Sunday, January 22, 2006

Underground DSM-IV: Splitting

If one staff member moves to rescue an Axis II patient, someone else will lean toward punishment to an equal degree. In large groups the mathematics of balance is more complicated but the principle is the same: the group will balance its transference, which is driven by the patient. Moving to the extremes just increases splitting: shift wars, team vs. line staff, community vs. hospital.

Once everyone takes a deep Lamaze Cleansing Breath and remembers this, the treatment of the patient can procedd.


Anonymous said...

I agree that this happens, but I have not had much difficulty diffusing it. It requires gathering everyone and discussing Axis II and splitting and how to recognize it. Then we all take the deep breath and go on.

I enjoy when you post these observations. Please continue.

Mr. Parx

Anonymous said...

And of course, the Axis II patient may foster the splitting. In my days as director of an inpatient psych-program, if we did an "autopsy" after a significant splitting of staff, it was almost always initiated by the patient, often in extremely subtle ways and more often than not the Dx was BPD. You brought back some memories and a smile. Thanks.

Note also that Mr. Parx is correct, if you know an Axis II patient is being admitted, a team meeting ahead of time can work wonders to lessen the "splitting."

Assistant Village Idiot said...

In the Monty Python sketch about the Four Yorkshiremen (which I will post immediately, as it is the best send-up of victimology I have found), one of the characters counters a one-upping tale of woe by saying dismissively "Looxury."

That was my thought when I thought of gathering everyone or having advance meetings about the admission of a personality disorder. They constitute about 30% of our admissions, and we always have a Borderline Olympics going on.

Don't make me jealous. I'm already grouchy enough.