Responding to Schizophrenia, Bipolar disorder and Borderline disorder

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Responding to the Schizophrenic, Bipolar and
Borderlines

• Dr Douglas Kong
• Retired Psychiatrist
• Executive/Business and Life Coach

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• Responding to the Schizophrenic patient

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Prepare yourself mentally

• Remember that they are really not well, in fact
  severely sick
• Learn to keep calm not matter what
• Learn to cope with your own fears and get support
  even supervision
• Be willing to learn about schizophrenics
• Read books about them and attending courses on
  how to help
• Join a fellowship eg Anglican CRSS, Bcare, SAMH
  etc

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Understand the Schizophrenic patient

• They are human beings have feelings, emotional
  needs
• They can relate, there is a part that is well
• Relate to the well part
• Help them to understand the part that is unwell
• Know that they are disinhibited and react
  spontaneously
• Provide a structure at all times to relate to
  them
• Get them to act and to initiate things respond
  appropriately

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Challenges in working with Schizophrenics

• They tend not to habituate
• They tend to be highly aroused
• They have a higher incidence of anxiety and
  depression
• Drug treatment produces side effects
• Hand tremors, abnormal movements, irritability,
  pigmentation, drooling, smacking of lips,
  abnormal chewing motion
• Their behaviour often lead to disturbed
  relationships
• Schizophrenics tend to have low self-esteem

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Structure in handling schizophrenics

• Consistency in handling them eg time, place,
  contingencies
• Understand basic behavioural techniques
• On a basic level, behaviour change depends on
  reinforcement
• The behaviour that you want is reinforced
• The behaviour that is unwanted is not reinforced
  ie extinguished
• Any response is a reinforcement including
  criticism
• Behaviours can be shaped but require detailed
  analysis

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Behavioural principles

• Unconditioned Stimulus(UCS)
  Unconditioned Response (UCS)
• (pairing)
• Conditioned Stimulus(CS) Conditioned
  Response (CR)

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Operant conditioning

• Complex action analysed into series of small
  actions
• As each action is learned, move on to the next
• Can shaped very complex behaviours
• Reinforced types time interval, different
  domains
• Different type of reinforcement schedules
• Negative reinforcement aversive conditioning
• Example ABA used for Autism
• Advanced Behavioural Analysis

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Responding to bipolars

• Bipolars who are severely ill has similar
  behavioural characteristics to schizophrenics
• Bipolars who are well in between episodes can
  respond normally when well
• Bipolars can show the psychological and social
  maladjustments of borderlines
• Need to listen to bipolars when they are well
• Greater need to listen to them when unwell, as
  psychotic symptoms may uncover inhibited
  responses

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Preparing to help borderlines

• Many people find borderlines very stressful
• Successful borderlines as your boss
• Borderlines in any role in your life
• Make sure you have a foundation for stability
• Recognize borderline traits in yourself
• Are you helping them because you need them
• Would you then blame them for your own problems
• Looking for emotional targets of your own issues
• Supervision essential, as most of us are to
• some degreeborderline

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Responding to Borderlines

• Borderlines who need help are often unsuccessful
  in life
• Their behavioural characteristics include
• Impulsive actions
• Unstable moods
• Chaotic relationships
• Social isolation is one consequence of above
• They may knowingly/ unknowingly manipulate people
• Opposites such as untrusting and trusting you
  100 common
• Lies, denials often to their advantage is not
  uncommon

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How to respond to borderlines

• Respect them as persons
• Recognize that they have been let down by others
  in their past
• Insist on their respect for you
• Communicate clearly, do NOT hint
• Insist on boundaries, whats permissible, whats
  not
• Be flexible though but be wary of being
  manipulated
• Make explicit issues of trust and dependability
• Do not get yourself emotionally involved

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What works

• Structured approach with clear boundaries, goals,
  objectives, motivations, control of emotions,
  mindfulness, tolerate frustration etc as
  dialectical behavioural therapy
• Combination of CBT, relational (ORT), gestalt
  therapies combined with mindfulness and systemic
  orientation, combined with spiritual
• Combination of working with them in groups and
  one-to-one
• Ideal way of helping them is to treat them as
  complete individuals body (behaviour) mind (
  thoughts, attitudes, beliefs and emotions) social
  (systemic) how we perceive (gestalt, patterns)
  with mindfulness (spiritual)

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Helping borderlines is difficult

• Need support
• Supervision is essential
• Traps and snags are almost always present
• Always take care of yourself
• Take care of yourself holistically mind,
  social, behaviour, social and spiritual