This article summarizes the treatment of an older adult with borderline personality disorder and a co-occurring opioid abuse using an integration of the recovery model, person-centered therapy, and the stages of change. Therapy included rapport building, a nonjudgmental attitude, enhancing understanding of behaviors that interfere with the client’s goals, clarifying consequences of the client’s choices, empathizing with the client’s fear of reducing opioid use, building coping skills, and providing a strong, supportive presence through the opiate reduction process. Over the course of treatment, the client’s overuse of opioids decreased as did her depression and suicidal ideation. This case highlights the importance of understanding medication abuse from the client’s perspective, emphasizing nonjudgment and clarifying the client’s choices and the consequences of her choices.
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