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Validation (or emotional validation) is an extremely powerful tool when it comes to emotional situations. It is complex and multi-stepped and it takes a lot of practice to master. On my Internet list, I talk a great deal about validation because it is essential to managing a relationship with someone with BPD. If you learn to master validation, you can see a marked change in the way your loved one with BPD interacts with you.
Validation is a tool that verifies that the other person’s feelings are valid, but doesn’t necessarily condone or agree with their behavior. Remember, the behaviors come from feelings, beliefs and “action impulses” so they can be separated from behaviors. You are not “giving into” the person with BPD if you learn to validate their feelings. And, if you master validation, you might eventually receive validation back from your BP, which is a remarkable improvement over IAAHF (“it’s all about his/her feelings”). Don’t expect it right way, but after some time, it can happen.
With validation, you are basically saying, “Your feelings matter. It is OK to feel that way. It is normal to feel that way.” The way in which you validate someone else’s feelings is important. Many people believe that saying “It’s OK. I love you” or “You are safe with me” is a form of validation, but it is not. Those statements are about your attitudes toward the other person, not about his/her feelings. Validation is always about the OTHER person’s feelings, not about our own feelings. In some ways, this can get frustrating for us, because everything always seems to be about the other person’s feelings – and in the beginning, that is true. There are other tools that get your feelings on the table, but for now we need to focus on the other person’s feelings and how to validate them.
Validation is not giving advice. In fact, if you do give advice when the other person is emotional, they are likely to get angry with you. People don’t like to feel that they are being told what to do about an emotional situation – that is quite invalidating. It feels like you are telling them how they should feel and they can’t control the emotions.
This is where things get interesting. You see, I believe that since BPD is a very relationship-oriented disorder, changing the way in which you interact with the person with BPD will in turn change them. Mostly, the point is to make your life easier. If you learn and apply emotional tools, you will have less raging, less acting out and more peace in your life.
Exercise in validation
I sometimes like to assign homework assignments for my list members. I don’t do it very often, but I think it’s easy to learn from one another’s experience if you are all having a very similar experience. One of the exercises we worked on last year was one to help us learn the benefits of validating another person. My suggestion to the group was to make a validating statement to someone with whom you have a temporary interaction. This person could be a server at a restaurant, a clerk at the grocery store or an acquaintance at work. Here is an example conversation that I had with a co-worker who I knew by sight, but with whom had never really had a conversation on an elevator. She was about 8 months pregnant and it was the middle of the summer. She looked hot and stressed. I said that it must be frustrating and painful to be pregnant in the height of the summer. She immediately brightened up and talked to me about her feelings and her family.
My suggestion to you is that your emotionally validate someone in your life today. Test it out on someone with whom you have a passing contact. Remember validation is about their feelings, not about you. Just validate and listen and see what happens. If you don’t know how to validate, you can read all about it in When Hope is Not Enough.
Ok, after posting about book sales recently and stuff like that, now it’s time for a much more substantive post about BPD. Today, I plan to talk about self-regulation and a new study that points out an intriguing aspect of BPD. There has been much talk in the BPD research and clinical community about the “core” of BPD. Once it was thought to be a personality disorder or even an extreme form of PTSD. Dr. Marsha Linehan (the inventor of DBT) talks about dysregulation in a number of systems, the most important of which (in my interpretation) is the emotional regulation system. People with BPD are extremely emotionally sensitive and subject to emotional “cues” or triggers. They seem to have a less tolerant (in the “controls” sense of the word, meaning more highly sensitive) emotional system. They are triggered more easily and the reactions seem to be more intense and longer-lasting. In “When Hope is Not Enough” I compare this feature to a heat-sensing device and say:
The core problem with BPD is poor emotional regulation. That particular problem can cause other symptoms to arise as the person with BPD becomes emotionally dysregulated. This term emotionally dysregulated (or just dysregulated) is used to denote the state in which a person with BPD is overcome with powerful and, at many times, misaligned emotional reactions. Remember that emotions don’t arise on their own; they are based on cues or triggers from the environment and compared by our “emotional immune system” to the meaning of the cue. For a person with BPD, the meaning can be misjudged or, as is more often the case, the sensitivity to emotional cues is greatly heightened.
An example is a heat-sensing system that helps to detect and suppress fires. Sometimes companies will install heat-sensing equipment in addition to smoke detectors so that they can protect assets that need a certain temperature to operate (e.g. computer equipment which might cease working at a high temperature). The setting at which an alarm goes off might be 80 degrees Fahrenheit. In the case of someone with BPD, the setting (or “tolerance” as it is called in the control community) is naturally set much lower, at say, 50 degrees Fahrenheit. That means that the alarm will be raised much more often and lead to a reaction to the alarm. In other words, people with BPD will experience many, many (what you would consider) false alarms. However, these false alarms seem completely real to them, because their tolerance for emotional triggers is set very low. They are constantly running a fire drill. Unfortunately for you, the BP may drag you along unwillingly and unwittingly for the drill. (Pages 32-33 of WHINE)
As you can see, the position I take in WHINE is that emotional regulation is the “core issue” of BPD. This position is in line with the DBT way of thinking, which is why one of the “modules” of DBT is emotional regulation skills.
The question is today: is emotional regulation at the “core” of BPD? Or does it go deeper than that? Is there a “cause” for emotional regulation? What are the triggers and how does a person with BPD’s internal feelings affect this “systems dysregulation”?
In the American Journal of Psychiatry, Drs. Stanley and Siever recently (January 2010) publish an article entitled “The Interpersonal Dimension of Borderline Personality Disorder: Toward a Neuropeptide Model “ in which they seem to posit (in my interpretation again, since I am a lay person and not a doctor) that this systems dysregulation actually has another cause instead of being a “core cause’ of the disorder. They begin the article like this:
Borderline personality disorder is a complex disorder associated with substantial morbidity, mortality, and public health costs. Prominent symptoms include suicidal behavior, nonsuicidal self-injury, aggressive outbursts, and emotional reactivity, all of which typically manifest in an interpersonal context. For several years, there has been an ongoing discussion about whether impulsive aggression or affective dysregulation is at the core of the disorder. While these factors are important in borderline personality disorder, it is the exquisite interpersonal sensitivity that frequently triggers both dysregulated affect and impulsive behaviors, which suggests that this sensitivity perhaps rests at the core of the disorder and may in turn drive impulsivity and dysregulated affect.
Here is an interesting article on emotional validation for parents of people with BPD… from a new blog about understanding DBT.
Dialectical Behavior Therapy Validation Strategies for Parents
By Christy Matta, MA
How Do We Validate
Validation and active listening techniques are specific ways of approaching your child to increase cooperation and balance the change we are often asking for from our children.
1. Responsiveness: Addressing our children with interest in what they are saying, doing and understanding. Expressing concern about his or her wishes and needs.
2. Warm engagement: Approaching kids with warmth and friendliness. Active positive communication with our voice, tone and posture.
3. Self-Disclosure: Communicating our own attitudes, opinions, and emotional reactions to our children, as well as reactions to how they are behaving.
4. Genuineness: Being ourselves, rather than always acting as “parent” or “authority figure.”
5. Vulnerability: Empowering them, rather than having an exclusively high-power-low-power relationship.
6. Cheerleading: Cheerleading is helpful in validating the person’s inherent ability to overcome difficulties and learn new skills. It is believing in our children, assuming the best, providing encouragement, focusing on their capabilities, contradicting other people’s criticisms that are not accurate, and providing praise and reassurance.
7. Articulating their unverbalized emotions, thoughts, or behavior patterns. Children are often unaware of their own feelings and behaviors. It is validating for us to give voice to what they are thinking and feeling.
Remember: what each individual child finds validating is different. One child may respond to simply being listened to, while another may respond when you articulate and express understanding for how he or she feels. Our children are not the only ones who can benefit from understanding and active listening. Husbands, friends, family and yes, even we, ourselves, need it. We all have times when we’ve got an important problem, emotional pain, are having trouble with change or are feeling out-of-control. Validation can help us and our children make necessary changes and face challenges.
In my house, once I stop pushing everyone to ‘get things done,’ I find the solutions come fairly easily. My kids will pick up the toys if I assure them they can keep out their favorite. They’ll put their dishes in the dishwasher if we spend dinner talking about their day and I notice small attempts they’ve made to be helpful around the house. My family life is not a fairytale of cooperation and teamwork, but I do find that when I’m paying attention and listening to my kids, I feel less like I’m alone in the never ending battle against disarray.
See my March 31, 2010 post for more discussion of validation. Comment below to share how you create an atmosphere of cooperation in your family.
References:
Linehan M. Cognitive Behavioral Treatment of Borderline Personality Disorder. New York: Guilford Press; 1993.
 Sometimes the holidays can be stressful Hey all, I haven’t posted much in the way of skills lately, but today, as the holidays are upon us, I think it is helpful to go over some emotional skills and other tools that can help us non-BPD people get through the holidays reasonably unscathed. The holidays are a tough emotional time for everyone. There are expectations that the holidays be “jolly and happy” when, sometimes, the holidays are anything but. The get-together with relatives – many who don’t understand the actions, feelings and behaviors of someone with BPD – can cause huge stress for those with BPD and for the loved ones. Expectations of a low conflict Christmas (or other holiday) are typical, but not often “delivered upon”. Stress and the feeling of being “on-stage” or “good enough” for the family can cause emotional dysregulation and distress. Sometimes an invalidating family can compare the person with BPD with other, less emotional family members. You know, “why can’t you be like your cousin?”
So, in order to skillfully approach the holidays, I’d like to remind non-BPD people and people with BPD alike of the following skills that can help all of us get through. Here we go:
1. Frustration Tolerance. Sometimes we are overcome with frustration. We feel like we “can’t stand it” or “can’t take it anymore.” When you feel that way, I would encourage you to ask yourself some questions that can help build frustration tolerance. Some questions are:
a. Can I really not stand it?
b. Am I really going to explode?
c. How does exploding/raging help me in my relationships?
d. What can I do to decrease the frustration?
2. Mentalizing with yourself in a search for meaning within other people’s actions. Often people jump to conclusions or assume the intent and motivation of others. Sometimes these motivations are assumed to be malevolent, invalidating or uncaring. You can ask yourself the following questions to help understand the intent within yourself:
a. Do I really believe that he/she is being mean?
b. Is there another explanation as to his/her motivations?
c. What would he/she be feeling that could explain this action?
3. Mentalizing with others to understand others’ internal mental states. Be curious. Ask questions. Don’t “load” these questions. That is, ask “can you clarify what you meant, I’m not sure I understand you intention?” vs. “Why are you being so mean to me?”
4. Be validating toward yourself and others. Remember that emotions are a major influence on people’s behavior. Listen to others and validate the emotions. Validation does not equal agreement with behavior. It shows that you have heard the other person’s emotions and that it is ok to feel however one feels. Normalization can also be helpful here.
5. Don’t label people, label events. In other words, rather than saying “he’s an asshole”, say “he did something that bothered me.” This can be used on your own actions as well. Rather than telling yourself you’re a “failure,” you can say “I didn’t do that as I would have liked.”
6. Be mindful of the moment. Monitor interactions actively and in a way that is non-judgmental. Don’t get caught up in past reactions or fear of future reactions.
7. Cheerlead yourself and others. This is not “positive mental attitude” statements. This is encouraging others to be brave and effective. The essence of this skill is “you can do/face hard/difficult things.”
8. Consider the consequences of mind-altering substances. Too much alcohol and/or drugs can create impulsive situations and ones that you may regret later. Think before you drink.
Here’s wishing you all an effective holiday season!
Take good care,
Bon
 Are you and your BP on the same team? I often hear people with BPD/ERD say that they feel that their loved ones are “not on my side” or that the loved ones are “supposed to be on my side.” This phrase stuck out at me when I read the story about the suicide of Megan Meier (the “MySpace suicide” case), because, although I have no insight into Megan’s mental health, clearly when she was insulted and rejected on MySpace, and she was emotionally dysregulated. She came to her mother, and after her mother admonished her for the use of foul language on MySpace, Megan cried and said, “You’re my mom. You’re supposed to be on my side!” ( This according to her mother’s reports).
When someone is highly emotional, they need to know that they have an advocate and that someone is on “their side.” I often ask my consulting clients (especially partners of people with emotional regulation issues) if they feel that their partner and they are “on the same team.” Many times the answer is no. Why does someone have a desire to have someone on their side, even when the “sides” are not desired, intended or even clearly delineated? The answer in my mind comes down to shame and rejection sensitivity.
If a person has shame (or even low self-worth, which is similar), then the person is likely to have a high level of rejection sensitivity. Being rejected by others is painful, especially for emotional people. Having an advocate of their “side” of the issue, which is essentially answering, “I am on your side no matter what the situation,” is tantamount in these highly emotional, social interactions that involve rejection. One can be “on their side” emotionally without condoning whatever behavior that one doesn’t agree with.
There are teaching moments and there are times that one doesn’t teach. If you try and teach, punish or impart values during a period of emotional dysregulation, the relationship will be damaged and nothing effective will be accomplished. Instead, emotional validation and support can be used to cool the bonfire. Once it is cool, then a teaching moment can present itself.
Last week, I was reading a portion of Dr. Marsha Linehan’s book “Cognitive Behavior Treatment Of Borderline Personality Disorder” and stumbled upon a reference that I had never noticed before. It reads:
Emotional validation strategies contrast with approaches that focus on the overreactivity of emotions or the distorted basis of their generation. Thus, they are more like the approach of Greenberg and Safran (1987), who make a distinction between primary or “authentic” emotions and secondary of “learned” emotions. The latter are reactions to primary cognitive appraisals and emotional responses; they are the end products of chains of feelings and thoughts. Dysfunctional and maladaptive emotions, according to Greenberg and Safran, are usually secondary emotions that block the experience and expression of primary emotions. These authors go on to suggest that “all primary affective emotions provides adaptive motivational information to the organism” (1987, p. 176). The important point here is the suggestion that dysfunctional and maladaptive responses to events are often connected or interwoven with “authentic” or valid responses to these events. Finding and amplifying these primary responses constitute the essence of emotional validation. The honesty of the therapist in applying these strategies cannot be overstressed. If emotional validation strategies are used as change strategies – that is, if lip service is given to validation in order to simply to calm the patient down for the “real work” – the therapist can expect the therapy to backfire. Such honesty, in turn, depends on the therapist’s belief that there is a substantial validity to be found, and that searching for it is therapeutically useful.
This idea is an important one for loved ones of those with BPD because it touches on several points:
- It acknowledges that emotional validation focuses on “normal” emotional reactions, not “the overreactivity of emotions or the distorted basis of their generation.” That is the way of emotional invalidation, i.e. “You’re overreacting to something trivial. Look at what really happened.” I see that expression from Non-BPs all the time.
- It points out the differences between primary and secondary emotions. This distinction is extreme useful for Non-BPs. Why? Because most often the anger and rage are secondary emotions (not always) and that is typically what Nons focus on. If the emotional validation is used for secondary emotions, then I interpret this as not therapeutic, because you are “validating the invalid.”
- Probing (gently and compassionately) for the primary emotions seems to be a more effective strategy and those are the emotions that can be validated effectively.
- One has to approach emotional validation as a tool unto itself – without using it as a “change strategy.” That is, “it is ok to feel that, but you have to change the way you feel to be ‘normal’.” That is, bound to backfire.
- If this distinction of primary and secondary emotions – the first being true and “authentic”, the second being dysfunctional and maladaptive – is applied to the concept of mentalization, then the idea within mentalization to use emotional validation to probe for further feelings begins to make more sense. One has to help the BP locate the primary emotion.
 When Hope is Not EnoughGet the Non-BPD book that has helped hundreds! If you have the disorder, give it to you loved ones! It will help.
Occasionally, a discussion on my private email list that I feel it would be helpful to share here. I only do it if the discussion is not personal in nature. This discussion is about proper application of the skills in WHINE and how they compare to DBT skills. My list member’s question/comments are indented… my responses are not.
Now I have some time to answer these questions and the ones you ask in a later post. Let me start with these.
Thanks again Bon. Now I am re-examining how best to communicate. I
have a bunch of things I have been thinking about WHINE that I wanted
to ask you about:
WHINE is not perfect. It was my best effort at the time and continues to evolve. But I think I put in WHINE what was most effective for ME, as opposed to using DBT skills by rote. I had to adapt them beyond what I learned in DBT-FST class.
- You describe a modification of DEAR (using different words) as a
tool for the non. Do you just see the rest of the acronym as not as
relevant for the non?
That’s a good question. Actually, I think the MAN part of the skill IS applicable to the non. Although it is intended to be a skill for BPs to use to have an effective conversation and ask for what they want. I believe the DEAR is the WHAT to do and the MAN is the HOW to do it.
M – mindfully (ignore distractions and stay on subject)
A – appear confident
N – negotiate
However, in the case of the non, I adapted the tool to make it about the non’s feelings, rather than about asking for what you want. What you are asking for in my version is for a behavior change that would improve your feelings. I think that what nons have to do is become more aware of emotions – both theirs and their BP’s – and become less dependent on rational argument. If you talk about desires in the communication, you might be likely to lean on rational arguments. I tried to craft the tool such that it would “meet in the middle” with a BP. You see, when you start such a conversation, your wife will immediately start to feel judged. She will fear that you are creating “boundaries” (really behavioral rules) for her and that HURTS her. If you make it about your feelings more so than her behavior, then she can’t argue with you – see below for more on that. She also finds that the conversation will not hurt as much. When you talk to her about something “important to you” she’s going to feel dread that you’re going to judge, reject and shame her.
- You discuss these modified DEAR tools in your “Inserting your
feelings” section, which is separate from your discussion of
“examining the consequences” and “facilitating problem-solving” (which
you include as parts of validation). But I think each of these are
useful for communicating to a BPD beyond validation and attempting to
elicit behavior that you would prefer to see.
The examining the consequences and facilitating problem-solving is to encourage more effective future behavior in her. You do that when ineffective behavior has arisen as a result of an EDM. It should be done in a GIVE kind of way. “Gentle, Interested, Validating, Easy Manner”. That is the HOW. What I have provided is the WHAT to do. Inserting your feelings is a way of soliciting some sympathy/empathy from your BP – it is about YOU. The complex validation technique (steps 1-6) are about HER – IAAHF. Inserting your feelings is a way to make it IAABOYF (it’s all about both of your feelings). I think one must build trust with validation and, if possible, facilitate effective behavior in HER. Both skills are important, but they have different goals. Obviously, they can be used in conjunction (and I put a conversation in WHINE in which both skills are used).
- Also, the I-AM-MAD tool seems to be a summary of the validation
tool, and does not include the “inserting your feelings” tool (but it
does include “examining the consequences” and “facilitating problem-
solving”–am I right?
Yes, the I-AM-MAD tool is a sub-set/summary of the six step validation technique.
- You say that if we state “I feel ____”, then there is nothing for
the BP to argue with because this is a non-judgmental statement. But
my wife consistently tells people what they should and should not
feel. And I really expect that she’ll feel judged by this because she
thinks in terms of blame–she’ll assume I mean that it is her fault
that I feel that way. Of course I can clarify, but my point is that I
will probably *have* to clarify.
Clarify by using normalization statements about your own feelings. I do state that you can’t be argued with and I still believe it. If I say “I feel angry” the only thing that can be argued with or thought to be judgmental is WHY I feel angry – the fact that I DO feel angry can’t be argued with – it is a statement of an internal feeling. She might expect blame and judgment – but that is why I broke the tool up into the different steps. People with BPD understand emotions. She will know how it feels to feel angry, sad, frustrated, scared, etc. Talking to a person with BPD on an emotional level is one that they will instinctively understand. One has to be careful not to have “weasel words” in your statements that indicate judgment. Even better is if you don’t actually judge the person at all, just state what happened. The “inserting your feelings” tool is like a reverse of the validation tool. It is to work on your feelings, not theirs.
- DEAR includes reinforcement–we can say that if they do change or
adopt the behavior, then there will be benefits (or negative
consequences, I suppose). But you changed reinforcement to “thank you
if they choose to do what you want” and your example says, “this will
definitely make me feel less ____.” I don’t really understand why my
wife would be motivated to change her behavior because of how I feel.
This is the last thing on her mind.
I disagree with that. I think that if your show appreciation for a commitment to change behavior that makes a BP think that they are being thoughtful and appreciative/appreciated. A person with BPD LIKES (desperately sometimes) to be liked, apprecaited and wanted. If you can navigate that tool without judgment, I suspect your wife will feel relieved that it wasn’t a dreadful statement of “thou shalt” from you to her. Also, I think “negative consequences” is not reinforcement – it is the threat of punishment. There is an implied positive consquence that you will feel better and thus treat her better – when someone is angry and frustrated they are unlikely to treat another person very well. The problem with real reinforcement at that moment is that reinforcement must occur when the desired behavior is performed (as I say in the reinforcement section) and your wife is not performing the behavior, just committing to perform it in the future.
 Not too long ago I wrote an article on why tough love is not the answer for BPD. I still believe that ONLY tough love is not the answer; however, I have come to reconsider tough love and BPD.One of the reasons was that the TIME article said that DBT is a combination of emotional validation and tough love.
One of my list members has moved from the techniques that I provide in “When Hope is Not Enough” – which is basically a non-judgmental attitude plus validation and normalization – to a combination of those techniques plus “tough love.” What is tough love? In my opinion, tough love is the application of PERSONAL boundaries on a relationship. These personal boundaries need to be understood. Often, people don’t understand personal boundaries. Even popular books about BPD for Non-BPs (such as SWOE) get this concept wrong. In fact, even books that are ABOUT boundaries get this concept wrong. The other day I posted a link to a video of a part of the film “The Basketball Diaries” in which Jim Carroll’s mother (Jim Carroll is played by Leonardo DiCaprio BTW and the film is based on the book by Jim Carroll and is true) denies her son money for drugs (he is a heroin addict). She enforces her own boundary (I will not give my son money to buy drugs). She does not enforce a “rule” which is the way that someone tries to control the behavior of another person. Rules and boundaries differ significantly. With a rule, you try and control another person’s behavior – such as telling a child “you have to go to bed at 8:30 PM.” That is a rule, not a boundary, because it has to be enforced. Rules have to be enforced, boundaries do not (except on yourself).
Back to tough love… how does one use tough love with BPD? Well, first of all I have to say you can’t START with tough love, because first emotional trust has to be established. If you start with tough love and use ONLY tough love, that is a recipe for disaster with someone with BPD. The problem is that tough love hurts too much for them. They feel “different” and “broken” and tough love reinforces these feelings. However, tough love can be used once the trust is established. Tough love is something you can use FOR YOU to establish your own boundaries with someone with BPD. But you have to make sure that it’s your boundaries that are being applied and not rules for another person’s behavior.
When Hope is Not EnoughGet the Non-BPD book that has helped hundreds! If you have the disorder, give it to you loved ones! It will help.
 Here is a new article from Time magazine on Borderline Personality Disorder (BPD):
Thursday, Jan. 08, 2009
Minds on The Edge
By John Cloud/Seattle
Doctors used to have poetic names for diseases. A physician would speak of consumption because the illness seemed to eat you from within. Now we just use the name of the bacterium that causes the illness: tuberculosis. Psychology, though, remains a profession practiced partly as science and partly as linguistic art.
Because our knowledge of the mind’s afflictions remains so limited, psychologists–even when writing in academic publications–still deploy metaphors to understand difficult disorders. And possibly the most difficult of all to fathom–and thus one of the most creatively named–is the mysterious-sounding borderline personality disorder (BPD). University of Washington psychologist Marsha Linehan, one of the world’s leading experts on BPD, describes it this way: “Borderline individuals are the psychological equivalent of third-degree-burn patients. They simply have, so to speak, no emotional skin. Even the slightest touch or movement can create immense suffering.”
Borderlines are the patients psychologists fear most. As many as 75% hurt themselves, and approximately 10% commit suicide–an extraordinarily high suicide rate (by comparison, the suicide rate for mood disorders is about 6%). Borderline patients seem to have no internal governor; they are capable of deep love and profound rage almost simultaneously. They are powerfully connected to the people close to them and terrified by the possibility of losing them–yet attack those people so unexpectedly that they often ensure the very abandonment they fear. When they want to hold, they claw instead. Many therapists have no clue how to treat borderlines. And yet diagnosis of the condition appears to be on the rise.
A 2008 study of nearly 35,000 adults in the Journal of Clinical Psychiatry found that 5.9%–which would translate into 18 million Americans–had been given a BPD diagnosis. As recently as 2000, the American Psychiatric Association believed that only 2% had BPD. (In contrast, clinicians diagnose bipolar disorder and schizophrenia in about 1% of the population.) BPD has long been regarded as an illness disproportionately affecting women, but the latest research shows no difference in prevalence rates for men and women. Regardless of gender, people in their 20s are at higher risk for BPD than those older or younger.
What defines borderline personality disorder–and makes it so explosive–is the sufferers’ inability to calibrate their feelings and behavior. When faced with an event that makes them depressed or angry, they often become inconsolable or enraged. Such problems may be exacerbated by impulsive behaviors: overeating or substance abuse; suicide attempts; intentional self-injury. (The methods of self-harm that borderlines choose can be gruesomely creative. One psychologist told me of a woman who used fingernail clippers to pull off slivers of her skin.”
No one knows exactly what causes BPD, but the familiar nature-nurture combination of genetic and environmental misfortune is the likely culprit. Linehan has found that some borderline individuals come from homes where they were abused, some from stifling families in which children were told to go to their room if they had to cry, and some from normal families that buckled under the stress of an economic or health-care crisis and failed to provide kids with adequate validation and emotional coaching. “The child does not learn how to understand, label, regulate or tolerate emotional responses, and instead learns to oscillate between emotional inhibition and extreme emotional lability,” Linehan and her colleagues write in a paper to be published in a leading journal, Psychological Bulletin.
Those with borderline disorder usually appear as criminals in the media. In the past decade, hundreds of stories in major newspapers have recounted violent crimes committed by those said to have the disorder. A typical example from last year was the lurid tale of an Ontario man labeled borderline who used a screwdriver to gouge out his wife’s right eye. (She lived; he got 14 years.”
There are several theories about why the number of borderline diagnoses may be rising. A parsimonious explanation is that because of advances in treating common mood problems like short-term depression, more health-care resources are available to identify difficult disorders like BPD. Another explanation is hopeful: BPD treatment has improved dramatically in the past few years. Until recently, a diagnosis of borderline personality disorder was seen as a “death sentence,” as Dr. Kenneth Silk of the University of Michigan wrote in the April 2008 issue of the American Journal of Psychiatry. Clinicians often avoided naming the illness and instead told patients they had a less stigmatizing disorder.
Therapeutic advances have changed the landscape. Since 1991, as Dr. Joel Paris points out in his 2008 book, Treatment of Borderline Personality Disorder, researchers have conducted at least 17 randomized trials of various psychotherapies for borderline illness, and most have shown encouraging results. According to a big Harvard project called the McLean Study of Adult Development, 88% of those who received a diagnosis of BPD no longer meet the criteria for the disorder a decade after starting treatment. Most show some improvement within a year. Continue reading Interesting Article from Time Magazine on BPD →
 Unfortunately, the concept of cheerleading is something that I mention in WHINE, but I left out as a tool for a Non-BP/BPD relationship. I mention it when talking about what NOT to do in when a person with BPD is emotionally dysregulated (or experiencing an EDM – emotional dysregulation moment). I am planning on providing a “supplement” to WHINE on this website when I finish working on it. I left out a few things that can be effective in a relationship with someone with Borderline Personality Disorder, and these things have come up in the ATSTP Email Support Group. So, I’ve decided to address one of these, cheerleading, now.
Not all interactions are appropriate for cheerleading; in fact, many interactions are not. If you tell someone “you can do it” when they deeply believe that they can’t, this could lead to a mistrust of your opinion of them. In the case of dealing with an emotional person, typically, “positive mental attitude” statements are unhelpful and invalidating. Saying there’s “no need to be sad/scared/angry” for example just serves to invalidate the emotion that the other person is already feeling.
Many people think that effective cheerleading statements involve saying that one person is “proud of” the other, “believes in” the other or “loves” the other. The problem with each of these is that 1) those statements are about how YOU feel and 2) Those statements don’t necessarily foster effective behavior.
At www.dbtselfhelp.com (which is a wonderful resource that I highly recommend) the worksheet on cheerleading states that there are three types of effective cheerleading statements. Mainly, that site is for self-cheerleading, so I will try to adapt these to relationship cheerleading. The types are:
Three types of cheerleading statements:
1. Statements that provide the courage to act effectively
2. Statements that help in preparing for the situation, getting ready to be effective, to focus on what works
3. Statements that counteract myths about interpersonal behavior.
In WHINE, I suggest a tool that can help with #1, which is the tool to “Be Brave.” While a person’s inclination may be to avoid an uncomfortable situation or to behave in a conditioned or ineffective manner (because of lack of courage or self-assurance about the situation), being brave in the face of uncomfortable situations reinforces itself and serves to support type #1.
Some examples of #1 might be:
“You can do hard things.” (which is my favorite and can apply to both #1 and #2)
“Remember the time you did [whatever]. That was so brave of you in that situation.”
“I’m impressed with your courage in the face of that.”
“Yeah, that is really hard. At the same time you have faced something like that before…”
If you combine “Be Brave” with “You can do hard things,” you go a long way to being more effective, because these two concepts help counteract the idea that you are “walking on eggshells” around someone else and that your feeling that avoidance of an emotional situation is the best route to take. I believe taking on an emotional situation head-on is more effective than letting it fester – both for you and for the person with BPD.
In type #2, the focus should be on effective behavior for a future task. #2 is quite important and, in some ways, is the most difficult type to effectively navigate. Because of conditioned ineffective behavior and the sway of negative emotions, a person might be tempted to repeat ineffective behavior, based on the emotions that they are feeling. A work (or school) situation is a good example of this dynamic. If someone is having a problem with their boss, they might, in anger, have the urge to quit the job or lash out at the boss (or the customers). Work situations can be especially frustrating for a highly emotional person. Work that they consider menial or “beneath them,” overbearing bosses, long periods of downtime in which a person can ruminate or become paranoid that others don’t like them, all contribute to frustration at work.
Some examples of #2 might be:
“You have every right to be angry. Still, the last time he said that sort of thing, you reacted positively. I think that worked out pretty well.”
“Bosses can be a real pain. I know when my boss gets on me; I try to do [something effective]. I’ve seen you do that in the past, so you know you’re capable.”
“You had a similar situation when [whatever] happened and you handled that well.”
In type #3, you are debunking deeply-held beliefs about interpersonal behavior. This technique can be tricky, because a person who is overcome with emotion might not be able to see the other side of the coin. In this type, you are basically reiterating that a person has the rights to their feelings and emotions and helps counteract the idea that other people might not like them just because of an emotional situation.
Some examples of #3 are:
“It’s hard when your co-workers are angry at you. I know I don’t like that either. Yet sometimes it’s about their anger more than your behavior.”
“I think you have the right to state your feelings about the situation.”
“You have every right to ask for what you want, even if you think that will annoy them.”
“I think there’s a lot of validity in how you feel, certainly as much as how they feel.”
“Sometimes I think you have to stand up for your rights. I’m impressed when you have done that in the past.”
“Sometimes people get annoyed when you don’t do exactly what they want. However, you have rights and feelings too.”
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