A client with borderline personality disorder has had 21 admissions to the mental health unit, each
precipitated by a suicide attempt, usually resulting in superficial cuts on the arm.
On this admission
the client has developed a relationship with a highly supportive nurse. The client has progressed to
having a pass to spend an afternoon in a nearby shopping mall. The nurse is shocked when the
emergency department calls to say that the client had just been brought in with multiple self-inflicted
lacerations. The nurse asks a peer, Why? Everything was going well. How could she do this to
me? What response by the other nurse reflects understanding of the client's borderline disorder?
a. I know what you mean. You put a lot of energy into working with this client. It
must be disappointing to have her do something like this..
b. I could have told you this would happen. A client like this always gets you in the
end. I hope this will teach you not to get so involved..
c. I know the client's behavior seems personal, but it's really not. Clients with
borderline disorder act out to relieve anxiety, and I suspect having the pass
provoked a great deal of anxiety..
d. I wonder if all this could have been avoided if I'd clued you in on the client. This
is a usual pattern for her. She burned me once, too, when I first worked here..
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