Providing Consultation to Organize Specialist Treatment

Abstract

Unlike other chapters, this chapter specifically addresses BPD treatment by specialists in the disorder, providing consultation for a complex case of a patient with considerable prior treatment experience but with limited overall benefit. Effective treatment planning for BPD patients begins with a consultant assessing the appropriate level of care by thoroughly evaluating current presenting problems as well as lessons learned, behavioral change sustained, and consistent functioning achieved – or the lack of these markers – across varying clinical settings and levels of support and containment. Reviewing collateral history and records from previous treatments is essential for comprehensive assessment. It is important to outline a level of care that supports the highest possible level of functioning without burdening patients beyond their capabilities. The consultant generally also determines the modality, scope, aim, and frequency of the primary therapy and each proposed adjunctive component, and assists with identifying clinicians to carry out each designated role. “Pre-treatment” meetings are usually held with prospective patients and their families, either jointly or separately, to outline the recommended treatment plan and obtain all parties’ agreement to begin.