Nina Rovinelli Heller

Utilizing cognitive-behavioral techniques in psychodynamic practice with clients diagnosed as borderline

Many factors, including theoretical controversies, treatment constraints, and an increasing awareness of the high incidence of childhood trauma, compel practitioners to reevaluate both theory and practice in the treatment of clients diagnosed as borderline. Our purpose in this paper is to encourage clinicians who practice primarily from a psychodynamic perspective to reconsider the judicious use of relevant cognitive/behavioral techniques with this population. We focus on the rationale of utilizing relevant cognitive/behavioral techniques in out-patient settings, and discuss specific problem areas where these techniques might be useful. These problem areas include (1) cognitive and affective splitting, (2) affective dysregulation, and (3) faulty attributions. Each problem area is discussed with clinical illustrations of appropriate cognitive/behavioral interventions. The vignettes also illustrate the essential role the therapeutic relationship plays in order for cognitive/behavioral interventions to be effective.

The influence of early drinking contexts on current drinking among adult lesbian and bisexual women.

BACKGROUND: Differences exist in alcohol-related outcomes across subgroups of sexual minority women. Likewise, stressors associated with coming out and living as lesbian or bisexual are hypothesized to be highly variable. Lesbians’ and bisexual women’s risks for hazardous drinking are explored in a 2006 NIAAA-funded interview study of women living in the Northeastern United States. OBJECTIVES: The primary objective of the present study is to replicate and extend an earlier analysis of the relationship between early drinking contexts and current drinking outcomes of adult lesbians with a convenience sample that includes a subgroup of self-identified bisexual women. Potential differences in the early drinking contexts of these two groups of self-identified lesbian and bisexual women are also explored. DESIGN: Bivariate and multiple regression analyses are used to examine relationships between early drinking contexts and current drinking of a racially and age-diverse convenience sample of 145 adult lesbian (N = 94) and bisexually identified (N = 51) women. RESULTS AND CONCLUSIONS: Consistent with previous research, patterns established while coming out have an enduring effect on drinking outcomes of lesbians; findings for bisexual women are inconclusive. Implications for research and practice are discussed.

Assessment of cognitive schemas and attributions in psychodynamic treatment

Abstract The authors draw upon cognitive‐behavioral, psychodynamic, and the integrative theories and literature to propose assessment guidelines which pay attention to the understanding and use of cognition in treatment. They demonstrate how the careful assessment of schemas and attributions, when completed as part of a general ego psychological assessment, engages the client, facilitates the integration of historical and current affects and events, and offers a means of systematically exploring and challenging motivating beliefs and assumptions about the operation of the world. Contemporary clinical examples and a focus on cognitions in the social realm, typically a neglected dimension, are utilized to illustrate theoretical concepts.

The slippery slope of constructivism

Abstract While constructivism as both a philosophy and a clinical practice is being embraced by many individual and family practitioners, it remains controversial. This paper examines the difficulties one encounters in trying to balance the clients “relative truths” with those around them, including that of the therapist. Through the use of clinical vignettes, the authors demonstrate the difficulties inherent in dealing with ambiguities in the clinical situation, balancing the clients perspective, with that of a predominant culture or biological “fact,” and considering the issue of the clients “veracity.” Particular attention is paid to the difficulties involved in work with trauma survivors, whose own recollections of events may be ambiguous. Finally, the authors discuss the implications that constructivism holds for research and social action and advocacy. In sum, the authors recognize significant promise in the constructivist perspective, but caution clinicians to consider the inherent difficulties in a theory that relies on the relativity of truth.

Octogenarian Reports of Lifetime Spiritual Experiences: Types of Experience and Early Life Predictors

This study assessed lifetime histories of discrete spiritual experiences recalled by 144 octogenarian men studied since adolescence and 80 spouses. Women were more likely to report discrete spiritual experiences, as were those from higher socioeconomic backgrounds and those judged more open to experience as young adults. Factor analysis revealed four types of experiences related to beauty/nature, negative life events, protection by a sacred other, and traditional religious settings. Men from better childhood environments more commonly reported spiritual experiences concerning negative life events. Those with serious childhood illnesses were less likely to report experiences of feeling protected by a sacred other.

Boundary Ambiguity and Borderline Personality Traits: Implications for Treatment for Adolescent Girls in Foster Care

This article explores the relationship between boundary ambiguity and borderline personality traits in adolescent girls in foster care. Boundary ambiguity is a family systems concept: family members are uncertain about who is in or out of the family—in either psychological or physical presence or absence. In foster care, it can be assumed that an adolescent girl has experienced trauma significant enough to be removed from her family. The connection between early childhood trauma and attachment disruption in addition to the connection between insecure/disorganized attachment and borderline personality disorder leads to the conclusion that these same adolescents are at high risk for developing borderline personality traits. The sample consists of 40 caseworkers from New England’s child protection departments and therapists from residential programs working with adolescent girls. They completed the Shedler-Westen Assessment Procedure for Adolescents to determine the presence of personality disruption as well as a variation of Pauline Boss’s Boundary Ambiguity Scale #1, and demographic questionnaires. The results find a significant correlation between boundary ambiguity and borderline personality traits. These findings provide directions for future research in clinical treatment and child welfare policy making.

Constructivism: A meeting ground for evolving psychodynamic and cognitive‐behavioral practice?

Abstract The authors propose that constructivism provides a theoretical framework suitable for the complexities of contemporary social work practice. The specific focus is on the areas of confluence of cognitive‐behavioral and psychodynamic theory and technique. Building on their earlier work on psychotherapy integration, the authors extend their notion of “starting where the client is,” is in fact a constructivist concept, critical to the meaning‐making process. Through the use of case vignettes and a select review of the literature from both the psychodynamic and cognitive‐behavioral traditions, the importance of the active participation of both the client and the therapist are demonstrated. The use of the therapeutic relationship is highlighted in both the psychodynamic and cognitive‐behavioral perspectives, as is the social context of the client.