Customer Reviews

Living on the Razor's Edge: Solution-Oriented Brief Family Therapy with Self-Harming Adolescents

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This note is being written in defense of this book, which I and other fellow peers who work with adolescents in crisis found to be quite insightful and useful. I agree with the author that it is not appropriate to give a Borderline Personality Disorder (BPD) diagnosis to a teen. At the most, I would give "traits of BPD", but at this developmental stage it is truly impossible to say with certainty that a client is personality disordered.

As per DSM-IV-TR, Fourth Edition (APA), pg. 687 of Personality Disorders under Specific Culture, Age and Gender Features reads: "Personality Disorder categories may be applied to children or adolescents in those relatively unusual instances in which the individual's particular maladaptive personality traits appear to be pervasive, persistent, and unlikely to be limited to a particular developmental stage or an epiosde of an Axis I disorder. It should be recognized that the traits of a Personality Disorder that appear in childhood will often not persist unchanged into adult life. To diagnose a Personality Disorder in an individual under 18 years, the features must have been present for at least 1 year."

This book continues the unscientific and simplistic family systems theory that claims that all psychological problems are the fault of the family and never the individual, and as usual, simply dismiss psychiatric disorders. Self-mutilation is most closely associated with borderline personality disorder. The author claims the DSM-IV does not allow diagnosis of personality disorders under 18 (not true). It is true that many adolescent females "copycat" the cutting of other adolescents, but the one they are copying likely has a borderline personality disorder (and consequently a great deal of skill at manipulating others). The person with the personality disorder needs far more than brief family therapy, and the copycat should not have their family blamed but instead be kept away from the borderline they are copying. And it is critical to separate the two phenomenon. The author provides no research data to back up his claims, only a few carefully chosen cases. Family systems has much to offer as an adjunctive therapy, and sometimes as a primary therapy, but like chiropractors, they need to stop claiming to be able to explain and cure everything because in the process they discredit themselves and do damage to many of the people they try to uniformly apply their theory and therapy to. This book continues that unfortuante legacy.