Borderline personality disorder The cure (Part two)
Psychotherapy by GrahameMilton-Jones
Treatment for Borderline BPD is a learned condition (or a failure to learn properly) and therefore it can be unlearned. The past only defines the person until they define themselves. This means that it is not the fault of the sufferer if they have BPD, but it is their responsibility to resolve it.
A part of the process of recovery is to learn about themselves. It is important that they develop a realistic self-image so that they can feel better about themselves. It is of no use having a low or inflated self-image; it must be based on proper principles and not just on appearance, wealth or fame.
Along with other organisations, the National Health Service recommends a variety of treatments for BPD. The main ones being:
Dialectical behaviour therapy (DBT). A behavioural therapy incorporating mindfulness (meditation training) based on skills training to increase coping skills. It involves the idea that a non-supportive environment has contributed to the development of BPD in early life, leading to emotional dysregulation.
Mentalisation based therapy (MBT). Mentalisation is a psychological skill, and refers to the ability to consider one’s own and other’s mental states (emotions, wishes, beliefs and so on) in making judgements about situations. People with Borderline have more difficulty processing facts in some situations.
Therapeutic Community (TC). A treatment for personality disorder involving mutual support, care and challenge in a group based environment. TCs are also used in the treatment of addictions. Locations of possible NHS funded therapeutic communities can be found at: www.bpdworld.org/therapeuticcommunities.html.
Art Therapies. These include art therapy, dance movement therapy, drama therapy and music therapy.
Transference-Focused Therapy. This is a psychoanalysis therapy based on the theories of Freud.
Borderline is treatable but medication may be needed at the outset to enable the powerful, raw emotions to be tamed. This enables the talking therapies to begin. It must be stated that anger is a major problem with sufferers and the anger triggers can only be dealt with when the person is calm.
In all cases, the relationship between therapist and client is key. The therapist must be seen as an ally and not an adversary. This problem often arises due to the paranoia of the Borderline character, believing that the therapist must take sides, either with the client or against them.
A further problem arises with therapists, and that is burnout. The success rate for BPD is relatively low, not much better than that for schizophrenia and due to the nature and presenting condition of the client progress is difficult. Some therapists see the lack of improvement as frustrating and may even end the therapy due to lack of progress. The choice of therapist is therefore vital; the wrong or inexperienced therapist may inadvertently make the condition of their client worse.
The key to successful therapy must be to let go of past grievances and focus on the present. Old thinking habits must therefore be challenged and experience all present emotions with perspective and proportion. As a part of the process, facts must be discussed excluding judgements such as “good, bad, unfair” etc.
Many Borderline sufferers grew up in an environment where their emotions were either dismissed, told that they had no right to feel that way, or that they were being silly. The result was that they grew up feeling worthless and guilty for having such feelings. Powerful emotions therefore make the sufferer feel that they are bad. The overall aim of psychotherapy is to break the cycle of rejection, worthlessness and failure, but to experience their emotions in a more measured way.
Recovery Recovery is often difficult and takes time; the mainstream therapies mentioned above can go on for years, and in-patient care can be for between one and two years. Some of the issues of recovery include:
1 Borderline people may feel uncomfortable in normal company, more like aliens.
2 The familial pattern must be broken, or they may pass on BPD to their children.
3 A good idea during treatment may be to admit to their family that, “I am feeling rejected right now”. This will teach their family how to rephrase and recognise triggers that will illicit an angry response.
4 It is useful for parents to understand that they do not have to be right all the time. Sometimes it is better not to contradict or correct unless really necessary.
5 Recovery from BPD must be seen as a marathon and not a sprint.
6 Those with BPD are extremely sensitive in the same way that rubbing a bad burn with sandpaper is sensitive. Those in contact with BPD should not walk as if on eggshells, but be aware that highly sensitive antennae are tuned into every word, looking for hidden meaning.
7 Borderline people should look for ways to soothe themselves such as playing music when aroused.
8 Relaxation techniques must be investigated and adopted in an attempt to slow down or minimise the explosions.
9 In addition to psychological support, it is important to look after the body, so correct eating, avoiding drugs and alcohol; sleep and exercise are important.
10 Borderline people should be encouraged to be gentle with people. Many BPD sufferers have a fearful temper and can frighten their friends and family.
11 They should be willing to apologise (only once), remember to adhere to their moral code and be truthful.
12 Criticism must be given carefully; their behaviour can be criticised but not their character.
13 Everyone, including the BPD sufferer should remember that being constructive is more important than being right.
14 Success rates are dependent on the ongoing commitment of the BPD sufferer.
Close It would appear that Borderline Personality Disorder is certainly something to avoid, because once acquired, it is hard to remove. Once it is in a family, the likelihood is that it will be passed on. Though recovery rates are low, this must be seen in the light of very low support levels. If support levels were increased, the numbers of recovered Borderline sufferers would improve. Where support is available, the results are encouraging, once an accurate diagnosis is made. For more information call Grahame on 96 540 5631 or visit the website www.san-luis-clinic.co.uk