Getting to know you – the essence of supporting someone with BPD

In the documentary “Back from the Edge” Dr. Marsha Linehan (the DBT inventor) says: “you can actually define borderline personality disorder as the ‘I don’t fit in’ disorder.” In the past few days I have been thinking about this concept quite a bit. I believe that this is the core of living with and loving a person with Borderline Personality Disorder (BPD).

The core is for the loved ones to make sense of the other person, based on the borderline’s feelings, thoughts, motivations and beliefs (even if these beliefs are not aligned with the environment).

Too many times the loved ones, family members and partners of those with borderline personality disorder, use their own frame of reference, their own “window on the world”, to make sense of the behavior of the person with BPD. The family members judge the behavior based on their own values, motivations, desires and moral frameworks.

After listening to the recording of Dr. Anthony Bateman about Mentalizing , I also realized why the ability to “get” the person with BPD can be so difficult for the loved ones. People with BPD feel that they do not fit in. They feel that most other people don’t understand them, don’t understand how they feel or reject/judge them for their natural feelings.

In my book, I have a phrase: It’s all about his/her feelings (IAAHF).

The essence of this formulation is the idea that the nonsensical behavior is motivated by the person’s intense emotions. Yet, when thinking more about mentalization skills, I have realized it is more than just the feelings. It’s also about the beliefs that underpin those feelings, the beliefs that have been ingrained in the borderline that trigger these emotional responses.

I once heard an adult daughter with BPD tell her mother: “You only listen to me when I’m screaming!” If her mother had practiced mentalization skills with her daughter, perhaps her daughter would feel more heard and more understood. Perhaps the daughter’s words and actions would make sense to the mother if she knew the underpinning thoughts, feelings and motivations of the daughter when the behavior took place.

The reason that it is so difficult to mentalize with a person with BPD is complex. Dr. Bateman says in his talk that it is difficult to get therapists to learn these skills because therapists are supposed to know the motivations of the other individual. That’s their job, right? It is difficult (so says Dr. Bateman) to get the therapist to “not know,” to not assume that they know and to become curious about the patient’s current mental state. It is difficult to get the therapist to become a detective and not be a judge.

The same is true with parents and partners of people with BPD. To become curious, to ask and not assume, to make sense of the borderline’s behavior by understanding the mental states that lead up to the behavior is a very difficult task. While mentalization is a skill that most of us have (the exception is in autism in which mentalization is diminished), we also have an ingrained judge and typically use our own window on the world to view, measure and assess the world, even when the other person is looking through a drastically different window.

In order for a relationship between a non-BPD and a person with BPD to flourish, the family member must engage in mentalizing and must try to see the world through the eyes of the other person. Any human connection requires that both parties do this. Yet, too often I see family members that feel that they are in a place of (moral) authority over the other person. Whether it is a parent whose job it is to raise this sensitive child “right” and to teach them about the world or it is spouse who believes that they are the rational one and can make better decisions than their “crazy” mate, each of these people feel that it is in their rights (and in some cases their obligation) to judge, to make decisions for the borderline and to be in the right. They don’t accept that the behavior, words and feelings of the borderline make sense when looking at the world through their own window.

Making sense of the other person is, in my mind, the essence of compassion and acceptance of the person for who they are and how they think. It is the essence of human connection, yet it can only be done from a “stance” of acceptance, curiosity and non-judgment. In Beyond Boundaries, I summarize this stance and these skills as being a CHAMP:

CHAMP
Compassion, Curiosity
Humility, Hope and Honesty
Acceptance, Authenticity, Affect Awareness*
Mentalization
Practice, Patience, Persistence

* Affect awareness means that you actively monitor the feelings of the other person and address those feelings as they arise.