Wednesday, October 29, 2014

Intervention tidbit #3: Borderline eggshells and land mines

A client is probably about to marry a woman with Borderline Personality Disorder, Persecutory-Type.*  I cannot yet tell if deep within him he actually wants to, or if in the majority he is depressively terrified to lose this lifeline dependency, or if he is little-boy scared to say “no” to the Master.  I suspect all three.

The diagnosis is an educated guess at this point, as I have not seen the woman but have only heard the man’s detailed, anguished accounts of her behaviors over the course of a dozen sessions.  Based on these it is obvious that we are looking at a seamless personality, a mindset, that justifies violence, prisoner-of-war-type monitoring and ownership-level control, regardless of whether her mood is rosy or hellish, if she is idealizing him or devaluing him.

I am not optimistic.  He has asked my opinion and assessment any number of times and I have told him.  It seems not to be what he wants to hear.  I have had to look at him and say – “I can’t help you bend over and stand up at the same time.”  I have actually said a hundred different things from bleak to hopeful, theoretical to practical.  She will need to go into her own therapy.  I wondered to him if we were wrong to talk so much about Borderline and, through him, convey the conjectural diagnosis to her: Maybe she wouldn’t have angrily resisted it had she found it herself, or heard it from a therapist who broached the subject in a nice, delicate way.

The most recent intervention, though extremely simple, may be the strongest, the most cleansing of his battered sickened mind.  The suggestion was to give her his own rendition of this:

“We all have problems, personalities.  Mine is difficult, yours is difficult.  There is no ‘one’ Borderline Personality.  Maybe you qualify for the generic idea of it.  But you are the person I love – that’s the person, or ‘personality’ that I don’t want to change.  But I will not tolerate certain behaviors.  You will not hit me, scratch me, shove me, nothing at all.  You will not try to control me, give me ultimatums, demand to know who I talked to at work.  There will be no unfairness such that you can buy something but I can’t, we go where you want but not where I want, you can do something hurtful now because I had an indiscretion in the past, before we began dating.  And when I hear this kind of blatant irrationality from you that makes no sense in the real world, I will shoot it down and will not watch it get up again.
“For my part, I will continue to be a good person.  But I will be standing up, not bending over.
“Have a nice day.”
The book Stop Walking On Eggshells advises the family member of a Borderline to save himself, guard his self-esteem, help the sick person, “stop taking the Borderline’s actions personally,”  “detach with love,” not “delay your own happiness,” face one’s “issues about being needed,” and more.  I’m sure this information will be helpful to some partners, but it misses essentials.  Howard I. Weinberg, PhD, is quoted: “If you care about someone with BPD, remember that you did not choose the borderline because you are sick.  You chose this person because they were important to you.”**  This is an incompetent and dishonest statement: Psychotherapists should know it is our unhealth that is attracted to unhealthy people: Only a wounded person will be drawn to the persona of a Borderline, a persona informed by underlying severe childhood abort and dysfunction.  Only a sick person will stay with one.  And though I may have missed it in my perusal of the book, I did not see any help for the individual who is yet free and facing the choice and danger of committing to a Borderline.

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* There are no specifiers within the DSM’s description of Borderline.  Christine Lawson poignantly describes the Queen, Waif, Hermit and Witch types (and subtypes), and there may be other writers’ typologies.  It makes sense to perceive that some Borderlines are predominately persecutory, vicious and violent; some more sexualized and without violence; some rageful and self-injurious, etc.

** Paul T. Mason, MS and Randi Kreger, Stop Walking On Eggshells – taking your life back when someone you care about has Borderline Personality Disorder, Second Edition, 2010, New Harbinger Publications, Inc., pp. 96-97. 

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Comments are welcome, but I'd suggest you first read "Feeling-centered therapy" and "Ocean and boat" for a basic introduction to my kind of theory and therapy.