Borderline Personality Disorder Therapy - Is Your Loved One Serious?
Essay: A.J. Mahari , author of The Other Side of Borderline Personality Disorder Introduction: BPDFamily Staff Video: Christian Rück, M.D. Sidebar: BPDFamily Staff
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Interview of Alan Fruzzetti, PhD by Christian Rück, MD at the Karolinska Borderline Seminars, Sweden,2007
Take Care of Yourself First
Recovery from BPD is not by any means a straight line or a steady climb up the side the mountain; it's a long rocky road and where your borderline family member or relationship partner learns how to become emotionally independent and to regulate their own emotions and moods in response to life's challenges.
Never to forget - this is their journey alone, and not yours. You can support them, but it can't be your life plan.
The hard reality is that the changes a BPD must make in recovery often alters their attraction to you and the role of your relationship in their life. As they move into a healthier state, the BPD must jetison unhealthy ways - and the relationship partner is often one of them.
It's important that you honestly look at your self, take your own inventory, enter into some counselling of your own. There will be huge life changes before you, and you need to understand them clearly, and make decisions wisely;
~ that your loved one's therapy is not what you are basing your emotional well-being, boundaries, or life choices on - you need your own life plan;
~ and that while you can take a wait and see attitude, you must reassess continously; success may mean fitting yourself to an environment that helps you (and you BPD) progress - or - success may mean identifying, in a timely fashion (i.e., not years), that the relationship is not going to survive or be fulfilling - and moving on;
There are no simple rules here. This is not the rehabilitation of a physical injury. This is the rehabilitation of an "emotions". There are significant risks - you could support your partner failthfully, only to have them "fall out of therapy" and revert to their old ways - or - your partner could recover and you could become consummed, broken, or discarded in the process.
~ Facing the Facts.
It is important for any family member or relationship partner of borderline to be able to evaluate how their loved one with borderline personality disorder (BPD) is progressing in terms of recovery.
Some with BPD will not ever acknowledge that they have problems, let alone a personality disorder. Others will, for whatever reason, seek treatment, but not admit to having issues . Still others will seek treatment only when experiencing "fear of abandonment" because others are pressuring them.
Any of the above scenarios aren't likely to effect a high success rate in therapy or the kind of results that are desired and needed.
The most promising situation comes only when a borderline has the personal desire and motivation to change. When your loved one needs to, at the very least, turn suffering into manageable pain, and at the very best, get on and stay on the road to recovery. This motivation must come from deep inside the person with BPD to enter into treatment, and make a meaningful ongoing commitment to it.
You, as a family member or relationship partner, can lead, or in some cases coerce, or even force a borderline to therapy - but you cannot lead, or coerce, or force them to drink it in.
What every Non Needs To Know
A borderlines who is serious about therapy will be responsible enough to make their appointments, be honest with their therapists, and do any and all suggested homework. Borderlines serious about treatment will pursue it, and make a commitment to it.
Anything less than this is a waste of time and money, typically with the borderline just going through the motions to placate someone else.
Some with BPD may want to change but cannot make a commitment, or have the motivation and personal responsibility needed to make it work. If the person with BPD in your life misses appointments, re-schedules them, and/or finds endless reasons why the therapists they've seen is "the problem", "make things difficult" or "just doesnt understand, you are likely dealing with someone who isnt really invested in getting help, or getting better.
How Can You Tell If Progress Is Being Made?
Progress of those with BPD in therapy isnt as easy to measure as you may think it should be.
Some with BPD, despite being motivated and committed to the therapy process, will need longer periods of time to take in information, understand things more, and to create change. Even when a borderline gets it intellectually, there is still a lot of very ingrained and patterned self-defeating and negatively distorted thinking that they must work through. Recovery from BPD is like thoughtfully peeling away the layers of a giant and complex onion, one layer at a time.
So speed alone isnt a way to gauge how your borderlines therapy is going.
While many professionals use common treatment methods, to some degree, no two borderlines walk the exact same path to recovery. The way that each person learns to find him or herself and take personal responsibility is highly individualized both in terms of the process and the amount of time it takes.
In BPD recovery, your loved one may be in one stage or another of recovery for years. It can be a very long and complex process.
The 5 Stages of Recovery
From my own personal experience as a successfully recovered borderline, I believe that it is ultimately the reclamation of "the authentic self" from the "false self in BPD" that must be achieved.
The stages of this recovery, and the language used to describe it, depends on the type of therapy a borderline is receiving, so these terms may vary in your loved one's therapy plan.
Accepting Personal Responsibility (1)- Accepting Personal Responsibility is shifting from other focus to self-focus learning to take personal responsibility for how one thinks and feels and what one needs. Here the borderline begins in therapy begins to accept the challenge of responsibility. Over time this will mean a major shift from learned helplessness and victim-like persona to an emotionally maturing person who is on the road to finding self and identity.
Re-parenting (2) Re-parenting is learning to soothe, and comfort one's self and be ones own emotional container. Here the borderline most often meets with his or her lost, repressed, angry and previously abandoned inner child.
By coupling personal responsibility with re-parenting, your borderline love one can make great strides in emotional individuation and independence. Here the borderline begins to experiment with taking more care of "self" and demanding less from others. The borderline makes efforts to self-soothe and to learn to be alone more. Object constancy issues are also starting to be understood from a new perspective.
A few ways to gauge if your borderline loved one is serious about the treatment includes:
Are they motivated?
Are you seeing any changes at all, even slight?
Are they making their appointments regularly?
Are they beginning to take "personal responsibility"? Is it increasing at all?
Are they doing the work between sessions that they were asked to do?
Are they beginning to catch themselves in ways that they act, speak, or think and try to slow down old patterns or interrupt them and make new choices?
Are they willing to try new things, think new thoughts?
Does their fear of suffering outweigh their fear of change?
Do they have some sense of respect for the therapist and the process?
Does their fear of suffering outweigh their fear of their pain?
Emotion Regulation (Affect & Behavior) (3) In the emotion regulation phase, the borderline begins to deal with his or her triggers and the source of the triggers rather than projecting everything out onto others as an extension of lost "self". Emotional behavior should start to change in this phase. Amidst the stumbles and triggers the borderline begins to slow things down and steer away from ingrained, self-defeating styles of relating (which are often abusive).
The Big Picture and Everything Grey [The Paradox ,The Dialectic of the Wise Mind] (4) Here the borderline crosses the threshold of seeing only "all good/all bad" or "all white/ all black" experiences and begins to see a mixture of dialectical opposites held simultaneously. Borderlines in this stage of recovery begin to see what others have always known , that life is a mixture of happy, sad, good, bad and that the he key to coping is knowing oneself. And "knowing oneself" is having boundaries, respecting others boundaries, and taking primary responsibility for the meeting of ones own needs (i.e., asserting and negotiating needs). In this stage of recovery your borderline loved one will ease away from the ever-so-familiar, destructive and abusive ways of relating with others.
The lessons of phases 1-3 are used to address the lack of "object constancy", the relatively enduring emotional investment in another person. Here, the separation/individuation issues of the borderlines past; specifically the abandonment fear, fears of engulfment, get away closer behavior, I Hate You, Dont Leave Me behavior are examined, and all the incongruence of emotional affect that drove the borderlines polarized ways of thinking, feeling, acting, and relating are explored.
Reclamation of Authentic Self (5) The Reclamation of Authentic Self is the apex and epicenter of recovery. Having a known "authentic self" means that the borderline has done the work of peeling back all the false self layers of archaic, dysfunctional, primitive and narcissistic defence mechanisms that are at the center of why a borderline is borderline. Here the borderline is a "found" emotional adult and is no longer an emotional child. "Authentic self reclaimed" is a place from which a borderline can relate with less intensity, without the unstable always previously present fear of abandonment and/or engulfment. At this point the borderline can cross over into the world of the non borderline.
What Should You Do To Help?
What Should You Avoid?
Recognize that one major aspect of a borderline in serious and long-term therapy is to commit to the goal of individuation. As such, you must support an environment that lets your borderline loved one find the individuation they need to be healthy.
Accept at face value that your borderline loved one is in treatment and that it will make a difference.
Be supportive, but not try to control whether your loved one actually follows through with treatment.
Let your loved one take personal responsibility if change or recovery is going to be possible.
Be aware and ready for what will be required from you when your loved one starts making changes that will lead to recovery. These changes will mean shifts in the way that the relationship works. Even changes for the better can be confusing, feel scary and present a challenge to you in terms of trust.
Emotionally disengage in the outcome of the borderlines treatment. The less you are involved, the more able you will be to take care of yourself and up-hold your own boundaries.
Take a neutral stance to what is said about therapy if it is negative. Listen, do not invalidate but do not really support the complaints or anger or devaluations.
Take a somewhat neutral stance to good news about the therapy process while still strongly validating the borderlines efforts and commitment without crossing that emotionally detached line.
Recognize that one major aspect of a borderline in serious and long-term therapy is to be committed to regulate their own emotions and moods in response to normal life challenges and their therapy. Therefore you must make sure that you do not allow any old patterns between you and the borderline patterns that you also have played a role in to continue.
Dont fall into or get shoved into a parental role with a borderline partner. Do not become the care-taker of your borderline loved one, especially emotionally.
Do not reward "acting in" or "acting out" episodes with the attention they are designed to pull out of you.
Do not get pulled into any issues between the borderline and the therapist. The only time to respond directly to the process of the borderlines therapy is if you are contacted by the therapist.
Dont take any of the responsibility for the borderline in terms of whether or not they stay in therapy, such as making therapy appointments and so forth. Do not act like a prison warden over-seeing your loved one's therapy or therapy homework. Do not lecture, scold, or take your borderlines inventory.
In joint therapy, do not allow yourself to be manipulated or judged or blamed or allow your loved one to put the focus on you.
Be careful not to make unreasonable demands or expect too much, too soon.
Can These Stages of Your Loved One's Recovery Be Measured
Maybe it isnt how you measure recovery or change that matters, but rather that you have reason to invest in or hope for something better than what you have been experiencing in the relationship with your loved one.
In this sense, progress can be measured based upon the degree to which actual changes in the way that your borderline loved one relates and acts in with respect to the staged issues they are working through.
For instance, if your borderline has made progress in Stage 1, personal responsibility you will likely notice that there is less acting out, less blaming, and more reasonable dialogue between you.
If your borderline loved one has progressed to Stage 2 and is continuing to learn and apply the lessons of therapy, you will notice a shift from "clinging need" or "victim behavior" to a more adult focus of taking responsibility for and meeting his or her own needs. Assertion skills and the beginnings of both boundary setting and the recognizing of your much needed-boundaries should also come into play here.
If your borderline progresses through Stages 1,2 and onto Stage 3, you should witness a dramatic drop, if not elimination of, raging meltdowns, blaming verbal abuse, self-harm. The previously self-defeating and destructive choices of your borderline should be finding more healthy expression.
In Stage 4, ironically, you may initially see a return of previously troubling behavior. As the borderline progresses through this very formidable aspect of therapy. It can and does produce a fair bit of cycling around old regressive patterns based upon triggers and the struggle to continue to consistently use new coping skills versus the impulses to resort to older more primitive ways of coping. There are many reasons for this which go beyond the scope of this discussion.
In Stage 5 is when the borderline can enter the world of "average" adult mental health. At this stage it is fair to say one is no longer borderline anymore. However, this is not without its own unique challenges. "Authentic self found" is a major part of what I know to be recovery from BPD. However, that said, once the borderline finds and reclaims this "authentic self" there is still a lot of work to do.
Recovery is not a destination but a starting place from which the journey of the evolving individual continues. One must alter their lifestyle and learn to apply what they have learned in all life's challenges - on the bad days and well as the good.
The recovery from BPD is not by any means a straight line or a steady climb up the side the mountain. It is a journey that involves taking three steps forward, to take two steps back, to then take another step further forward, often, at each stage of recovery, and over and over again within each stage of recovery. You need to look at the big picture, try not to let temporary set-backs produce the fear that your borderline loved one is not progressing.
A.J. Mahari wrote this article for Facing the Fact in 2007. Miss Mahari recovered from Borderline Personality Disorder and is currently a life coach helping others. Her article is based on what she learned during her own 8 year recovery over 15 years ago.
Ms. Mahari began writing about the disorder at the age of 32, at the peak of her struggles. Diagnosed with BPD at the age of 19, and after living a life devastated by this disorder, Ms. Mahari began to make significant progress on her recovery in her mid- 30s, a process that took her almost 8 years to complete.
Ms. Mahari's early life was, in her own words, "a mess", and included leaving an abusive home as a teenager, countless minimum wage jobs, 3 unfinished college degrees (Radio and Television Arts, Journalism, Social Worker), 3 failed relationships, and health problems.
Ms. Mahari, a women devistated by BPD, has turned her life around, starting The Voice Magazine in 1998, with a Southwestern Ontario circulation of 20,000. Mahari's early articles on a multitude of subjects have appeared in Canadian newpapers. Ms. Mahari expanded from the print media to the Internet in early 2000's, publishing 8 e-books that have sold over 1,000 copies . Ms. Mahari has been quoted in numerous books and has made radio appearances on Canadian radio.
Ms. Mahari, who now lives alone comfortably in the Province of Ontario, lives free of the struggles that punctuated her early life. Mahari recently began writing her memoirs.