The MUHC Borderline Personality Disorder clinics
There are 3 Personality Disorder clinics at the MUHC, that constitute the Personality Disorders Program of the Department of Psychiatry.
1. The BPD Short-Term Clinic
Individuals diagnosed with Borderline Personality Disorder who are receiving treatment for the first time, or do not have an extensive psychiatric history, may be best served in the Short-Term Clinic. Treatment at this clinic aims to increase intrapersonal, social and occupational health, bringing the patient to a level where they no longer require hospital based interventions. This 12 week program includes weekly individual and group therapies. The starting dates are in September, January and April. Each group can accommodate 10-13 patients.
The clinic accepts referrals from outside the MUHC.
Because of the limited duration of this clinic’s program, it is important for its patients to be connected to community healthcare facilities. Although medication recommendations may be made at the time of the assessment, the patients of the Short-Term Clinic will continue to have their medications followed by physicians in the community.
Patients who have been experiencing effects of shifting moods, angry outbursts, impulsivity, difficult inter-personal relationships and self-damaging behaviours, are provided the opportunity to learn skills and strategies to manage their intense emotions and impulsive behaviours.
2. The BPD Extended-Care Clinic
This clinic provides treatment to people with a diagnosis of Borderline Personality Disorder whose level of functioning obstructs autonomous participation in daily activities.
Treatment is offered in six-month blocks up to a maximum of two years and consists of several components, including: individual and group psychotherapy; a life skills group; an after-care group; and regularly scheduled psychiatric consultations. All patients of the clinic are simultaneously followed by a psychiatrist or general practitioner for medication management.
The program can treat up to 40 patients at any given time. When openings occur, new patients are integrated into the program. The clinic accepts patients from outside the MUHC sector.
If hospitalization of a patient becomes necessary, that patient is directed to their catchment area psychiatric facility. Every effort is made to maintain a short waiting list for each of the clinic’s therapeutic components.
Individual treatment plans are developed for each patient with the following goals: improving quality of life; fostering a positive personal identity; coaching in adaptive interpersonal relating, promoting accountability; and increasing mastery over themselves and their lives.
The BDPD Clinics provide:
- Multi-channeled interventions
- A container for impulses, affect, ideas, and behaviours
- A safe environment to ventilate and respond
- A safe environment to revisit history
- A laboratory to safely experiment new attitudes and behaviours
- Peer-based learning
- Safe opportunities to challenge, confront, identify and empathize with others
- Reparative relationships with authority figures and peers
- Opportunities to experiment with emotional intimacy
- Opportunities for a peer support network
- Peer assistance with situational coping
- Life event celebrations
- Creativity shared with the group
Patient Gains:
- Increased ability to contain and regulate reactivity
- Decreased impulsivity; increase in spontaneity
- Increased creativity
- Decreased rage and healthier anger management
- Reduced frequency of self-destructive behaviour
- Greater positive investment in self
- More positive and stable identity
- Increased effectiveness in social and work relationships
- Movement from ambivalent/avoidant attachment toward connection
- Greater relationship stability
- Reduced resistance to intimacy and interpersonal commitments; patients feel less fearful, isolated, lonely, and empty
- Increased self-esteem
- Clear and more stable boundaries between self and others
- More evolved developmental level of functioning
- Training in reality-testing
3. General Personality Disorders Clinic
This clinic offers treatment to people who either have a severe personality disorder other than Borderline Personality Disorder and/or people who are diagnosed with Borderline Personality Disorder and are either unable or unwilling to adhere to the structure of the treatment process offered in the Extended-Care Clinic. The treatment consists of medication management and individual therapy during monthly medical visits.
The objectives are:
- A reduction in the use of secondary and tertiary care resources in mental health facilities (particularly psychiatric emergency)
- The avoidance of polypharmacotherapy and the unwarranted use of psychotropics
- The development of a better self-assessment regarding relationship problems and diagnosis
- The gradual weaning from the sick role
- The gradual improvement in psycho-social functioning, in concert with the gradual development of a sense of responsibility for one’s own life