Borderline Personality Disorder
Borderline Personality Disorder is a crippling and disabling psychiatric condition that comes from a persistent and negative pattern of thoughts, feelings and behaviors, which then lead to negative inner feelings and negative self-defeating behaviors.
GROUP A: Negative Inner Feelings are troubling and distressing and include the following:
- A chronic fear of real or imagined abandonment
- A poor sense of identity with feelings of worthlessness and unworthiness
- Severe depression and anxiety
- Repetitive patterns of negative thinking/feeling that aggravate feelings of desperation and irritability leading to repetitive, impulsive, self-defeating behaviors
- Poor concentration and inability to complete essential tasks
- Chronic feelings of emptiness
- Inappropriate and intense anger
- Stress-related experiences that lead to feelings of paranoia, de-realization and de-personalization
- Thoughts of suicide
GROUP B: Negative Self-Defeating Behaviors include the following:
- A pattern of intense, unstable negative relationships that alternate between extremes of idealizing or devaluing another person
- Irritability and frustration leading to impulsive and self-damaging behaviors in spending, sexual acting-out, substance abuse, reckless driving and binge eating
- Suicidal behaviors including suicidal threats, gestures and attempts
- Self-harming behaviors (e.g. self-mutilation and other risk-taking behaviors)
- Frequent displays of anger and recurring provocations of physical fights and confrontations
- Excessive alcohol and drug use leading to dependence and addiction
If you have 5 or more symptoms in Group A and 3 or more symptoms in Group B, you may have Borderline Personality Disorder (BPD). You can see that at best, BPD complicates relationships, and at the very worst, destroys them. If you think you may have BPD, Sherwood Couples Counseling can help. Please read on to improve your life and your relationships.
Steps in the Treatment Process
Dialectical Behavior Therapy (DBT) is a special treatment approach for BPD and we will organize your treatment plan around six stages with individualized goals for your specific needs. For detailed information about each of these stages, click the icon on the right side of each of the areas listed below.
Confidential Assessment Interview
We will focus on your mental and behavioral health history and together, assess the presence and the severity of conflicted inner feelings and negative self-defeating behaviors as described above and how these feelings and behaviors impact your life and your current relationships. We will stress the importance of stabilizing these negative feelings and behaviors before we begin the rigorous work of doing Couples Counseling. We will also assess the presence or absence of suicidal thinking and detail the necessity of safety where you acknowledge that you are “not currently suicidal” and that you will follow a stipulated ‘Safety Plan’ should you begin to have suicidal thoughts. Finally, we will agree on a psychiatric referral to insure that you have the benefit of appropriate medications before we start our work.
Mindfulness
Mindfulness is the core for each of the treatment stages and the foundation for you to learn to tolerate the powerful emotions you will feel when you challenge old habits and when you are exposed to distressing emotions or situations. Mindfulness comes from the traditional concepts of Buddhist meditation and although it does not require particular religious or metaphysical ideas, it does ask that you give mindful attention, without judgment, to living and being in the present moment while openly and honestly experiencing your emotions. You will learn to ‘observe’ and experience yourself and your environment in a way that is non-judgmental and that is consistent with your truth and your reality.
Distress Tolerance
Our approach will be to focus on past, current and changing events and circumstances that continue to be stressful for you: on-going marital conflict; the death of a loved one; conflict with a parent or child; the loss of a job or career; a serious illness; addiction to alcohol and drugs; a sexual assault; a terrorist attack; exposure to combat and military hostilities and other traumatic events. You will learn to focus gently on the truth of your life, to find meaning in that truth, and to bear your pain patiently and skillfully. You will learn to build tolerance for distress with mindfulness skills and you will learn to accept without judgment or evaluation, the distressing feelings and circumstances that make up your life. You will learn that taking a ‘non-judgmental’ position does not mean you approve of or are resigned to your distressing situation, but only recognize and accept your reality. This will allow you to face your truth rather than avoiding it and more importantly, allow you to develop healthy coping skills and make wise decisions about your situation rather than falling into intense, desperate, and often destructive emotional reactions that are part of your ‘Borderline’ past.
Emotional Regulation
Because of your disorder you are likely to have frequent emotionally intense, unstable and impulsive situations, built around intense feelings of anger, frustration, depression and anxiety, especially if you have had prior suicide thoughts or suicide attempts. In our training, you will learn to:
- Identify, label and appropriately express your emotions
- Identify obstacles to changing your emotions
- Reduce your vulnerability to overwhelming emotions
- Increase positive emotional events
- Increase mindfulness to current emotions and past events
- Face your fears responsibly rather than denying and avoiding them
- Apply distress tolerance techniques
- Find meaning in current emotions and past events
- Keep a journal to record your progress
Maintain Sound Physical Health
Because you understand that sound physical health promotes healthy emotions, you will agree to:
- Seek treatment for physical illness
- Eliminate unhealthy foods, drink plenty of water and eat a balanced healthy diet
- Avoid mood-altering, de-stabilizing non-prescription and illegal drugs
- Get 8 hours of restful sleep
- Engage in physical exercise to improve body image and release endorphins
- Do one thing each day to build competence and control
Interpersonal Effectiveness
As you move through the treatment process you will be able to identify and distinguish the 4 main styles of social and interpersonal behavior and the underlying non-verbal messages that your behaviors express about interpersonal conflict.
MY BEHAVIOR WHAT I DO WHAT IT SAYS
| When I am Passive | I turn my anger on myself | That I don’t matter |
| When I am Aggressive(Verbally and Physically) | I turn my anger against you | That you don’t matter |
| When I am Passive-Aggressive | I express my anger indirectly by avoiding you, withholding what you need from me, and by manipulating you | That we don’t matter |
| Assertive | I turn toward you with respect, with hope and with love | That we both matter |
Learn New Skills
You may already be able to describe effective behaviors when discussing another person’s situation but you may have difficulty applying similar behavioral responses for yourself. As we work together, you will discover the skillful benefits of becoming more assertive: asking for what you want and need from others; being able to say “no” when you can’t give what others ask of you. These skills will reinforce your good feelings about yourself and will help you to cope more effectively with interpersonal conflict. You will learn to make clear requests for what you want and you will learn to resist changes that are not in your interest to accept. The skills you acquire will maximize your ability to get what you want and need without changing or damaging your relationship with yourself or with others. Here are a few of the new skills you will learn:
- Describe thoughts, opinions in a clear concise way
- Express your feelings
- Assert yourself by clearly asking for what you want and need
- Reinforce your position by offering a positive consequence
- Be mindful of what you want and ignore distractions
- Appear and act confident even if you don’t feel confident
- Negotiate with an unwilling person and be able to reach a compromise
- Use appropriate language without resorting to verbal attacks or sarcasm
- Listen respectfully and maintain good eye contact when the other person is talking
- Show understanding and empathy for the other person’s position
- Be calm and comfortable during your conversation
- Be fair to yourself and the other person
- Apologize once, if an apology is appropriate
- Be true to your values
- Always be truthful
One final word: to surrender old, worn-out dysfunctional habits may feel “un-natural” and may make you feel more vulnerable as you let go of what is customary and familiar. Very soon, you will see that those early habits were coping mechanisms, not very good ones, but they helped you survive in those early years in the midst of so much pain, confusion and uncertainty. You will be challenged in treatment to trust what you know is right rather than what feels right! Ultimately you will learn to trust yourself, then to trust others and eventually you will learn to trust what it means to live in an uncertain world in times that are no less uncertain. It is time to heal and to know that a world of hope and promise await you. Begin your journey now to free yourself from the negative inner feelings and negative self-defeating behaviors that rob you of the intimate relationships and the joy of living you deserve.