7 Tips for Working with Clients with Borderline Personality Disorder By Bill Eddy, LCSW, ESQ
7 Tips for Working with Clients with Borderline Personality Disorder
© 2019 Bill Eddy, LCSW, Esq.
Click below for audio dictation of the article, or scroll down to read.
Clients with borderline personality disorder (BPD) suffer from constant “emotion dysregulation” (wide mood swings, sudden anger, unnecessary suspiciousness, inappropriately intense excitement, misplaced loving feelings, etc.), as the accompanying article by Shehrina Rooney describes. This is not something over which they have conscious control, unless they are learning to regulate their emotions in some form of therapy. In fact, such emotion dysregulation is at the heart of most of their problems in relationships, with romantic partners, family members and professionals. With this in mind, here are seven tips for those working with someone with BPD:
1. Stay calm.Even though your client may be on an emotional roller coaster doesn’t mean you have to be. If you can maintain a friendly, calm and reassuring tone of voice and body language, then your client will often calm down as well. They will mirror your emotions. In other words, if you get angry at your client for being angry, stubborn, unreasonable, self-contradictory and so forth, you will reinforce their out-of-control feelings and make matters worse.
2. Be empathetic.In our High Conflict Institute trainings we teach EAR Statements®as a method of calming and connecting with upset clients. EAR stands for Empathy, Attention and Respect. A statement that includes EAR generally feels good and helpful to anyone who is upset. Those with BPD especially like the empathy part, because they so often feel criticized, rejected, alone and like no one could care about how they feel. So emphasize statements that show empathy and compassion, such as: I see how frustrated you are. That must be hard. I’ll work with you on this. This is a confusing situation. I know these are big decisions in your life. I want to help you.
3. Focus on the future.In general, those with BPD frequently create conflicts, crises, chaos and fear in their lives without realizing it and without understanding their part in causing these situations. If you focus on their past behavior—or allow them to get stuck in the past—you will simply reinforce these problems and likely make them worse. Instead, acknowledge that the past was difficult, but focus on what the person can do now.
4. Don’t focus on feelings. Since their emotions are so hard to manage, it’s best to help them focus on what they think and on tasks. Avoid asking them how they are feeling, because they are usually feeling helpless, vulnerable, weak, out-of-control, and like a victim-in-life. Put them in touch with their feelings and you are likely to get out-of-control feelings. When making decisions, ask what they think about that, rather than how they feel about that. Don’t ask them why they did an undesirable behavior yesterday or last month. They often don’t know why and it will probably put them in touch with their deep sense of shame or anger about what they did.
5. Don’t try to change them. You might think that you see the key to solving many of their problems: Just stop doing this or that behavior! But this will tend to backfire on you. First of all, they have a barrier against having insight into themselves (that’s part of the disorder), so that your “constructive feedback” will not get them busy thinking and reflecting on their past behavior. Instead, it will get them busy defending themselves. Secondly, it will damage your working relationship with them because it will feel to them like you do not like them; that you think there is something wrong with them so much so that you are criticizing their past behavior instead of accepting them as they are. They are so used to a lifetime of this type of constructive feedback, that they will surprise you with how angry it makes them feel. Your relationship may never fully recover after such feedback.
6. Focus on their choices now.Instead of opening up a discussion of how awful everything feels or what they should have done differently in the past, focus on what their choices are now: their options or alternative. By focusing on the choices ahead of them, they don’t have to defend themselves about the past. You can give your advice about what you think is the better choice, but recognize that they have a choice. Since people with BPD really don’t like to be told what to do—they have a lifetime of experience with that—having a choice is empowering and respectful of their decision-making process. Would you like me to help you with that or would you like to try it yourself? Please let me know, Yes or No, by Thursday at 5pm. The reality is that you can’t control another person’s behavior, but you may be able to control your consequences, positive or negative, for their behavior. It may be helpful to tell them about the potential consequences of each choice, but do it in a friendly manner so that it doesn’t sound like a threat.
7. Create a sense of us.Rather than getting into conflicts or expressing your frustration with the client, try to create a sense of us: “building a team against the problem,” rather than creating a feeling of “me against you.” Keep the focus on what to do next and how it will help. Avoid expressing anger at these clients, as it can trigger intense, unmanaged emotions within them. They can usually do anger better than you can. And if you do get angry at them, try to recover quickly and explain how it wasn’t your intention to criticize or blame them and that you want to focus on the next task. Avoid putting energy into defending yourself. They carry most of their problems inside of themselves, so that many of your conflicts will be caused by them—but they can’t see it or accept it. Just remind yourself: It’s not about me, and focus on the next task.
In short, it is possible to manage a working relationship with someone with BPD, if you abide by these general principles. Just manage the relationship and focus on what you need to do to help them solve their own problems with your assistance.