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Table 3 Family Case Study: Parenting with Personality Disorder

From: A new intervention for people with borderline personality disorder who are also parents: a pilot study of clinician acceptability

Sam is a 31 year old single mother of three children, Ethan aged 14 years, Jack aged 8 years, and Mia aged 3 years. Sam loves her children, and wants the best for them. Sam has been diagnosed with Borderline Personality Disorder, and has difficulties managing relationships and stormy emotions, often using self-harm to cope when she feels overwhelmed. Sam has been working with a mental health clinician to reflect on her relationships with her children and on the choices she makes in caring for them on a daily basis, as small actions can make a big difference in her family. Sam and her clinician have been talking about the following choices Sam has recently been faced with:
1. Sam was in the bathroom and had cut herself. Jack was worried about where his mum was, and knocked on the door, asking her to let him in. Sam was feeling overwhelmed, alone, and was wishing for someone to support her, and her initial response was to open the door to seek support from Jack. However, she then took some time to reflect and consider her choices and how they would impact on her son. She then chose to tell Jack that she was ok and was washing her face, and would be out shortly. She asked him to watch TV with his sister. Sam engaged in some self-care, and washed and bandaged her arm before joining the children to watch cartoons. This choice protected Jack from being exposed to her self-harm.
2. Sam was sitting on the lounge in a dissociative state. She was caught up in painful memories and feelings from the past. Her daughter Mia wanted to play, and came over to Sam, tapping on her leg and calling to her “Mummy, Mummy.” Sam felt irritated by this, and conflicted about providing for her young daughter when she didn’t receive nurturance in her own childhood. Sam had a choice to yell at Mia, and push her away, or to put aside her worries and memories for a little while to be with Mia and play with her in the present moment. She chose to join in the play session, which strengthened her bond with Mia and allowed her to experience positive new feelings to replace older ones.
3. Sam was having a fight with her boyfriend over the phone and was becoming increasingly distressed. The children were in the kitchen, and Ethan was packing lunches and getting everyone ready for school. Sam was feeling abandoned by her boyfriend, and had a choice to seek further support from Ethan and ask him to stay home from school to be with her, or to take charge of getting the children to school before seeking support from appropriate services, so that she would not burdening her son. Choosing to ensure all children attended school helped them maintain contact with their learning and peers, and provided respite so that Sam could attend counselling.