HANDOUT: PERSONALITY TRAITS SEEN IN THE HARD-TO-SERVE CLIENT: CHALLENGES FOR THE TREATMENT TEAM. Stella L. Blackshaw M.D. FRCPC Professor of Psychiatry University of Saskatchewan. Outline. Case History #1, “Kevin” Defense mechanisms used by clients with severe personality disorders
Stella L. Blackshaw M.D. FRCPC
Professor of Psychiatry
University of Saskatchewan
Characterized by :
- Projective Identification
- towards different people
- towards the same person but at different times
- towards the self at different times
3-Step interactive process (Ogden):
- projection of a (strongly negative or positive) mental representation onto the other person,
- believing it to be true (in the moment) and acting towards the other as if it were true,
- thus inducing the other person to act in a way consistent with the projection.
(a self-fulfilling prophecy)
- presents him or herself differently to the same person at different times.
- presents differently to different people.
- may be idealized at one time, devalued the next.
- hears the client idealizing or devaluing other staff members.
- has intense feelings and may find themselves reacting to the client in ways “not like me”.
- have polarized opinions of the client (“are we talking about the same person?”).
- take polarized positions about management (“rescue and nurture” vs “confront and set limits”).
- have strong feelings about the client and feel strongly about their therapeutic position.
NOTE: Document reasoning for admitting or not admitting to hospital, e.g. “chronic suicidal ideation with no known change in circumstances, history of hospitalization resulting in regression”.