When someone asks me what is single most important life skill for supporting a loved one with borderline personality disorder, I say "empathy". I typically follow with "and many of us overestimate our own empathy skills".
What is empathy?
Empathy is often confused with sympathy. Empathy it is distinctly different. Empathy is the experience of understanding another person's condition from their perspective. You effectively place yourself in their shoes and feel what they are feeling. Seeing things from another person's perspective isn't simply understanding their point of view -- it extends to understanding why they feel their point of view is just and appropriate and fair.
So, when your loved-one returns from a therapy appointment and proclaims "I really like this one", it's most likely related to the therapist's ability to empathize and communicate it. We will not be able to motivate, coach, lead or redirect anyone without having this knowledge, too.
In a research funded by the US National Institute of Health and sponsored by Mount Sinai School of Medicine, New York, NY, (Family Influences on Borderline Outcome) Perry Hoffman, Ed.D. from found the #1 predictor of recovery of Borderline Personality Disorder is the presence of a caring and empathetic person in the patient's life. The researchers were surprised with this finding.
It is also worth noting that the architects of the Personality Disorder work committee headed by John M. Oldham, M.D. recommended that a personality disorder be diagnosed when a person has diminished skills in two of the following -- either "empathy or intimacy" and either "identity or self direction". This raises two practical issues for us.
First, our loved-one may very well have impaired empathy skills and so we don't want to mirror that back as a way to "teach them a lesson".
Secondly, we may have had a parent that wasn't very empathetic and in turn, we didn't develop effective empathy skills ourselves. We may need to become very deliberate in developing empathy skills now and seek the advice of others to help us to better "step in the shoes" of our loved-one.
This 3 minute video is a good starting point. Empathy is the experience of understanding another person's condition from their perspective. You effectively place yourself in their shoes and feel what they are feeling.
Empathy is the experience of understanding another person's condition from their perspective. You effectively place yourself in their shoes and feel what they are feeling.
Set Aside Personal Beliefs, Concerns and Agenda - Just for now, at least. Go into the conversation empty handed—with no personal expectations or goal of fixing anyone. Be willing to have your mind and perspective changed. Your only agenda is listening and trying to understand the other’s point of view.
Remove Ourselves / Gain Perspective - When you take things personally, you cannot separate yourself enough to feel the other person’s pain. Detach enough so that you are not in a emotionally heightened state— do not allowing the other person’s behavior to upset you or trigger you.
Be Present/ Be an Active Listener - Listen to the person in the moment, truly utilizing the skills of actively listening. Don't jump ahead, re-frame what they are saying and compare it to a personal experience you had, don't rush to project ahead, or to frame a response. When we do this we completely lose sight of the reason of our conversation in the first place, sharing information as a means to build, maintain and sustain the relationship.
Getting Beyond the Facts / Relate - When the other person begins to share, focus on their feelings. Think of situations that you’ve experienced in the past that are similar. Just think about this - connect with it - don't share it. This will deepen your emotional insight into the other person’s plight.
Talk to the Person's Inner-Child - When we visualize our child as their vulnerable inner-child we can lower and lessen our defenses, that will then allow us to want to preserve the relationship and communicate in an effective way.
See Empathy as a Lifestyle, Not an Event - Make an effort to heal the past hurts, to remember to accentuate the positive, and to nurture the relationship on a daily basis. Most importantly, be mindful that when we are angry we can do a lot of damage and set things way back.
Assess Your Empathy Level
The five levels of empathy as defined by the DSM 5.0 architects are listed below. Want to know where you stand? Ask someone very close to you - ask your children - don't make a self-assessment.
Helping each other to grow to be more empathetic is one very important way we help each other at BPDFamily.com
Healthy (0) Capable of accurately understanding others’ experiences and motivations in most situations. Comprehends and appreciates others’ perspectives, even if disagreeing. Is aware of the effect of own actions on others.
Mild impairment (1) Somewhat compromised in ability to appreciate and understand others’ experiences; may tend to see others as having unreasonable expectations or a wish for control. Although capable of considering and understanding different perspectives, resists doing so. Inconsistent is awareness of effect of own behavior on others.
Impaired (2) Hyper-attuned to the experience of others, but only with respect to perceived relevance to self. Excessively self-referential; significantly compromised ability to appreciate and understand others’ experiences and to consider alternative perspectives. Generally unaware of or unconcerned about effect of own behavior on others, or unrealistic appraisal of own effect.
Very Impaired (3) Ability to consider and understand the thoughts, feelings and behavior of other people is significantly limited; may discern very specific aspects of others’ experience, particularly vulnerabilities and suffering. Generally unable to consider alternative perspectives; highly threatened by differences of opinion or alternative viewpoints. Confusion or unawareness of impact of own actions on others; often bewildered about peoples’ thoughts and actions, with destructive motivations frequently misattributed to others.
Extreme Impairment (4) Pronounced inability to consider and understand others’ experience and motivation. Attention to others' perspectives virtually absent (attention is hypervigilant, focused on need-fulfillment and harm avoidance). Social interactions can be confusing and disorienting.
John M. Oldham, M.D. is Senior Vice President and Chief of Staff The Menninger Clinic; Professor and Executive Vice Chair Menninger Department of Psychiatry and Behavioral Sciences Baylor College of Medicine; Immediate Past President American Psychiatric Association
Perry D. Hoffman, PhD, is president and cofounder of the National Education Alliance for Borderline Personality Disorder (NEA-BPD). Hoffman has several grants from the National Institute of Mental Health (NIMH) with a focus on families.
Scott Peck, DD earned his Masters Degree in Education and Doctorate in Divinity (Divinitatis Doctor) and has worked professionally as an educator, national advertising manager, reporter, photographer, copywriter, & real estate broker.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders (2013, 5th ed.). Washington, DC.