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Overcoming Borderline Personality Disorder by Valerie Porr is perhaps the most up-to-date and complete book for family members of people with BPD published to date. When I read the book, I couldn’t help but think that Ms. Porr had the therapists and mental health professional more in mind than the family members. It appears as though she is trying to dispel many myths about BPD that exist not only in the family environment but also in the mental health community. This book is steeped in scientific research, including research involving the biological under-pinnings of BPD. It includes many skills for family members from both DBT and mentalization based therapy (MBT). Clearly Ms. Porr is highly respected by the clinical community since many of the leading experts in research and practice in BPD treatment have written blurbs for this book. The book is quite dense and a must read for family members of those with BPD. Yet it might not be the best book to start with because of the complexity of the scientific research, the psychoeducational aspects and the technical details about the various therapies for those with BPD. Still, I highly recommend Overcoming Borderline Personality Disorder.
Excellent article about what BPD feels like:
What BPD Feels like
A lot of friends and family members want to understand what the BPD sufferer is going through, but they don’t have a proper understanding of what is actually happening. For the BPD sufferer it is hard to explain what it feels like when honestly, they don’t know exactly what it is that isn’t “normal”. People around the BPD sufferer know that something isn’t right with the person, but quite often the sufferer does not know there is anything wrong, which is why they can attack you when you suggest there may be.
As a BP sufferer myself, I can say that there are definitely times when you can “cope” better than others. But then there are times when it is all you can do to get out of bed. Your emotions can be that out of control that you suffer an emotional pain that is similar to the experience one feels when a loved-one has died, but it doesn’t get better and there is no reason for it. Some people deal with emotional pain in various ways, such as drinking, using drugs, crying all of the time, or becoming angry. It can affect BPD sufferers in different ways, depending on how they usually deal with stressful situations. I know for me I have a strong belief in being non-violent as I know that if I don’t keep my anger in check it can verge on being out of control, so I work extra hard to avoid that. Unfortunately that means that I will do things like drink or drugs to distract myself, and so I have had addiction problems in the past that I have also had to deal with. This is quite common in BPD personalities, as they try to do whatever it takes to find a way to distract themselves, or ease their pain, for a little while. If they find something that works, even if it is for a little while, then they will latch onto it in the hope that if they do it all of the time the pain will go. This obviously doesn’t work, and provides the BPD sufferer one more thing they need to fix in their life.
At my worst, the ability to think clearly or to make rational decisions is completely gone, and it is almost an impossible task. You can try your hardest to take your time to think about things to make the right choice, but this doesn’t happen. It is unclear whether this is a response to the overload of emotions on the brain or another cause due to this illness, but it is a fact.
Then there is also the other part of BPD which can cause depersonalisation, which can cause huge problems in a person’s life. Depersonalization is when the person experiences a sense of detachment from the self. It is often associated with sleep deprivation or “recreational” drug use. It may be accompanied by “derealization” (where objects in an environment appear altered). Patients sometimes describe depersonalization as feeling like a robot or watching themselves from the outside. It may also involve feelings of numbness or loss of emotional “aliveness.” When I have experienced this it is almost like I have been tricked into thinking I have no feelings for certain things. For example, a few years ago I went through this phase of depersonalization in which I was convinced that I had no feelings (almost overnight) for my partner. Whilst in hospital after a suicide attempt I met someone there, and thought that because I felt something for them that my relationship with my partner must be over, so I split up with my partner. A few weeks later my feelings for my partner kicked back in and I realized that I had made a huge mistake. Luckily for me my partner took me back after this indiscretion, but I know it is the only chance I have. I now understand from this experience that I can’t always trust my emotions, because for me, as a BPD sufferer, they are not all real.
BPD sufferers can also experience bouts of dissociation, which can lead to dissociative amnesia. This means that they will have no memory of what happens when they are in a dissociative state. Dissociation is the state in which, on some level or another, one becomes somewhat removed from “reality”, whether this be daydreaming, performing actions without being fully connected to their performance (“running on automatic”), or other, more disconnected actions. This can be a lot more serious than the usual “automatic pilot” that most people will experience, and can be as a result of depersonalization as well.
Family members and friends say that BPD sufferers have extreme mood swings for no reason, and while this is true to outsiders, the BP sufferer always thinks they have good reasons. They feel like they are only reacting to what the people around them are doing, but this is only because their view of what is happening around them is skewed. Because of the extreme emotional reaction they have to normal events, what may seem small to other people becomes a huge thing in the mind of a BPD sufferer. For example, if my partner looks at me in a weird way, it could mean absolutely nothing on their end, yet I may blow up at my partner because in my mind it means that they are angry at me. The mind of the BPD sufferer makes these kinds of assumptions all of the time – they believe that they are experts in reading people and body language, when in fact they are the exact opposite. And it is when they make these errors in judgment that they react wrongly and overly emotionally, and the friend, partner or family member has no idea why. In our mind it all makes sense, as we tell ourselves we know what is truly going on, when in fact we have no idea.
The fear of abandonment is also a major issue in the life of a BPD sufferer, and this is what can cause most of the issues when it comes to personal relationships, either romantically or not. When starting a new romantic relationship, the BPD sufferer will usually test the potential partner to see whether they will stick around. If the partner passes this test, then the BPD sufferer will latch on and treat that person like they are a God/Goddess so that the other person will fall in love also. Once the BPD sufferer is comfortable with where the other person is at, they may then start to switch between intense bursts of love/hate that confuse the other person. This is not done consciously to torture the other person – in fact, the BPD sufferer has no idea that they are doing it. They are actually responding to perceived events in their own mind which causes them to act this way, even though these acts don’t exist. For example, there are times in my relationship where my mind makes the leap that my partner is cheating on me even when I know in reality that this is not the case. All it takes is for me to experience rejection one night when I make sexual advances, and my emotional response is out of control to try to figure out what the problem is. In my mind it couldn’t actually be that my partner is tired from work and our children – it has to be more than that. So I go into this emotional free-fall until it ends up in an argument where my partner has to defend themselves from something they haven’t even done.
It is extremely difficult for BPD sufferers to have successful relationships, and it is because of our reaction to the fear of abandonment which is the reason why a lot of non-BPD sufferers refuse to have relationships with us. I can certainly understand why, if my partner was always looking for the negative in our relationship instead of just being happy. I know for me if I have times where I recognize that I am happy, it will be quickly followed by me searching for a reason that things are bad as I can’t believe that things are as good as I think they are.
The BPD sufferer can not accept that things are good or happy or uncomplicated – they expect things to go wrong any second and are always searching for any sign of this occurring. It even gets to the point that if they can’t see one then they will make one up (sub consciously of course) so that they can prove themselves right. This can be very frustrating for those around them, as they constantly go through this dance of proving to their partner or loved one that they are not leaving. It eventually gets to the point where the BPD sufferer will push the other person that much that they will leave, and then the BPD sufferer is in some way validated for doubting the person in the first place. It is a no win situation.
Another area in which BPD affects my life is in maintaining focus on areas in my life. For example, I will develop an interest in religion, so I will then have to read books, watch documentaries, live, talk and breath religion until a few weeks later when suddenly this obsession will pass. It also happens in things like career choice. I have started University study four times as each time I start a course I am 100% sure that this is what I want to do, but as soon as I start studying I lose interest so I stop. I have sunk money into so many ridiculous career choices and money making schemes that I guarantee I will commit to, only to have given up when my focus changes to something else. I can get so excited by something only to give up on it after a month or so, and it is just as frustrating for me as it is for those around me.
A lot of BPD sufferers, including myself, have experienced episodes of self harm and suicide attempts. Luckily for me I have never been successful, but unfortunately 10% of all sufferers are. This number should indicate how hopeless, distraught and pained BPD sufferers are. Suicide is not something anyone takes lightly. I know for me, every time I have thought about it, it has been over a long period of time, until finally it gets to the point where it feels like I have no choice. It is not something I rush into. Suicide is only an option to sufferers because they are not thinking clearly, and are having inappropriate reactions (which they can’t control) to events and the environment around them.
To a lot of non-BPD sufferers it can seem like the BPd sufferer is using suicide attempts as a form of manipulation. From my experience, although I can’t speak for everyone, this was never my intention although I can see how it has been interpreted like this. Normally to get the point where suicide is considered the BPD sufferer is experiencing an episode of immense pain for a long time, although sometimes if they can feel one of these episodes coming on they may consider it as a way to stop the torture they are about to sink into. When I have got to the point of actually attempting suicide, for me it has been more about preventing other people from being hurt by me than trying to hurt them by committing suicide. As I have previously said, I can not say that this is true for all sufferers, but I know the majority would feel this way.
Episodes of self harm are also common for BPD sufferers. I have experienced these episodes on many occasions, but for me there is not always one reason as to why I do it. Sometimes it is because I feel so much emotional pain I want to let it out so I try to do it physically, other times it is because I am feeling absolutely no emotion that I want to feel pain so that I know I am still capable of feeling something. Some times it is even because I am almost in a psychotic state that for me it makes sense to cut myself if an angel tells me to. Whether this is what the doctors call true psychosis or not I am not sure, but it can seem real enough at the time. All I know is that the ability to think properly becomes that distorted that things that would normally seem stupid become really good and sensible ideas. You start believing things that could not possibly be true, and can even imagine conversations with people that don’t exist.
BPD affects virtually every area of a sufferer’s life. It affects the decisions they make, how they respond to stimuli in their environment, how they behave towards themselves and other people, and their emotional reactions. I could not imagine anyone choosing to live this lifestyle, as it destroys virtually everything around them. Overcoming BPD is the biggest challenge a sufferer has, but it is possible with a lot of hard work. And to have any semblance of a normal life it is necessary.
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.
 Cognitive-Behavioral Treatment of Borderline Personality Disorder 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 is designed for staying and working on the relationship
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.
 Tough Love 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 is designed for staying and working on the relationship
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