T14 – 4.5 Teletherapy Video Case Study Additional Considerations…

Additional Consideration…

• Although Estelle denies cutting with the intent to kill herself, it’s important that the provider continuously monitor Estelle’s self-harming behavior and suicidal ideation/intent. Estelle is at higher risk for suicide given the intense moments of distress and mood dysregulation that she experiences.

• Estelle may require ongoing care and support, even outside of the therapy room. It is important that she has access to support throughout the week as she learns to manage her emotions and distress.

• Individuals with borderline personality disorder may try to push boundaries with the provider. It is important that the provider create and maintain a strict adherence to rules and boundaries.

• It’s possible that Estelle may find ways to harm herself using the replacement (i.e., non-harmful) behaviors to manage her distress. For example, suggesting she snap a rubber band on her wrist when she feels the urge to self-harm can lead to progressively more intense “snapping” (e.g., leaving marks on her wrists). Estelle might benefit from alternative behaviors that have little-to-no possibility of harm in any way.