Internet Searchs on BPD and Why you need WHINE
I have been looking over the keywords that found my blog in the past few days and have noticed that I’m getting more traffic from people seeking information, self-help, advice and assistance with their borderline personality disordered partner. Here is a (small) sample of of these search terms:
helping someone with bpd
bpd crazymaking
levels of validation
“self-destructive behavior” friend
how to get bpd to go to psychiatrist
bpd communication
bpd and lying
high-functioning borderline
borderline how to convince ex i have changed
are emotions painful for bpd
invalidating environment, boundaries
advice for dealing with someone with a bpd
bpd dealing with love
borderline girlfriend
when she clearly has a personality disorder
bpd google groups
how to deal with a bpd
rejection-sensitivity
borderline rage attack
telling someone they have bpd
mental illness that exhibits rage, blaming
borderlines and lying to hurt their partner
did i give my child bpd
If you found my blog while searching on one of the above or on a similar search term, I would suggest you read my book When Hope is Not Enough (aka WHINE), because it contains answers to all of the above search terms and provides a how-to guide for solving those issues. WHINE is available for sale on Amazon and other Internet retailers. You can also buy an eBook version from Lulu.
I’d also like to respond to two reviews of WHINE from Amazon – one negative and one positive.
First, the negative review…
Sorry, I didn’t care for this book as much as the others on BPD. The techniques were pretty much the same as recommended in “Stop Walking on Eggshells” but the technical background and reasoning behind the techniques was not as clearly discussed. Perhaps this book could be useful to someone who prefers the “lay” or non-professional approach and needs a book written in simpler terms.
OK, the techniques that I discuss are different than “Stop Walking on Eggshells” (although some of the techniques DO overlap). The main reason that my tools are different than in SWOE has to do with the fact that I present a different view of BPD focusing on three main aspects: emotional dysregulation, impulsiveness and shame. Unlike SWOE, I do not take you on a step-by-step review of the DSM-IV diagnostic criteria and, in this way, I feel that WHINE is more practical as a how-to guide than SWOE. Additionally, I explain the techniques in DETAIL, that is, HOW to do each one, what to say and what NOT to say, etc. As an example of this surrounds validation techniques. I have flipped through SWOE and found very little on emotional validation of the BP’s emotions. There is 1/2 a page on the “triggers” of invalidation and a how a “I know how you feel” response could trigger rage (that’s on pages 113-114 of my copy of SWOE). There is some additional information that MAY be considered validation on pages 142-145 of SWOE about “Acknowledge Before Disputing;” however, this information is not detailed. In WHINE I spent over 30 pages (of a 185 page book) on emotional validation – why to do it, how to do it, how not to do it, when to do it, etc. Why? Because emotional validation is central to learning how to communicate effectively with someone with BPD.
Where SWOE spends many, many pages on boundaries and limits, the message is inconsistent. In the beginning of the introduction of boundaries SWOE says this:
Personal limits are not about controlling or changing other people’s behavior. In fact, they’re not about other people at all. There about you and what you need to do to take care of yourself. (pages 118-119)
THAT I agree with wholeheartily! However, later in SWOE we get this:
If you want the BP to change, you have to be willing to make some changes yourself if the person does not observe your limits. (page 157)
Alright, I would believe in the first part; however, the second part is what I have a problem with. My understanding of boundaries and limits are that they are for YOU and not about other people’s behavior. A person can’t “violate your boundaries” because only YOU can violate your own boundaries. If they do, your “boundaries” are not about your behavior anymore, they are about ANOTHER person’s behavior and those type of “boundaries” are really rules for the other person’s behavior. On this point (and on the importance of emotional validation) is where my book and SWOE completely diverge. (Another note creating such “boundaries” – that are really rules – is a trigger for BPD rage too).
Finally, the two books were written for two separate reasons. If you look at the subtitles of each you can see where each book has a separate purpose. The subtitle of SWOE is “taking your life back when someone you care about has borderline personality disorder.” The subtitle of WHINE is “a how-to guide for living with and loving someone with borderline personality disorder.” SWOE is written to focus on validation of the non-BP (which has its place, no doubt, I got a LOT of validation out of SWOE when I first read it 3 years ago). WHINE is written as a “how-to” guide for (peacefully) living with a person with BPD. The difference is subtle, but important. A member of my Internet list summed it up rather well this way:
I want to add another thought about this…
I think when Randi [Kreger, the co-author of SWOE] wrote her book, she likely recognized the importance of
validation, but her frame of mind was on healing herself. So, I would
venture to say that is why there was a strong bent towards validating nons.
In addition, Randi got out of her BP relationship, so she didn’t really know
what to advise those who wanted to stay. If I was her, I don’t think I’d
even care about any of that “staying stuff”… I’d probably just want to
help the nons move on with their lives (something she was familiar with.)Bon, on the other hand, it seems had already gotten through the stage of
being able to self-validate, and had decided to stay. So, his focus was, of
course, on problem solving. And the only way to be effective at that is
through validation of BPs.Each of their situations are different, as are their target audiences
(Randi’s being X-Nons and Bon’s being Staying-Nons.) I think they both did
an excellent job speaking to the feelings of those they could sincerely hope
to reach out to. The audiences that are getting caught up are the
Undecided-Nons. Those are the ones who would benefit most by reading both
books in the exact order you advise.
So, as you can see both books have their place in the life-cycle of being a non-BP. I think what you have to do it decide where you are in the life-cycle. My book is aimed at making BP/Non-BP relationships more calm without “walking on eggshells.” SWOE is not really a “staying” book – although Randi Kreger does have a new book due out in the Fall with staying in mind.
Ok, so back to the key words… if you are searching on those types of things and WANT to maintain a relationship with someone with BPD, WHINE is an excellent resource for that. If you’re searching on “i hear demon moaning in husband” or “cutting ties borderline personality disorder” I suspect you should look for a book other than WHINE.
I’ll have to review my “good review” in the next post.
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Randi Kreger
I’ve think you’ve got a great enough book, Bon, to sell it on its own merits without having to put down me and SWOE so consistently. I would prefer, however, that your observations be accurate.
Concerning validation, I used info in SWOE directly from Linehan. In the second edition, see p. 128 and 128, BPD-specific communication skills in which I cite Linehan, and p. 146 where I use the term validation.
In fact, if you compare Linehan’s communication skills to mine, I don’t believe you’ll see a lot of differences in either SWOE or The Essential Family Guide to Borderline Personality Disorder: New Tools and Techniques to Stop Walking on Eggshells. I researched her well before I wrote either book.
Now, here I am just confused:
In SWOE I said, “If you want the BP to change, you have to be willing to make some changes yourself if the person does not observe your limits. (page 157)”
Nowhere in that do I say the BP is “violating” limits. In fact, I took the phrase “observing limits” directly from Linhan. I also used Linehan’s limi-setting technique DEAR: Describe, Express, Assert, Reinforce. This is directly from the Linhan text (1993A) and workbook (1993B).
I do think your material is much more “staying” focused in the promotion and the purpose. The promotion of SWOE was all about getting people to read it, as back in 1998 no one had ever heard of BPD.
It is incorrect to say that my goal was to get people to leave the relationship. My goal was to help them understand BPD and make changes that would improve their own life WHILE improving the relationship. Because when you do one, you do the other! You don’t HAVE to choose between you and your BP.
This is from my new book, The Essential Family Guide to Borderline Personality Disorder: New Tools and Techniques to Stop Walking on Eggshells (2008, Hazelden Publishing). Since I wrote this a decade later, this more accurately states my belief about this:
…………………………………………..
Keep these principles in mind as you read this book. These thoughts need to become a permanent part of your mind-set when dealing with someone with BPD.
*********TO HELP YOUR FAMILY MEMBER, YOU MUST HELP YOURSELF FIRST **************
Your intuition may tell you that it should be the other way around—that the health of your relationship is dependent on your family member’s willingness to get help, and your job is to ignore your own needs and concentrate on fixing the other person. Wrong.
People spend years trying to please their borderline family member by twisting themselves into a pretzel to avoid conflict. Even if it works, the price is high. Family members suffer from depression, isolation, helplessness, low self-esteem, sleep deprivation, and even physical illnesses (especially adult children of people with BPD).
Predictably, the relationship begins to degrade, which is exactly what family members are trying to avoid.
This means that paradoxically, the long-term health of your relationship partly depends upon your willingness to look after your own needs, such as taking time away, setting limits with love, and having a hearty life of your own separate from your borderline family member.
This curious paradox is many family members’ undoing. They may hear it but not believe it; they may have lost the ability to take care of themselves (or never had it to begin with), or they may be unwilling to accept that giving, giving, and giving some more is just not helping the situation.
…………………………………………..
As you said, “I got a LOT of validation out of SWOE when I first read it 3 years ago.” Validation is the very first step toward family members helping themselves, which is the first step to them helping their BPs.
As I said, your work speaks for itself and is very good. it’s quite likely that your readers will also read something of mine: people want anything that will help. People don’t have to choose between our books. You could just as easily stress the similaries between our approaches as what you see as our differences.
Randi Kreger
Randi @BPDCentral.com
Author, “The Essential Family Guide to Borderline Personality Disorder: New Tips and Tools to Stop Walking on Eggshells”
(Available at http://www.BPDCentral.com)
Bon Dobbs
Randi,
Rather than provide a blow-by-blow response to each of your points, I’d like to respond to the ones that I find most foggy and on which you and I differ. You said: “In order to help your family member, you have to help yourself first.” I agree with this assessment for the most part, although I believe that this can be done through skills acquisition and personal emotional skills. No need to talk about that anymore, since we agree on that point.
I believe there are 3 parties involved in the loved one/person with BPD relationship. These are: the loved one, the person with BPD and the relationship itself. The problem that I have with the use of boundaries and limits is two-fold… One is the over-emphasis of this tool. Too many people use only limits/boundaries in their relationship, not understanding that this tool is one EXCLUSIVELY for the loved one. It doesn’t help the relationship at all. In mentalization-based treatment, Bateman and Fonagy have posited 3 tools for when a person with BPD experiences a “failure to mentalize” (i.e. when the train starts to derail and the relationship is suffering). Those are: 1) Stop, Listen, Look; 2) Stop, Rewind, Explore and 3) Stop and Stand. The third one is the application of boundaries and it is to be used when the relationship goes completely off the tracks. The first two are tools to understand the point at which a relationship has started to derail and to get it back on the tracks so it can continue.
You see, my problem with the over-emphasis of boundaries and limits is that many people believe that those tools will actually help the relationship. This is not the case. In fact, if you use the third tool (Stop and Stand, the application of boundaries) the relationship will suffer. Why? Modern fMRI research on BPD (see “Dysfunction in the Neural Circuitry of Emotion Regulation–A Possible Prelude to Violence” Richard J. Davidson,* Katherine M. Putnam, Christine L. Larson and “Quieting the Affective Storm of Borderline Personality Disorder” notes from presentation of Marianne Goodman, M.D., Erin A. Hazlett, Ph.D., Antonia S. New, M.D., Harold W. Koenigsberg, M.D., and Larry Siever, M.D.) shows that the “resting state” of the brain’s of people with the disorder is not the same as those without the disorder. The resting state of a person with BPD is one of more pre-frontal cortex activation in those with BPD. The result of this brain state means that a person with BPD will be actively scanning the environment for potential threats (particularly emotional ones). When a threat actually occurs (or is perceived), the pre-frontal cortex goes “off-line” and the limbic system lights up. The effect of this is that the person with BPD will react reflexively and impulsively to threats; however, the decision-making process becomes inhibited. This reaction, in combination with the person with BPD’s preoccupation with attachment relationships, means that it is likely for the attachment person (particularly a parent or partner) to be a trigger of the reaction. So, the amygdala lights up and the “fight or flight” response begins. That in concert with the activation of the anterior cingulated cortex portions of the brain (which is the personalization part on the top of the limbic system) makes a person in this state (which I call emotional dysregulation in my book, although it might be better described elsewhere) feel that there’s a threat, the threat is to them and the ability to make a wise decision goes-off line. They react and usually react impulsively.
OK, so, why am I bothering with this? It is because boundaries (and even more so “detaching with love”) feel like a HUGE threat to the person with BPD. They can’t take tough love. While boundaries can make YOU feel better, they make the person with BPD feel decidedly worse. That dynamic, and the resultant impulsive BPD behavior, hurts the relationship. What family members don’t understand is that boundaries have this function. I have seen many, many people recommend boundaries as a tool for the relationship, rather than as a tool for you, as a family member, to keep your sanity.
I will give you an example from my life. I have a boundary for myself that I will not go outside the house with my wife if she has been over-medicating (something that she does, though not as much, from time-to-time). If she is over-medicated, I tell her, “No, I will not go out with you when you’re in this state.” For me, it is an effective tool, yet it inevitably causes RAGE in her. The reason is that she experiences it as a threat of rejection, which is painful for her, and impulsively strikes back at me. Partners of people with BPD need to understand that the application of their own personal boundaries will most likely trigger this reaction. I personally expect it and know that it is coming, yet I have this boundary (for me) and I am consistent about this boundary. And yes, I have communicated the boundary to her. Why does she “not observe it”? Because she doesn’t feel like it at the time. I say that not flippantly at all. Her emotions are engaged in such a way that she is not thinking about me or my boundary at all. She is experiencing the brain reaction I described above. The “not observing other people’s boundaries” is usually situational, yet the reaction to the application of boundaries is typically pain, shame and impulsive behavior.
So, when the family member applies boundaries to a person with BPD, they are expecting it to be effective in the relationship. Then, they are surprised when the natural BPD reaction occurs and feel that the person with BPD is trying to manipulate them into changing their mind about the boundary. It becomes characterized as “pushing limits”. However, that is NOT the case. I try to explain in my book and in my blog postings that the application of a boundary is solely to help YOU and that, when it is done, you should EXPECT rage, judgment, criticism and impulsive behavior from the person with BPD. It is based on the neurobiology of BPD. Boundaries should only be used for yourself and should be used sparingly – only in the most extreme cases of situations you don’t want to participate in. In my case I use that boundary when she’s in that state because I feel uncomfortable and experience emotional pain myself when we’re out and she’s over-medicated. Yet, when I apply that boundary, I expect fireworks.
The second problem with boundaries is that many, many people confuse boundaries with rules. This is not your fault at all, Randi. I think you have done a pretty good job of explaining that boundaries are tools for YOU, not to be applied to the other person. The problem I see (and perhaps this is why you said “the B word”) is that boundaries in the context of child-rearing really ARE rules. If I tell my son he has to go to bed at 9 PM, that’s a rule, not a boundary. Unfortunately, the word is commonly used in a variety of settings and is inaccurate in its application. The effect of the Internet amplifies this misunderstanding. That is why I talk so much about boundaries and try to clarify the differences between boundaries and rules. I guess that’s why you choose “limits” rather than boundaries in your new book. Maybe “guidelines for self” would be even better, as klunky as that is.
If a person DOES start issuing rules to a person with BPD (calling them boundaries, limits or anything else), then fur is going to fly again. I think you would agree with me that you can’t change the behavior of another person through rules. It is the threat of punishment which, if the person would like to avoid, enacts the behavior change. However, positive reinforcement works better than punishment threats, as you know. Plus, a person with BPD, because of the great shame that they feel on a daily basis, will take punishment threats seriously and to the heart. My experience is that people with BPD live in a kind of dread of punishment and will avoid blame at all costs specifically because if they have done something wrong, then they are ALL wrong as a person.
Finally, I’d like to address the use of DEAR in both of your books. Two things on that:
You left out the MAN part. In the case of DEAR MAN, the first portion DEAR is the “what” skill. The section one MAN is the “how” skill. Because you decided to drop the MAN part which is – Mindfully, Appear Confident, Negotiate – you are missing something essential to the skill. While the DEAR part provides a road-map for non-judgmental expression of your OWN feelings and desires, by dropping the MAN part, you are removing the give-and-take related to the relationship. If you’re not willing to negotiate and find a middle ground, then you’re providing a nice, non-judgmental way of saying “my way or the highway”.
Which leads me to my other point on DEAR. This skill (DEAR MAN) is probably the most “aggressive” of the skills within DBT. It is intended for a person with BPD, who may capitulate to other’s wishes because they don’t trust their own decisions and desires, to get what THEY want out of an interpersonal relationship. It is a tool entirely for the person using the tool – particularly when you remove the requirement to negotiate. So, if you apply that tool from DBT, and ONLY that tool, to the loved one, you’re again providing a one-way benefit that helps the loved one get what THEY wish, but doesn’t help the relationship at all. The DEAR MAN tool is intended to provide a non-blaming road-map to ask for what you wish, without it devolving into a shouting, demanding, raging mess. If there was any interpersonal effectiveness tool from DBT that I would place emphasis on it’s the GIVE FAST tool. That’s another discussion entirely. Yet, the DEAR MAN tool (like boundaries) is important for YOU, just not for the relationship.
I think that both of these instances, the tools are assumed by your readers to be beneficial to the relationship. I am saying neither helps the RELATIONSHIP, although both can help YOU. Unfortunately, if you apply only these tools, the person with BPD will experience emotional pain and be unable to make effective choices in the context of themselves or the relationship. It seems to me that both of these tools assume that the person with BPD is doing something “wrong” or nonsensical and neither encourages compassion, trust or empathy, which is the life-blood of an effective relationship, regardless of the disorder(s) involved. The choices and behaviors of a person with BPD make complete “sense” when a loved one understands the function of each. Usually the function is pain-avoidance. My book does include both boundaries and a DEAR-like tool (called “Inserting your feelings”), yet the main emphasis is on other inter-personal tools. The inter-personal tools that I emphasize are intended to cool the rages and to help the person get back to baseline from which they can make an effective decision about their behavior. And in the case of most loved ones, once the person with BPD begins to make more effective decisions and, therefore, behaves more effectively, the work is done. I don’t take this view… I believe the work has just started – because, for my daughter at least, I’d love to see her actually FEEL better, rather than just behave better. Many loved ones are so tied up in the person with BPD’s behavior they begin to believe that the disorder is just a case of the person behaving badly. You and I know otherwise. It is a real disorder and requires a lot of hard work on everyone’s part to help your loved ones with BPD and to build a trusting, loving and respectful relationship in both directions.
Take care,
Bon
Randi Kreger
Thank you for your well thought out comments. A more careful reading of both SWOE and “The Essential Family Guide to Borderline Personality Disorder: New Tips to Stop Walking on Eggshells” will answer most of your concerns, because I don’t disagree with some of what you’ve said.
As for your first point, that people overuse boundaries: what does that (if it is true) have to do with me or any of my books?
Nowhere do I state that Limits with Love are more important that validation and other communication tools. Discussions of limits in my books take up no more space that communication tools. In fact, there isn’t even an entire chapter on limits in SWOE. It’s a section in one chapter.
I talk about Limits with Love as the FOURTH tool in Essential Family Guide, AFTER validation and other communications techniques, and after steps that do not involve the other person.
The essence of EFG is that steps must take place in a certain order. Step 2, on communication, validation, and creating a climate of cooperation, happens BEFORE the limits step (step 4) for very good reasons. The relationship needs this first, and the non-BP needs to be ready.
Absolutely: your BP will NOT welcome limits and WILL get upset, and will not observe them at first. Perhaps you missed my extensive discussion about extinction bursts, or countermoves, why that happens, and how to plan for it (a long process with five components). (I also talk about the MAN skills in DEAR MAN, btw.)
So why are they worth doing? Let me give you an example from The Essential Family Guide, the story of Jack and his borderline wife Loreen. Jack is a real person I interviewed for the book.
………………………….…………………………………………………..
Loreen was an alcoholic with a history of suicide attempts. She was under the care of a psychiatrist and taking medications. Jack was also seeing a therapist, who helped him put some limits in place after not having any for many years.
Jack says:
“Loreen’s rages were uncontrollable. She would go from zero to ten over almost anything. Once I went on a business trip and she shouted, “I hope you come back in a body bag.” She called me names and said things like, “You’ve destroyed my confidence in myself,” and “You’re making me drink because being drunk is the only way I can deal with you.”
“She threatened suicide all the time, yelling, “You probably want me to kill myself. So maybe I’ll just do it and it will be your fault.” I was always on edge, afraid of saying the wrong thing. Things got worse and worse.
“After I started talking to other family members online I realized two things: first, I was going to have to get strong and stay strong because this was really tearing me apart. And second, I had to start re-establishing boundaries.
“One day I found her on the floor after another suicide attempt. The ambulance came and they were trying to revive her. It hit me that even though I had been trying not to offend her for years, she was still suicidal and drinking. Whatever I was doing wasn’t working. I was scared.
“My therapist explained that her actions were out of my control. That was a harsh thing to hear. Living like this was going to kill me. So I decided to try boundaries. I had nothing to lose.
“I told her, “What we’re doing isn’t working, and things are going to have to change around here.” I said if she started raging and calling me names, I was going to leave and pick up the conversation at a different time. That sounds simple, but it wasn’t. It just fired her up, made things ten times worse. She screamed that I was a control freak and that’s why she was so sick.
“But I was prepared. I had convinced myself ahead of time that leaving was the best course of action. It helped that members of her family had told me I had been giving in to her and I needed to be firm.
“I ended up leaving the house several times. I just said, “I just can’t be here with you” and walked out the door. Some days I stayed away for a day or two. She called me, asked when I was coming home. I said, “I honestly don’t know. I’ve assessed my life and decided that things have to get better because this is destroying me.” She knows I am loyal and I would never walk away if there had been any other choice.
“Eventually, it started to sink in to her that I was serious. Finally, one day she called me and apologized. This was the first time she had ever said she was sorry for anything. I just about fell off the chair. That’s when I started to realize this boundary thing is working. And it did. It took time, but it got better.
“She even started apologizing more, saying things like, “I’m sorry, I didn’t mean to say that,” or “I know I reacted badly to that.” She was starting to feel responsible for her actions.
“Finally, we got to a place where we could have a real heart-to-heart talk, and I could say, “This bothers me a lot.” I had been afraid to do that because she was so volatile. She really started listening to me.
“I learned you have to take care of yourself, because BPD is like an incredibly powerful vacuum that will just pull you in, whoever you are. Setting boundaries was a way of saying, “I care about our relationship. If this keeps happening, I can’t stay, and I want our relationship to continue.”
“You have to be willing to accept that things will get worse before they get better. But it may be the only chance you have.”
………………………………………………………………………………………………..
We are going to have to agree to disagree on limits not helping the relationship on the basis that the person with BPD finds them threatening and gets angry. In Dialectical Behavior Therapy, therapy does not begin without limits. Every patient gets a list of things that can and can’t do (in fact, you could call them rules) such as the need to not miss sessions, not coming to sessions on drugs, phone guidelines, working with therapists, etc. These kinds of limits save lives. Other limits save relationships—such as yours.
If you hadn’t been able to set that medication limit with your wife (and perhaps other similar ones) you would not be able to stay in the relationship at all. My guess is that you would be upset and angry and not as able to work with her on other issues. On that basis alone, I’m not sure why you say limits don’t work when they do.
In this space, I can’t go into a full discussion of how you use Limits with Love, because how you use them, and in which order, and how you communicate them makes ALL the difference. And that takes a lot of space that covers three different chapters.
I will add that in the planning process, you need to take a very deep look at how limits are your values and beliefs in action. And readers may find that they and their BP do not share these beliefs and values. I believe it is better to think about this and know it and deal with it, than it is to drag on in a day-to-day existence knowing this but never really examining it.
Like Jack, when implementing limits people may find that their BP would rather adjust what they do than lose the person they love, because as hard as limits can be to them, losing the other person is worth. Staying with someone with BPD is a very loving thing to do—and limits make it possible to do that and have your own life at the same time. Each non-BP deserves to have his or her own life and get some of their own needs met. That message, I believe, needs to be made loud and clear.
Randi Kreger
http://www.BPDCentral.com
Author, “The Essential Family Guide to Borderline Personality Disorder: New Tips to Stop Walking on Eggshells”
Stop Walking on Eggshells
Stop Walking on Eggshells Workbook