7 Tips for Working with Clients with Borderline Personality Disorder
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:
Understanding Borderline Personality Disorder in Family Law Cases
Understanding Borderline Personality Disorder in Family Law Cases ©2018 Bill Eddy, LCSW, Esq. The diagnostic manual of mental disorders (DSM-5) tells us that up to 5.9% of adults in the United States has borderline personality disorder (BPD).[1] When someone with this disorder is involved in a family law case, especially involving decisions about child custody and access, there is often a great deal of emotion, frequent professional conflict and numerous decision-making procedures that each barely resolve the conflicts (negotiation, mediation, court hearings, evaluations, counseling, etc.). It helps to understand BPD, in order to manage these cases better. What Is BPD? Borderline personality disorder is a mental health disorder with many of these types of symptoms: Fear of abandonment, unstable relationships, unstable self-image, impulsiveness, self-harming, wide mood swings, feeling empty, sudden and intense anger, and paranoid thoughts. However, personality disorders (there are ten in the manual) are typically not obvious at first until someone is in a close relationship or involved in a conflict. Often, in romantic relationships with someone with BPD, there is an intense and exciting romance, followed by making fast commitments, then a turn for the worse as conflicts and chaos take over both people’s lives. There is lots of blame, yelling, sometimes hitting and other forms of domestic abuse. All of this is often interspersed with periods of friendly and caring (and sexual) behavior. It can feel like a roller coaster and can be very confusing for both people. In many cases, only one person has this disorder and the other person doesn’t have this disorder (or another disorder), and is caught by surprise at the suddenly extreme behavior. In reality, the BPD sufferer has a “dual persona.” It’s all part of the same personality, but there is the public persona, which seems really great, and the private persona that may be involved in abusive verbal and/or physical behavior. Sometimes it takes up to a year to realize that a partner has this problem, because they can be very charming, exciting and loving at first. Therefore, people are encouraged to wait at least a year before making major commitments, such as getting married, having children or buying property together. Why Do People Have BPD? No one chooses to have BPD. There are three basic potential causes: Heredity: People are born with a temperament and genetic tendencies. This may be the biggest factor. They may have ancestors who were intensely adversarial in order to survive during wartimes and other adversities. Fearing abandonment may have been a very good motivator for survival, such that holding tightly onto mates and children would have been good for the family’s survival. Fierce jealousy, clinging behavior, anger at a partner’s and child’s independence may have been helpful to keep the family together through thick and thin. (In her new book, The BIG Book of Borderline Personality Disorder, Shehrina Rooney says she believes she was born with BPD, so she may have this genetic history somewhere in her background.) Early childhood trauma: The first five years of life are when personality development mostly occurs. Insecure attachments between parent and child can often be identified in the development of borderline personality disorder. A secure attachment is necessary to learn emotional self-control (self-regulation); gain a sense of confidence in oneself and trust in others; recognize differences between people and what others are feeling; learn to tolerate stress; learn give and take in relationships; and to learn how one affects other people in order to adapt and change one’s own behavior for greater social success. With an insecure or abusive parent, these essential lessons are often not learned, and unsuccessful or abusive behaviors are learned instead. Cultural influences: Our modern entertainment cultural relies heavily on images of dysfunctional relationships in movies, in TV shows, on the news, on social media, etc. These include lots of relationship manipulation, violence, impulsive acting out, yelling, throwing things, storming out of rooms, etc. It’s as if our culture is intentionally teaching borderline personality disorder behaviors. But it grabs our attention and gets us to watch, so it sells advertising and it won’t be changing anytime soon. For someone with genetic tendencies to have BPD traits, or who grew up in a very inconsistent household, these behaviors may be seen as the way to have normal relationships. (She shows her love and commitment to me by keeping track of my every move. He shows his love and protection for me by slapping me when he thinks I’m getting out of line. Isn’t this what everyone does?) Is There Treatment for BPD? Yes! Over the past thirty years, treatment methods have been developed that teach daily living and self-management skills and have been having a lot of success with people who are willing to commit to a few years of therapy. The most well-known and wide-spread method is Dialectical Behavior Therapy (DBT). There are therapists in most big cities and some smaller communities who have been trained in this skills-building approach. Whatever method is used, it’s important to have a therapist who is personally secure and can be emotionally stable in the face of the chaos and anger that those with BPD bring to therapy. Therapists trained in more standard psychodynamic therapy can be good with BPD if they are also good at staying calm and teaching some type of self-help skills. Just supportive therapy can actually make things worse, if they reinforce blaming comments, say their behavior is normal or justified, and join in focusing on the behavior of other people in their lives. Unfortunately, many therapists inexperienced at treating BPD often believe their clients and reinforce their problematic behavior, rather than helping improve it. Handling a Family Law Case involving BPD Given the dynamics of borderline personality disorder explained above, there are many mistakes that family law professionals commonly make. Here is a list of 10 Do’s and Don’ts: 1. Don’t try to give someone with BPD insight into themselves and their dysfunctional behavior. This just reinforces their defensiveness, triggers their
The Trouble with Making Decisions
© 2014 By Bill Eddy, LCSW, Esq. The following is an excerpt from the book: The Future of Family Court: Structure, Skills and Less Stress The Trouble with Making Decisions in Family Court Most judges like making decisions and are very good at it. However, with high-conflict people, the issue’s not the issue! As the case in Chapter 2 demonstrates, with HCPs the issue is their personality-based lack of conflict resolution skills and insecure relationships. They bring one issue after another to court for the judge to decide. Ironically, the better you are at making decisions for them, the more likely they are to depend on you for more in the future. Yet the court never satisfies them – and cannot satisfy them. What they are really looking for is: Vindication – that he or she is the “good parent” and that the other parent is the “bad parent,” for everyone to see, once and for all. Court is where vindication is officially bestowed in our society. (Particularly characteristic of Borderlines.) Respect – to make up for all the disrespect the person has received in his or her life. Court is where one can prove that he or she is a superior person and that the other parent is grossly inferior in every way. Being granted custody is the ultimate award. (Particularly characteristic of Narcissists.) Revenge – for abandoning the relationship, which may have been the most secure relationship the person ever had. Humiliation in the public process of Court is the most powerful weapon in today’s society that is accessible to anyone. (Characteristic of Borderline, Narcissistic, and Antisocial HCPs.) Protection from internal fears – to help insecure people feel safe from their frequent and extreme fears. Court has the power to lock people up, keep them away, and teach them a lesson so they will stay away forever. In today’s frightening world, the courts will protect you. (Characteristic of Paranoid HCPs.) Dominance – to put the other person in their place and dominate them again. Court is where one can regain control of someone who is beginning to act too independent. He or she can draw the person back into their life by serving papers requiring attendance at hearings, by serving subpoenas, by taking depositions, by delivering documents requiring responses, by demanding hundreds of personal documents, by seeing each other at court for hearing after hearing. (Characteristic of Antisocial and Borderline HCPs.) Attention – to finally be able to tell one’s story to the person with all the power. To have one’s “day in court.” Court is where one is allowed to freely use all of the drama one can muster, including tears, anger, charm, vulnerability, witnesses and evidence on one’s behalf to exclusively focus on blaming an “all bad” person. (Particularly characteristic of Histrionic HCPs, but all of the above.) It is for these reasons that you don’t want to create a dependency on you for making their decisions. You cannot get it right, because you are missing the point. The decisions they want are based on feelings – such as feeling vindicated, protected, dominating of the other party. Since legal decisions cannot meet such personality-based feelings, they will never be satisfied in court. Strongly Promoting Settlement Hopefully by now it is clear why I am promoting settlement efforts in cases of HCP parents – who lack settlement skills. This is a huge opportunity for family courts to help children by requiring their parents to learn conflict resolution skills and to practice them in their parenting and at court. This may only be at a very minimal level, but this must become an expectation of the court. When judges and other professionals make brilliant decisions for parents, it removes the motivation for them to learn to make any decisions themselves for their family. Therefore, judges should repeatedly quiz parents on what they have learned and how they have practiced their skills. The more that judges send the message that settlement is the standard expectation, the more that parents will try to fulfill that expectation. Praising them for their successes means a lot to HCP parents, who are constantly looking for validation from the court. It’s better to give validation for small successes in reaching agreement with the other parent, than for big “wins” against the other parent. Treatments for personality disorders have been showing us that many HCP parents may be able to change, with sufficient structure, learning small skills in small steps, and enough encouragement. Therefore, courts should shift the burden to parents to acquire and practice their skills in making decisions about their children. Judges should resist the urge to just make the decision for them, as much as possible. Bill Eddy is a lawyer, therapist, and mediator. He is the co-founder and Training Director of the High Conflict Institute, a training and consultation firm that trains professionals to deal with high conflict people and situations. He is the author of several books and methods for handling high conflict personalities and high conflict disputes with the most difficult people.