ABSTRACT
Jamie was a thirty-three-year-old single, Caucasian female living in a suburban area. Her father contacted the therapist saying that Jamie’s previous therapist did not feel qualified to treat her for her parasuicidal behaviour (i.e. deliberate self-harm intended to cause acute injury with or without intent to die) and that this therapist was terrified Jamie would kill herself. Jamie was a college graduate and, at the beginning of treatment, was working in advertising. At age sixteen, she was diagnosed with major depression with suicidal ideation and at age twentyone she was hospitalized for a suicide attempt and continuing suicide ideation. A year prior to receiving treatment with us, Jamie was hospitalized for twelve weeks. Most of her friends were no longer interested in friendship after that. At the start of treatment, Jamie was cutting herself at least once weekly. At her first session she reported that she was ‘addicted’ to cutting herself, saying that she enjoyed watching the blood drops as she cut. At the start of treatment, Jamie had a history of three suicide attempts (two overdoses, one attempt to stab herself to death), and multiple instances of self-cutting and infliction of burns. Jamie met criteria for a DSM-IV diagnosis of borderline personality disorder (BPD) (meeting eight out of the nine diagnostic criteria), obsessive-compulsive disorder, panic disorder with agoraphobia and major depression. Her panic attacks were particularly distressing to her, as she invariably sobbed uncontrollably during each panic episode. She felt humiliated by the sobbing, running out of groups whenever she would start to cry or felt like crying. Ordinarily, whenever a panic attack started Jamie would call one of her parents for coaching and soothing. Not infrequently, one of them would go and pick her up or, if
she were at her own apartment, would go over to her apartment to help calm her down. Her mother’s response vacillated between giving her over-simplistic suggestions (just smile) to lying down on the bed with her and handing her tissues. At the start of treatment, Jamie had also just broken up with her former fiancé and boyfriend of four years and complained that she was always attracted to the wrong men.
