person but it has been hard for her to have good relationships and keep them and sometimes she
feels that deep down it is her fault but normally she tries to justify why the other person is at
fault.
Lisa reports that at this time she would only probably incorporate spirituality into her
sessions if she reads from one of her journal entries about something that happened with
someone in her life. She states, “I may read the verses I wrote down but other than that, I will
CASE PRESENTATION
probably just keep that to myself.” Lisa reports that she has some fear of being judged or that
people that are part of a church wouldn’t stick around and accept her for how she lives her life.
She states, “I mean I don’t live the most innocent life I know that, but I don’t wanna be judged
for things, if I was having a good relationship like with a Christian man or a friend from a church
and then they got upset with me for doing certain things, I don’t know, I’d probably just have to
end the friendship right then because I’m a grown woman and I don’t need that kind of crap.”
Part III: Mental Status Exam
Lisa is a 37-year-old female who looks slightly older than her apparent age with graying
roots, long straight hair and some age spots and wrinkles. She has a stocky build and is short in
stature she is wearing an ace wrap on her left wrist which relates to past wrist injuries and no
physical deformities of note. She seems to hear and respond to questions in an appropriate
manner indicating no hearing or comprehension issues. She was well groomed and was dressed
appropriately for the session with jeans, a blouse and a woold cardigan and flats. Lisa reports she
uses reading glasses to see small print and had those around her neck. Lisa walked evenly but
kind of shuffles in a fast pace walk, she talks with her hands quite often and has a slouched
posture.
Lisa seemed to have a friendly demeanor and was cooperative in answering questions but
at times became defensive with her posture and gestures when talking about certain topics. Her
behavior seemed to be anxious at times and indifferent at other times. When talking about herself
and her struggles she was shifting in her seat and would put her head down a lot. When talking
about the people in her life that have done bad things to her she was much more direct and
looked up and made eye contact with the clinician. Lisa talks somewhat pressured and fast and
discusses things from a stream of consciousness kind of narrative and explained in detail some
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things and other things she was more reserved about. She explained in detail, for example her job
and how her mom was hard to get along with and their dynamic but she did not state as much
when referring to her past issues with an apparent eating disorder and two instances of
intentional overdose of pills.
Lisa seemed to hesitant and avoided eye contact and seemed to minimize some of her
reported behaviors. Lisa had a normal response in receptive language and used expressive
language a lot that sometimes sounded like how an excited teenager would discuss something.
Lisa had little to no issue with recall and memory but also had things she did not specify or did
not know like how old her dad is, just reporting he is in his late sixties. She also recalled an
approximate number of romantic partners and said it would take her too much time to sit and
think of every single one she’s had over the past twenty years.
Lisa was oriented to person, place, and date and appeared alert and made coherent
sentences and repeated herself when needed. Lisa seemed to have an adequate level of
concentration and seemed engrossed in the assessment and focused on discussion points at hand.
There was no evidence of impaired thought processes, and she denied having any hallucinations
or delusions at any time in her life. She was able to answer some average intelligence questions
and could recall some trivia about politics or pop culture.
Lisa’s mood was somewhat anxious and irritable at times. She got more expressive and
loud and made more facial expressions when discussing her issues with friends and family and
romantic partners she has had over time. She talked about getting into an argument with her
roommates she had been living with who were several years younger than her and they were a
male and female friend duo she met at the local bar she spends time at a few times a month. She
seemed to still have quite a bit of anger and resentment toward how things ended with the
CASE PRESENTATION
roommates and them essentially demanding that she move out. Lisa reports she has not had any
recent suicidal ideation and most of those types of behaviors stopped after her early twenties and
when she stopped having bulimic tendencies.
Lisa reports that she has not experienced any instances of domestic physical violence and
when she refers to fights, she refers to arguments and only verbal aggression and reports that on
a couple occasions with boyfriends she threw something against a wall onto the table to let out
frustration but it was not assaultive behavior as she views it directed at the partner. She states, “I
have been yelled at and did my fair share of yelling too but I’ve never been hit by a boyfriend.
My mom slapped me a couple times when I was a teenager and I one time threw a shoe at her
when we were having it out.” Lisa reports not being at any risk of violence currently and reports
that other than the two instances of molestation she reported to this clinician when she was
younger, she has not had any instances of sexual assault and has consented to all sexual
encounters with romantic or sexual partners.
Part IV: Answer Key
DSM-5 Diagnostic Criteria: Borderline
Personality Disorder F60.3
Client’s Reported Symptoms:
A pervasive pattern of instability of
interpersonal relationships, self-image, and
marked impulsivity beginning by early
adulthood and present in a variety of contexts
as indicated by five or more of the following
The client’s overall depiction of her
interpersonal relationships seems to be
unstable, including valuing and devaluing
relationships with roommates, partners, and
family.
Criterion 1: Frantic efforts to avoid real or
imagined abandonment.
Lisa reported trying so many things to make an
ex-partner stay and reports that she tries to
convince people to change their mind about her
after having some sort of conflict. This issue
occurred with her job, and she tried keep her
job after multiple write-ups prior to
termination.
Criterion 2: A pattern of unstable and intense
interpersonal relationships characterized by
alternating to extreme levels of idealization and
Lisa reported unstable or intense relationships
with her mother, father, roommates, and ex-
partners. She discussed about the back and
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devaluation. forth feelings of one moment idealizing the
relationship and it being seen as so happy and
harmonious to things ending or seeming like
they didn’t mean anything. All or nothing
thinking is something that seemed evident from
her report on her social life, romantic, and work
life
Criterion 3: Identity disturbance: unstable self-
image or sense of self
Lisa reported to crying and feeling bad about
her physical appearance especially after fights
with a partner. She also reported to about a
decade long history of bulimia that she never
reported to her family or got treatment for. She
informed that this self-image and self-harm
issue with eating dropped away when she
began dating men who didn’t seem to have a
preference of her being slim. Unstable sense of
self can be something that validation from
others also highlights. Lisa informed that when
her weight was validated by a partner, it no
longer became a preoccupation or thing she
worried about.
Criterion 4: Impulsivity in at least two areas
that are potentially damaging.
Lisa informed of going out to the bars around
once per week and that she has met up and then
had physical relations with men she met while
out drinking and some of them became long-
term or short-term partners. She informed of
becoming sexually active at a young age and
was trying to keep this from her mother at the
time and when a counselor informed her
mother of the harmful behavior, she got upset
with the counselor and dropped out of
counseling. Lisa also reported spending
impulses of going to the casino instead of going
to church, paying for bills of a partner as a way
to sometimes make them stay with her even
when it led to being evicted. She also reported
that her work terminated her for taking
hospitality items that are given to guests of the
hotel.
Criterion 5: Recurrent suicidal behavior,
threats, gestures, or self-mutilation.
Lisa reported two occasions of an intentional
overdose that she attributed to breakups or
conflicts with a romantic partner. She reports
that she does not seriously have thoughts of
suicide but has used suicide threats as a way to
try and avoid abandonment or keep a
relationship that is in jeopardy.
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Criterion 6: Affective instability due to mood
changes/reactivity.
Lisa discussed these unstable mood patterns as
a factor in her issue with relationships and
reported that her mood went up and down often
depending sometimes on the context of how
her relationships were going.
Criterion 7: Chronic feelings of emptiness No reported issues of emptiness, some allusion
to this when talking about how she would not
want to be judged for her lifestyle by Christians
she became friends with but would need to be
examined further to justify this.
Criterion 8: Inappropriate or intense anger and
difficulty with controlling anger.
Lisa reported a history of getting into many
arguments and instances of verbal aggression.
She also admitted to throwing things several
times during arguments including those with
her mother and with future romantic partners.
Criterion 9: Transient, stress-related paranoid
ideation or severe dissociated symptoms.
No evidence of paranoid ideation or
dissociation symptoms.
(American Psychiatric Association, 2013)
Part V: Treatment Considerations
Many people agree that dialectical behavior therapy or DBT is a successful treatment for
borderline personality disorder or BPD, with a focus on emotional regulation, distress tolerance,
being effective in interpersonal relationships. A study by Kujovic et al. (2024) discussed the ideal
length of treatment in DBT that is still being researched. The study compared the effectiveness of
8-week and 12-week DBT interventions with comparable content, this retrospective, naturalistic,
non-randomized study focused on the primary outcome of changing BPD-specific
symptomatology and the secondary outcome of reducing depressive symptoms. The analysis
included a total of 175 patients who underwent DBT and were given an 8- or 12-week
intervention. The study concluded that there was no significant difference in the 12 week
program and that within the 8 week program, there was a significant reduction of BPD symptoms
and overall reduction in depressed mood based on self-report measures. Medication
consideration was part of this study but showed no significant effect within a range of
psychotropic medications considered from benzodiazepines, mood stabilizers, and prescription
CASE PRESENTATION
stimulants. I would revisit medication considerations and a possible referral after the
implementation of counseling and a half-way update within the program timeframe.
A study by Gilbey et al. (2023) details another possible treatment recommendation which
is mentalization based therapy. MBT can help a client understand and regulate their emotions by
improving the client’s ability to understand their mental state and also the mental state of others.
The emphasis on pausing before reacting is something that could be effective in theory for clients
who struggle with volatile anger outbursts and impulsive behaviors. The study results indicated
that clients who received MBT and had BPD symptoms showed harm reduction to a significant
degree within suicidality acts, thoughts, and threats. The findings also saw an overall reduction in
negative moods and feelings for those treated with this modality. Another area that showed
reduction, was the reduction in the frequency of emergency room visits for various symptoms
reported by the population sample.
Spiritual Integration Considerations
When considering spiritual integration for Lisa, I would proceed with some caution
regarding implementing this aspect due to her hesitancy, her reported worry about how religious
friends may view her, which could possibly contribute to a diminished sense of self or
exacerbating self-image issues she has indicated previous struggles with. Lisa reported to some
spiritual activities like journaling and looking up bible verses, but she also related these to only
being done after having a big conflict or argument with a person in her life. There are still some
apparent areas to address in the client’s awareness of her symptoms and this can be delicate to
navigate when someone is diagnosed with a personality disorder. To add spiritual integration on
top of trying to assist the client with symptom awareness could present to be challenging or
overwhelming during an initial phase of counseling recommendation.
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References
American Psychiatric Association. (2013).KDiagnostic and statistical manual of mental
disordersK(5th ed.). https://doi.org/10.1176/appi.books.9780890425596
Gilbey, D., Brealey, G., Mateo-Arriero, I., Waters, Z., Mateo‐Arriero, I., Ansell, M., Janse van
Rensburg, E., De Gouveia Belinelo, P., Milroy, H., Pace, G., Runions, K., Salmin, I., &
Woolard, A. (2023). The effectiveness of a day hospital mentalization‐based therapy
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