BPD: Loving Someone with Borderline Personality Disorder

Linehan reclassified BDPD into five areas of dysregulation:

1. Emotions. They have fast emotions -- come up quickly and change quickly. They have extreme emotions -- they are typically very, very intense. 
2. Relationship problems. Relationships are the most important thing in the world to them.
3. Impulsive. Impulsive behavior often makes them feel better, gets rid of certain emotions. They lose their judgment when emotions are high. 
4. Self-Dysregulation. Don't have a sense of what they like, what their values are, who they are. This is a byproduct of extreme emotionality, as they have trouble paying attention to their internal experiences and reactions to situations. It's like trying to read a road sign in the middle of a hurricane. 
5. Cognitive dysregulation. Difficulty controlling attention b/c emotions interfere with anyone's ability to pay attention. 

Causes: 

Biosocial Theory. Innate, biological vulnerability to emotions; and invalidating environments. As babies, people with BPD had an extreme response to getting tickled on the nose with feathers. Intensity of emotions is out of proportion -- emotional reactivity. It takes them longer to return to baseline.

Invalidating environment = an environment where the responses of the child are pervasively treated as inaccurate, unrealistic, trivial, or pathological. E.g., -- 

• Child doesn't like green beans. "Of course you like green beans. Everyone likes green beans."
• Child gets 98 on test. "Why didn't you get 100? I know you could have gotten 100."
• Child is hungry. "You're not hungry. You just ate."
• Child comes home crying after a fright with a friend. "You didn't need him as a friend anyway."

"Parents can contribute to an invalidating environment without being awful, abusive, insensitive people and without having anything but the best intentions for their child." 

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Validation

Validation authenticates some aspect of the experience of another. It is finding one (sometimes very small) piece of a behavior that is authentically understandable to you and communicating to the other person that it is understandable. You don't even have to agree with them. 

People with BPD often have self-constructs of being out of control, having a lot of emotional pain, not being able to tolerate emotional pain, not being able to do things that others can do, not having a sense of who they are. So if your loved one has an identity that includes thinking she is worthless and undeserving of love and you are constantly telling her that she is wrong, that she is not worthless, etc., she will become more emotional around you and may well turn to her relationship with the violence drug addict who actually treats her like she's not worth anything and sometimes tells her outright she has no value. 

If your loved one believes she's worthless, and you say, "You're not worthless," you are arguing against her self-constructs. She will likely get more upset. Using validation, you would say, "Look, I know you see yourself as worthless. the fact is, you have done some things that have made you feel that way, and I know that your mistakes in life have made you feel bad about yourself. This is what I know about you, though...." 

Six levels of validation:

1. Stay Awake. This means paying attention and asking objective, probing questions -- basically showing that you're paying attention to them. Lean forward, nod your head.
2. Accurate Reflection. Communicate that you've heard the person accurately. You can repeat verbatim. Better to change the wording around so that they realize you get the gist of what they're saying. 
3. Stating the Unarticulated. Or mind reading. Requires that you create a little hypothesis about what the person is not telling you. Best to present it in question form. "You must really be beating up on yourself for doing something you had sworn not to do again, huh?"
4. Validating in Terms of Personal History or Biology. This is understanding one's action in the context of her entire life history. E.g., someone whose home burned down when she was five, her family lost everything. As an adult, she now becomes anxious during thunder storms. "I really understand why you want to hide in closes during storms. Your house burned down in a storm. It makes perfect sense that seeing lightning causes you to get really anxious. It's a part of your personal history." 
5. Normalizing. This communicates that others (without BPD) would have the same response. People with BPD feel they're different. When you normalize, you communicate that what's happening to them is the experience of being human, that anyone in the same situation would feel the same way. "We all have moments when we feel that way." "Of course you think that; anyone would in your situation." "I would feel that way you." 
6. Radical Genuineness. We often treat clients like they are more fragile than they really are. When you're radically genuine, you do not "fragilize," condescend, or talk down to the person you're trying to validate. This type of validation is talking to your loved one like you would anyone else.

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Five Steps to Respond Effectively to Borderline Behavior

1. Regulate your own emotions.
2. Validate (do this at every step).
3. Ask/assess.
4. Brainstorm/troubleshoot.
5. Get information on your role (if any) and what you can plan on hearing about the outcome. 

Step #1: Regulate your own emotions

• Pause -- take a breath and notice your physical sensations. Label them as the emotion you are experiencing. ("My heart is pounding, I have a pain in my gut... The emotion I'm feeling is anger.")
• Pay attention to your body posture -- unclench your hands, relax the muscles on your face, make sure your other muscles are not tensed.
• Half-smile -- send calming messages to your brain. 
• Validate and cheerlead yourself -- ("My emotions are understandable given what is going on."

If these steps don't work, do the opposite. Anger -- disengage, walk away, hang up, don't email; then practice kindness. Sadness -- go for a walk, play tennis, do pleasant events not related to your loved one.

Step #2: Validate

Step #3: Ask/Assess

• Specifically but gently ask: "How would you like me to help? Do you want me to listen, give advice, or help you figure out what to do?"
• If the answer is no, just listen.
• If the person wants your input, asses what is going on: What happened? When did it start? What does your loved one see as the problem? What would she like to be the outcome?

Step #4: Brainstorm/Troubleshoot

• Generate a list of solutions with her help. 
• Collaborate with her to select an option.
• Anticipate what could get in the way of your loved one carrying out the plan.

Step #5: Get information on your role and what you can plan on hearing about the outcome

• Are there things that you need to do to help/support her carry out the plan?
• Request a check-in/follow-up if it's important to you. Tell her you're interested in knowing what happened and ask to be updated. This is very validating for her. 

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Communicating a Limit

• Tell her that you are going to end the conversation if _____ doesn't happen. 
• Give her a chance to modify her behavior. 
• Make sure you "own" that you are ending the interaction because of your reactions and what you want from the interaction -- e..g., "I know this is painful for you, but it's what I need to be able to stay in our relationship."

Use four-way pros-and-cons analysis to make decisions about communicating that a limit has been crossed. 

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Practicing Acceptance and Self-Compassion

"We are often told that we cannot change other people. As a behaviorist, I believe that we have some capacity to change others by changing our reactions to them."

We must accept reality every moment. We need to accept: (1) Our loved one as she is in this moment, (2) Our reactions to our loved one as she is in this moment, (3) The situation at hand.

How to practice acceptance in the heat of the moment with your loved one:

1. Determine what you are not accepting. Ask yourself, what is making me miserable?
2. State out loud: "I accept..."
3. Pay attention to your body posture. Make sure you have an accepting posture: hands not clenched, facial muscles relaxed.

You can practice acceptance and emotional regulation by developing compassion.

How to practice compassion with yourself:

1. Visualize yourself as joyous and accepting. See a half-smile on your face. Visualize yourself doing kind things. Picture yourself responding to situations with patience and skill.
2. Think of your positive qualities. What are some of your past acts of kindness? When were you accepting of someone even in the face of unpleasantness?
3. Make statements out loud that are compassionate, accepting, statements of yourself. E.g., "I have put myself in her shoes and realized how difficult it is for her to feel like she is losing everything even when she was yelling at me that she hated me." Find things about yourself to love and say them over and over again.

How to practice compassion to your loved one:

1. Visualize: picture your loved one being joyous and unburdened. What does this look like?
2. Think of positive qualities of your loved one and kind, compassionate things that she has done in her life. 
3. Make statements out loud that are compassionate, accepting statements of your loved one. 

Self-care as compassion:

• Take care of your physical self.
• Soothe your senses.

Cheerlead yourself:

• Think what you would say if a friend called and told you of a situation that was similar to yours.
• List three things that you would say to cheerlead your friend. 
• Repeat those three things to yourself each day until they become statements that you can say automatically. 

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