Emotional Obstacles Research Articles

Employment for Persons With Borderline Personality Disorder

Back to table of contents Previous article Next article Frontline ReportFull AccessEmployment for Persons With Borderline Personality DisorderBeth Elliott Ph.D.Odile WeissenbornBeth Elliott Ph.D.Search for more papers by this authorOdile WeissenbornSearch for more papers by this authorPublished Online:1 Apr 2010https://doi.org/10.1176/ps.2010.61.4.417AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Individuals with borderline personality disorder often face obstacles to employment. Research indicates that over 50% of individuals with the disorder are severely impaired in employability. In light of the fact that a recent National Institutes of Health study found that the lifetime prevalence of borderline personality disorder in the U.S. general population is 5.9%, there appears to be an identifiable need for vocational services to help people with this disorder.In December 2006, under the auspices of the National Education Alliance for Borderline Personality Disorder, we initiated a job preparedness program in New York City called "The Connections Place" (TCP). Our goal is to help clients with borderline personality disorder take small steps toward employment.TCP offers a four-month job preparedness program. Many of our clients stay longer, however, depending on their particular needs. The curriculum consists of two modules. The "portals" module teaches the skills needed to overcome the emotional obstacles related to working. These skills include increasing the motivation to work, coping with the stresses of the job application process, and managing interpersonal conflicts with colleagues and supervisors. Many of the skills are similar to those used in dialectical behavior therapy, a therapy that has been highly effective with persons with borderline personality disorder.The "vocational" module focuses on identifying realistic and meaningful work, writing resumes, practicing interviewing skills, and completing applications for employment. This module uses elements of the "choose-get-keep" approach to employment. TCP also offers individual meetings with vocational coaches, internships, vocational assessments, computer tutorials, and presentations by invited speakers. These speakers include those who have the disorder and have successfully returned to the workplace.To our knowledge TCP is the first of its kind in the country—a job preparedness program specifically targeted to individuals with borderline personality disorder. Our office is open two days a week. Our group meetings are convened on both days for 1.5 hours with up to ten clients in a group led by two coleaders. Clients meet individually once a week with a vocational coach to focus on specific vocational goals. In addition, clients have ample time in the office to complete job-related computer work.To participate in the program an individual must be an adult (18 or older) and have received a diagnosis of borderline personality disorder or features of the disorder. Potential clients must also be in concurrent individual therapy. Finally, individuals seeking to enter the program must have a written agreement from their therapist in support of TCP and meet the TCP criteria of stability and absence of certain destructive behaviors. The monthly fee for attending TCP is based on a sliding scale.Since opening in December 2006, we have had over 85 clients. Clients represent a varied work-related background, from those who have never held a job to those who have had a significant career. While at TCP, clients have found work in a number of areas, including copyediting, pet care, legal services, marketing, and public relations. Work environments include bookstores, nonprofit organizations, a bakery, and a hotel. Some TCP participants have entered training programs, colleges, or graduate school.Most of our clients have taken steps toward employment. For example, clients have engaged in activities such as writing their first resume or improving their current resume, seeking jobs, and securing interviews. Clients report improvements in their lives, including decreased isolation, increased structure to their day, more social contacts, and greater productivity.We believe that the TCP program fills two gaps. First, it adds another option to existing services for individuals with borderline personality disorder. Second, because TCP is currently privately funded, our program fills a void in government services. As one of our clients stated, "TCP is a bridge between therapy and work."Dr. Elliott is director of The Connections Place (TCP) of the National Education Alliance for Borderline Personality Disorder. Ms. Weissenborn was formerly communications manager at TCP. Send correspondence to Dr. Elliott, TCP, 180 W. 80th St., New York, NY 10024 (e-mail: [email protected]). FiguresReferencesCited byDetailsCited ByNone Volume 61Issue 4 April, 2010Pages 417-417PSYCHIATRIC SERVICES April 2010 Volume 61 Number 4 Metrics PDF download History Published online 1 April 2010 Published in print 1 April 2010

Depression: an emotional obstacle to seeking medical advice for infertility

To investigate the mental and general health of infertile women who had not sought medical advice for their recognized infertility and were therefore not represented in clinical populations. Longitudinal cohort study. Population based. Participants in the Australian Longitudinal Study on Women's Health aged 28-33 years in 2006 who had ever tried to conceive or had been pregnant (n = 5,936). None. Infertility, not seeking medical advice. Compared with fertile women (n = 4,905), infertile women (n = 1,031) had higher odds of self-reported depression (odds ratio [OR] 1.20, 95% confidence interval [CI] 1.01-1.43), endometriosis (5.43, 4.01-7.36), polycystic ovary syndrome (9.52, 7.30-12.41), irregular periods (1.99, 1.68-2.36), type II diabetes (4.70, 1.79-12.37), or gestational diabetes (1.66, 1.12-2.46). Compared with infertile women who sought medical advice (n = 728), those who had not sought medical advice (n = 303) had higher odds of self-reported depression (1.67, 1.18-2.37), other mental health problems (3.14, 1.14-8.64), urinary tract infections (1.67, 1.12-2.49), heavy periods (1.63, 1.16-2.29), or a cancer diagnosis (11.33, 2.57-49.89). Infertile women who had or had not sought medical advice had similar odds of reporting an anxiety disorder or anxiety-related symptoms. Women with self-reported depression were unlikely to have sought medical advice for infertility. Depression and depressive symptoms may be barriers to seeking medical advice for infertility.

Getting to Darwin: Obstacles to Accepting Evolution by Natural Selection

Darwin’s theory of evolution by natural selection is central to modern biology, but is resisted by many people. This paper discusses the major psychological obstacles to accepting Darwin’s theory. Cognitive obstacles to adopting evolution by natural selection include conceptual difficulties, methodological issues, and coherence problems that derive from the intuitiveness of alternative theories. The main emotional obstacles to accepting evolution are its apparent conflict with valued beliefs about God, souls, and morality. We draw on the philosophy of science and on a psychological theory of cognitive and emotional belief revision to make suggestions about what can be done to improve acceptance of Darwinian ideas.

“But You Don’t Look Sick”

Introduction: Disability and Academia[1] The logical consequence of Disability Studies is that its principles are used to gain full inclusion for disabled academics. Beyond a method of analysis and scholarly inquiry, Disability Studies helps to put those stigmatized as inadequate on a par with those who inhabit the able-bodied world. "Disability" is seen not an impairment, but as a social construct, created by a society that excludes those who do not conform to an imagined status quo. "A disability must be socially constructed; there must be an analysis of what it means to have or lack certain functions, appearance, and so on" (Davis 2002, 56). Disability is usually imposed from without:Disability [is] a disruption in the sensory field of the observer....[It] is located in the observer, not the observed, and is therefore more about the viewer than about the person using a cane or a wheelchair. The term disability is a categorization tied to the development of discourses that aim to cure, remediate, or catalog variations in bodies. Thus, disability is part of a continuum that includes differences in gender, as well as bodily features indicative of race, sexual preference, and even of class.(1)The term disability is both helpful and harmful to those who could fall under its umbrella. The category engenders images of helpless, hopeless individuals who are without purpose or meaning in society, who cannot contribute towards society, and who must rely upon others for assistance even with the simplest tasks. However, these associations are merely products of society, and do not speak of the experiences of those who fall under the umbrella term of "disability." The disabled are merely individuals with unique challenges in life, who require creative solutions to these challenges. When given the necessary accommodations for such creative solutions, most disabled persons are able to complete required tasks. The term disabled is only beneficial for acquiring needed accommodations; afterwards, it becomes harmful and marginalizing.[2] Academia is both accommodating and exclusionary of disabled scholars. The flexibility of academic research can be very manageable, for example, but the grueling demands of teaching and research can be challenging for those with chronic illnesses. Many persons with auto-immune diseases and mental illnesses experience frustration gaining acceptance and support from their peers and colleagues. The disabilities and symptoms they experience are concealed, yet can be unpredictably debilitating. There seems to be no universal precedent for fairly accommodating scholars with such chronic, unseen illnesses; many sufferers worry about stigmatization, and do not want their acute mental faculties or scholarly aptitude to be overshadowed by their disabilities. Furthermore, many of these illnesses require creative accommodations that are unprecedented in many departments and universities.[3] I have undertaken a study of the challenges faced by scholars with invisible auto-immune diseases and mental illnesses-this paper represents a preliminary survey of my findings. I have compiled a list of strategies and accommodations employed by scholars in the UK, USA, Australia, and continental Europe. In presenting that information here, I hope to illuminate the ways that scholars from around the world might learn from each other to deepen mutual understanding of the accommodations required by differently-abled scholars. I will show that, with appropriate accommodation, scholars with disabilities can be successful in their careers and an asset to their musical disciplines.The Surveys[4] As part of this study, I have conducted surveys and interviews with scholars who face unseen physical, mental, and emotional obstacles. Interview and survey topics focused on the ways in which illnesses have affected a respondent's academic career, what accommodations have been sought, the extent to which the respondent's home institutions acted in accordance with the Americans with Disabilities Act or other national law (for scholars from Great Britain, Europe, and Australia), how the respondent discovered the agencies or offices at her university that assist disabled persons (if such an office exists), and how colleagues and/or instructors have responded to the knowledge of their disability or the accommodations enforced as a result of it. …

Does counsellor's attitude influence change in a request for a caesarean in women with fear of birth?

Backgroundthe attitudes of two counsellors towards women requesting a caesarean section due to fear of birth were identified. One emphasised the ability to overcome any emotional obstacle to vaginal birth (‘coping attitude’), and the other emphasised that the ultimate choice of mode of birth was the womans’ (‘autonomy attitude’). Two research questions were asked: (1) What are the predictors of change in a wish for a caesarean and of vaginal birth in women with fear of birth? (2) Does a change from an ‘autonomy attitude’ to a ‘coping attitude’ increase the number of women who change their request for a caesarean and who give birth vaginally? Methodsthe study population consisted of two samples of pregnant women with fear of birth and concurrent request for a caesarean, referred for crisis-oriented counselling at the antenatal clinic, University Hospital of North Norway between 2000–2002 (n=86) and 2004–2006 (n=107). Data were gathered from referral letters, counseling and antenatal, intra- and postpartum records. Findingsa coping attitude of the counsellor was positively associated with change in the request for a caesarean and with vaginal birth. A change from an autonomy attitude to a coping attitude was associated with a significant increase in the percentage of women who changed their desire for a caesarean from 77 to 93, and who had a vaginal birth from 42 to 81. Conclusiona coping attitude was strongly associated with change in the desire for a caesarean and giving birth vaginally. A coping attitude can be learned through critical reflection and awareness of the counsellor's attitude, with measurable clinical results.

Cognição, emoção e expertise musical

Este texto, sobre a relação entre cognição e música, objetiva lançar novas perspectivas para uma idéia há muito presente na pesquisa psicológica: de que a atividade musical tem importantes conseqüências para o desenvolvimento emocional e cognitivo da pessoa. Estas, no entanto, não são sempre positivas, já que processos de aprendizagem musical, da forma como tradicionalmente desenvolvidos, podem também levar à frustração e ao adoecimento tanto físico como psíquico. O texto analisa estes temas, tendo como foco a aprendizagem expert de instrumentos musicais da tradição clássica como uma aprendizagem permanente, que envolve o desenvolvimento e refinamento constante de habilidades metacognitivas e auto-reguladoras, bem como uma capacidade para superar obstáculos emocionais oriundos do tipo de investimento necessário ao alcance e manutenção da expertise musical.

Building the Emotionally Learned Negotiator

This piece reviews three recent books on the significance of emotion in negotiation and dispute resolution (Fisher & Shapiro: Beyond Reason: Using Emotions as You Negotiate; Peter Ladd: Mediation, Conciliation and Emotion: A Practitioner's Guide for Understanding Emotions in Dispute Resolution; and Lacey Smith: Get It! Street-Smart Negotiation at Work: How Emotions Get You What You Want), situating each work within a theory of practice for emotionally learned negotiators. After discussing the how the appearance of emotional sterility became synonymous with professionalism (and the toll this has taken on professional interaction), the piece sets forth a functional theory of emotion in negotiation based on four elements: emotion as (1) ether, (2) obstacle, (3) episteme, and (4) instrument. To cast emotion as ether (the ether of human experience) is to understand the inevitability of emotional impacts on negotiated exchange. For many, emotion in negotiation is encountered as an obstacle (that which obstructs mechanical application of established negotiating techniques). The more sophisticated negotiator recognizes emotionality as episteme (the medium of insight by which we consult interests and hypothesize about others) - a means for better understanding herself, the people she deals with, and a good deal else about the world. Finally, the emotionally learned negotiator uses emotion not only epistemologically but also instrumentally (as a tool for achieving desired ends), taking affirmative steps to help manage the emotional climate within a negotiation. She uses her emotional skills to mitigate undesired emotions and engender preferred emotions within herself and other participants: to soothe, bolster, win respect, build trust, and encourage creativity. The emotionally learned negotiator thus uses emotions not only as tools of knowing, but as instruments of persuasion. The new series of books on the subject offer strategies by which negotiators can learn to better integrate emotional skills into negotiation, among the most emotionally-charged of professional spheres. While the three books share the central premise that emotionality plays a critical role in the unfolding dynamics of all negotiations, each offers its own primary lesson. Lacey Smith's business-oriented Get It! examines how the emotions of hope and fear can be both tools and obstacles to the interest-based bargaining method we first learned in Roger Fisher's classic, Getting to Yes. Fisher and Shapiro's Beyond Reason takes the Getting to Yes method to the next level of sophistication, providing a taxonomy of core emotional concerns that underlie individual negotiators' behavior, and with it a Seven-Elements - like structure from which to prepare, advance, and overcome emotional obstacles in each negotiating context. Peter Ladd's Mediation, Conciliation and Emotions expands the analysis of emotional content in a negotiation from the individual to the shared experience, exploring the establishment of emotional climates that arise between individuals and offering empirically based counsel for mediators and conciliators about how to help remedy undesirable emotional climates and create emotional climates more conducive to problem-solving. No book has all the answers we need, but each makes a valuable contribution to the field.

Adaptation to American Culture

This naturalistic study explores the physical, social, emotional, and spiritual adaptation of Asian Indian elderly immigrants to American culture. The individuals interviewed suggested that while they physically adapted to American life, many of them encountered social, emotional, and spiritual obstacles that often impeded successful adaptation. Factors such as family proximity, reasons for immigration, and conflicting values helped predict the adaptation success of Asian Indian elderly immigrants. The study points to possible intervention strategies that social workers can use to promote more successful adaptation of Asian Indian elderly immigrants to American culture.

Loss of the imagined past: an emotional obstacle to medical compliance in kidney transplant recipients

Among kidney transplant recipients, the concepts of grief and bereavement have been considered in terms of graft rejection, side effects of drugs, or death of the donor. However, our research suggests that even after a successful kidney transplantation, patients may present with feelings of bereavement, grief, or low mood, which may appear paradoxical because they have just received a much desired transplant. This sense of bereavement should be considered in terms of an imagined past, which may help to understand the patient's current mood changes and medical noncompliance. In the case report presented here, we have used the concept of systemic integrative psychotherapy to analyze change in a patient's life. Based on our research, we suggest that feelings of bereavement and grief are generated as patients come to terms with their past, which has been irretrievably lost to chronic illness, and contemplate their future. Feelings of grief and bereavement in the posttransplant period may be due to the loss of an imagined past, and must be differentiated from the bereavement the patient feels for the donor and the donor family. These feeling of loss, if not resolved, may lead to social isolation and medical noncompliance.

Police reporting and professional help seeking for child crime victims: a review.

Most crimes with child victims are not reported to police, nor do child victims access other professional victim services, despite evidence that these yield positive outcomes. This article develops a conceptual framework about the barriers to such access: (a) the reluctance to define the crime episodes or their consequences as serious, criminal, harmful, or warranting intervention; (b) the extra authorities, including parents and schools, who mediate between victims and police or services; (c) developmental issues, such as concerns about autonomy; (d) attitudinal and emotional obstacles; and (e) time and expense factors. This article suggests the need for initiatives to stimulate reporting and help seeking, such as more publicity about the seriousness of juvenile victimization, more justice-system involvement with schools, more child and family friendly police services, and an emphasis on attractive outcomes such as justice and empowerment.

Adult Participation in Youth Sports: A Developmental Perspective

Societal and familial forces of enormous emotional intensity have contributed to the growth of youth sports during the twentieth century, and continue to affect adult participation in children's athletics. This article addresses the historical evolution of youth sport programs, then identifies opportunities for adults to facilitate developmental progress and surmount emotional obstacles as they interact in sport activities with children ranging from preschool ages through adolescence. Youth sports are viewed as offering tremendous opportunities to teach not only physical skills and playing strategies, but also psychological skills and coping strategies that have applicability throughout life. A developmental rationale is provided to support recommendations for parents and coaches. Child and adolescent psychiatrists are faced with the challenge of collaborating with other professionals and making their knowledge base available to the volunteers who coach in and support youth sport programs.

Patient education: Self-care guides

Verna A. Rhodes, Roxanne W. McDaniel, and Mary H. Johnson T EACHI, NG is an integral part of nursing, yet today s rapidly changing health care arena with shortened hospital stays presents unique challenges for the nurse to provide appropriate patient requirements for self-care. Much care for this chronic multistage disease takes place in the home, which demands knowledge not only of what to do to prevent and/or manage the symptom experience but also what to report to the health care provider. These patient education self-care guides have been developed to assist nurses in designing and implementing individualized teaching. A variety of educational strategies based on individualized assessment for efficient effective teaching of self-care are essential because of the overwhelming emotional and physical obstacles surrounding the patient and family.t Appropriate patient education that provides proactive management of the symptom experience may alleviate fears, enhance quality of life, and be cost effective.

Potential Negative Impacts of Nuclear Activities on Local Economies: Rethinking the Issue

Surveys of public opinion about perceptions of risk associated with the nuclear fuel cycle have shown that the public professes a widespread feeling of dread, a fear of associated stigmas, and a concern about possible catastrophic nuclear accidents. Various interest groups and state governments that oppose congressionally mandated siting of centralized high‐level radioactive waste (HLW) storage and disposal facilities are using this negative imagery to create a powerful, emotional obstacle to the siting process. From statistical analyses of images and location preferences, researchers have claimed that possible significant economic losses could potentially accompany the siting of HLW facilities. However, several paradoxes, or self‐contradictory statements, apparently exist between the responses expressed in surveys and the actual economic and demographic behavior evidenced in the marketplace. Federal policymakers need to evaluate whether the request for a change in siting policy is based on subjective fear of a potential negative economic effect or on proven negative effects. Empirically observed behavior does not support predicted negative economic effects based on survey responses.

Mediating Divorce Disputes: Mediator Behaviors, Styles and Roles

Despite the growing popularity of divorce mediation, there has been little systematic research on the process of mediation and the roles and skills of mediators. This article reviews 35 cases involving contested child custody and visitation and generalizes about the techniques used by experienced divorce mediators to help couples reach resolutions to their differences. The article discusses different ways mediators orient couples to mediation, gain their commitment, identify the issues in dispute, overcome emotional and substantive obstacles and generate agreements. Variations in the ways mediators deal with the expression of emotions and the amount of control they exercise in structuring the process and generating an agreement are noted.

Psychoanalytic approaches to biblical religion

A brief look at four studies of biblical religion from a psychoanalytic point of view (spanning the time from Freud'sMoses and Monotheism to the present) alerts us to the many ways biblical religion both reflects and mediates the dawning realization that for the well-being of humanity it is of decisive importance that sons do (in spite of all emotional obstacles) identify with their fathers and fathers do find ways of loving and caring for their sons (the eldest son in particular).

The pros, cons and pitfalls of "self-help" rehabilitation programs.

Abstract This paper reports on the findings of an in-depth case study of a residentially based self-help program for alcoholics. Semi-structured interviews with the program's ex-alcoholic staff and with its clients, observation of on-going program activities, and examination of program documents were used to investigate the program's developmental history and present functioning. Data collection centered on the unique service possibilities associated with the self-help approach to rehabilitation, and on organizational problems encountered in implementing and maintaining such potential in a residential setting. Unique aspects of the program under study included an aggressive and wide-ranging client recruitment policy, a balanced attack on social as well as emotional obstacles to abstinence, heavy reliance on client input in therapeutic activities and program planning, and the presence of successful role models with whom clients could easily identify. These qualities were, however, frequently threatened in leadership struggles, by resource crises, and by internal and external pressures to professionalize. Drawing upon the literature, the authors suggest that such problems may be typical of developing self-help programs.

The pros, cons and pitfalls of “self-help” rehabilitation programs

This paper reports on the findings of an in-depth case study of a residentially based self-help program for alcoholics. Semi-structured interviews with the program's ex-alcoholic staff and with its clients, observation of on-going program activities, and examination of program documents were used to investigate the program's developmental history and present functioning. Data collection centered on the unique service possibilities associated with the self-help approach to rehabilitation, and on organizational problems encountered in implementing and maintaining such potential in a residential setting. Unique aspects of the program under study included an aggressive and wide-ranging client recruitment policy, a balanced attack on social as well as emotional obstacles to abstinence, heavy reliance on client input in therapeutic activities and program planning, and the presence of successful role models with whom clients could easily identify. These qualities were, however, frequently threatened in leadership struggles, by resource crises, and by internal and external pressures to professionalize. Drawing upon the literature, the authors suggest that such problems may be typical of developing self-help programs.

William Lyon Mackenzie as Mayor of Toronto

IT IS HARD TO GET CLOSE to a man of such emphatic personality and decided political views as William Lyon Mackenzie and still be indifferent to him attraction or repulsion (perhaps both) must ensue. Mackenzie's life and works, therefore, form a subject loaded with emotional obstacles to its objective treatment, and a definitive estimate of his character and achievement is still lacking? Modem scholars have concentrated on the question of how seriously Mackenzie is to be taken as a political eader and ideologue. Lillian F. Gates and J.E. Rea have published thoughtful and sympathetic discussions of his political opinions, 2 while F.H. Armstrong has scrutinized his actions and found him apparently to be a bungling administrator, a corrupt and arbitrary wielder of power, and a thinker impossible to locate in any respectable stream of ideas? As a reaction, perhaps, to past glorification of Mackenzie, Dr Armstrong's assessment at present seems to hold the field. It is therefore

Counseling Middle-class University Students

Casework help for emotional obstacles to intellectual and social functioning enables students to make maximum use of their educational opportunities

Removing emotional obstacles to learning and performance by visuo-motor behavior rehearsal

Some innovative adaptations of desensitization, visuomotor behavior rehearsal and the use of competency, were developed to treat a Ph.D. candidate with a severe examination anxiety. Treatment was aimed at developing adaptive behavior, rather than simply the removal of the anxiety.