Qualitative Health Research 1–13 © The Author(s) 2015 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1049732315618659 qhr.sagepub.com Article New treatments for comorbid borderline personality dis- order (BPD), which frequently involves addictive behav- iors (Van den Bosch, Verheul, & van den Brink, 2001), must attend to issues involved with treating complex trauma, which is part of its etiology (Winston, 2000). This includes using methods that improve meaning mak- ing (Park, 2010; Skaggs & Barron, 2006). When success- ful, the process leads to better adjustment. Historically, however, having BPD has been viewed as a contraindica- tion for trauma-focused treatment due to concerns that such treatment would lead to symptom worsening. Fortunately, research has started to show that trauma can be treated safely among individuals with BPD (Harned, 2014). To build therapists’ endurance, optimism, and competence to treat comorbid disorders, however, we need a pragmatic, therapeutic framework (Gielen, Krumeich, Havermans, Smeets, & Jansen, 2014). We need a treatment that integrates approaches based on their ability to aid narrative construction, and we need to explore simul- taneous recovery using research methods with a high degree of clinical utility, such as the case study. In this article, therefore, we examine a case using both client and therapist process data to provide a context-interdependent (Flyvbjerg, 2006) model of simultaneous recovery from BPD, post-traumatic stress disorder (PTSD), and prob- lem gambling. BPD is known as a severe and pervasive personality disorder with hallmark symptoms of sensitivity to rejec- tion, difficulty regulating emotions, fear of abandonment during times of distress, an unstable identity including frequent episodes of suicidality, and substance abuse (Gunderson, 2011). Many clinicians fear that addressing trauma along with addiction in people with BPD will increase their clients’ emotion dysregulation and addic- tive behaviors (Gielen et al., 2014; Levy et al., 2006). In the case of complex trauma (Ford & Courtois, 2014), feelings of detachment or estrangement from others and a restricted range of emotions cause difficulty in relating to 618659QHR XX X 10.1177/1049732315618659Qualitative Health ResearchJohansen et al. research-article 2015 1 Norwegian Centre for Addiction Research, University of Oslo, Norway 2 Centre for Study of Mind in Nature, University of Oslo, Norway 3 Northeastern Illinois University, Chicago, USA 4 Wayne State University, Detroit, MI, USA Corresponding Author: Ayna B. Johansen, Norwegian Centre for Addiction Research, University of Oslo, Postboks 1039 Blindern0315 Oslo, Norway. Email: ayna.johansen@medisin.uio.no Constructivist Simultaneous Treatment of Borderline Personality Disorder, Trauma, and Addiction Comorbidity: A Qualitative Case Study Ayna B. Johansen 1,2 , Shedeh Tavakoli 3 , Ingerid Bjelland 1 , and Mark Lumley 4 Abstract This qualitative case study explored one client’s recovery from borderline personality disorder, trauma, and problem gambling. The client attended 18 months of integrative treatment and was followed for 5 years. The study included 106 data points of both client and therapist data. We identified three phases to treatment. First, alliance formation and normalization appeared as mechanisms, and the client experienced dependence. Second, working alliance and countertransference appeared as mechanisms, and the client experienced reduced gambling and suicidal ideation. Third, external controls and increased opportunity appeared as mechanisms, and “moving into the world” was the client experience. The findings give preliminary support to a phase-based constructivist treatment including trauma assessment to normalize self-feelings, countertransference work to support motivation for restraint, and case management principles to support continuity of change efforts. Keywords simultaneous treatment; borderline personality; trauma; addiction; qualitative case study; general inductive approach; Norway at Universitet I Oslo on January 6, 2016 qhr.sagepub.com Downloaded from