The Essential Family Guide to Borderline Personality Disorder

by Randi Kreger

  Repeat any of the following statements. Don’t argue or try to have the last word. Notice that these statements don’t point fingers at your family member directly:

  • “I want to hear about it, but it’s hard for me when things get too emotional” (instead of “you get too emotional”).

  • “We’ll talk later, when things calm down. I want to give you my full attention, and that’s too hard for me to do right now.”

  • “I can’t listen right now. Not until things are calmer.”

  • “Let me have a little while to calm down and then we can talk.”

  Say to yourself:

  • “I am not going to take this personally. This is the border-lion talking.”

  • “If I stay here and argue, things are going to escalate. If I stay and get beaten down, it’s going to hurt me and the relationship.”

  • “My family member can’t grasp all that right now, but I can. I am deciding to do what’s best, even if it doesn’t feel comfortable right now. It will get more comfortable as I keep doing it.”

  PHYSICAL ABUSE AND SUICIDE

  About 30 percent of men who batter have BPD, and about 50 percent of women who batter have BPD.11 If either physical abuse or threats of suicide are even a remote concern, you will need a safety plan.

  Physical abuse of parents by their adolescent children is a growing national problem, as is physical abuse of men by their female partners. Both are underreported and stigmatized. If your BP has a problem, break the silence and seek help right away. If your family member becomes violent in other ways—for example, breaks things when she’s angry—be on the alert.

  The risk of suicide in borderline individuals is discussed at great length in other books about BPD and elsewhere, so it won’t be repeated here because of lack of space. Briefly, if threats of suicide are an issue, read as much as possible on the subject. If your family member is suicidal and making imminent threats, call 911 or take him to the emergency room. Keep the following phone numbers handy: a local suicide hotline, the nearest emergency room, a nearby psychiatric facility, and the person’s therapist and family doctor.

  Psychiatrists John G. Gunderson and Cynthia Berkowitz say:

  When families see the signs of trouble, they may be reluctant to address them. Sometimes the person with BPD will insist that her family “butt out.” She may appeal to her right to privacy. Other times, family members dread speaking directly about a problem because the discussion may be difficult. They may fear that they would cause a problem where there might not be one by “putting ideas into someone’s head.” In fact, families fear for their daughter’s safety because they know the warning signs of trouble from experience. Problems are not created by asking questions. By addressing provocative behaviors and triggers in advance, family members can help avert further trouble. People with BPD often have difficulty talking about their feelings and instead tend to act on them in destructive ways. Therefore, addressing a problem openly by inquiring with one’s daughter or speaking to her therapist helps her to deal with her feelings using words rather than actions.12

  Use Intentional Communication

  People don’t enter into heated discussions intending to make things worse, yet it happens all the time. We vent our anger, defend ourselves, and try to convince the other person that we’re right and he’s wrong (and possibly ignorant, mean, and unreasonable). The trouble is that even if we get what we want, the cost to the relationship and our own psyche can be high.

  Compared to the “average” person, people with BPD can be much more provoking—and more easily provoked. The costs are higher. The automatic conversational tactics that non-BPs slip into—including defensiveness, finger pointing, blaming, and telling the BP that she’s wrong—trigger splitting-shame-fear spirals that set up family members to be the border-lion’s scratching post.

  Intentional communication is a good alternative to the spout-off-at-the-mouth-and-fight-to-win approach. Instead of talking off the top of your head, guided by intense emotions, you have an underlying intent in mind, such as “calm this person down,” “obtain their cooperation,” or even “build closeness and have fun.”

  Intentional communication gives you an advantage for these reasons:

  • You’re much more likely to reach your objective when you know what that objective is.

  • Even if you don’t reach your objective, you’re heading in the right direction.

  • You feel more in control of the situation because you can better manage your own responses.

  • You’re less likely to say something you regret, something that might make things worse.

  The techniques that follow come under the umbrella of intentional communication.

  Acknowledge What You Hear

  Acknowledging, or more properly empathic acknowledging, is the most powerful communication technique in this chapter; it is similar to the term validation. Lawrence J. Bookbinder coined the phrase on his Web site, “Touch Another Heart.”13 It is a blend of empathy, listening skills, and acknowledging.

  During conflicts, your family member experiences a loss of connection with you. Untethered, she becomes caught up in the splitting-shame-fear spiral. Family members use empathic acknowledging to grab hold of that spiral, to slow it down, and to start to rebuild the emotional connection.

  There are two steps to empathic acknowledging:

  • Step 1: Actively listen to your family member with 100 percent of your attention without interrupting, asking questions, offering solutions, or thinking about what you’re going to say next.

  • Step 2: Separate your BP’s distorted thinking from the intense, overwhelming feelings, and then empathically acknowledge those emotions to your family member without necessarily agreeing with the thoughts that link the two.

  Because empathic acknowledgment does not require agreeing with the thoughts connected with the feelings, it can be used with anyone, from small children who are scared of the bogey monster to veterans who are having a flashback and think they’re in the middle of a battle.

  Also, there is no such thing as too much empathic acknowledging, or validation. Repeat your main message—I care about how you feel—often and in different ways. The border-lion is a little deaf.

  Let’s take a closer look at the three components of empathic acknowledgment: empathy, listening, and acknowledgment.

  EMPATHY

  Empathy is different from sympathy. Sympathy has to do with compassion and commiseration; for example, “I’m so sorry your mother passed away.” Metaphorically, people who express sympathy are like people who drive by the scene of an accident, slow down, give an encouraging expression to the driver of the banged-up car, then speed up and go along their merry way.

  Empathy is emotionally putting yourself in someone else’s place to the point when you can almost vicariously experience the other person’s thoughts and feelings. Metaphorically speaking, people who express empathy pull over, get out of their car, clasp the shoulder of the driver, and say, “Oh wow, I bet this is the last thing you needed to happen right now,” in a way that implies, “I’ve been there, too” (whether or not they actually have).

  Think back to the times when someone has expressed empathy to you. Have you ever been really, really excited about something and rushed to tell a friend, who then gives an enthusiastic “whoop!” and hops up and down a few times? Or, have you ever had a surprising upset, called a friend, explained what happened, and heard the person gasp, “Oh no! How terrible!” almost as if it were happening to him, too? Empathy feels great!

  ACTIVE LISTENING

  Most of the time we listen on automatic. We hear “blah, blah, blah” and other thoughts float in and out of our head. Mostly, we think about how we want to respond. When the topic has stirred up conflict in the past, we may say something and wait, with steam coming out of our ears, for the person to shut up so we can talk again. We filter out what we disagree with or don’t want to hear and focus on whatever affi
rms our own beliefs.

  When we listen on automatic, we miss out on the subtleties of what is being said—or unsaid. We may miss an emotional tone in the voice or a gesture that could have clued us in to a problem. This creates frustrations, misunderstandings, and predictable, predetermined interactions with predictable outcomes.14

  Active listening is powerful because it says, “You and what you say is so important that I’m giving you my undivided time and attention. I am willing to listen to you with an open mind.” This helps you achieve a climate of cooperation, which, hopefully, eventually, the BP will try to create for you.

  Suspend your judgments, opinions, and history with the person speaking. Push everything out of your mind except your family member—you’re about to enter his world. Focus on what he’s feeling as well as saying, with his words, tone of voice, facial expressions, and body language. Resist the urge to make faces if you don’t agree with what he’s saying.

  Sometimes, the splitting-shame-fear spiral is covered by a cloak of invisibility. It’s hard to know what the real issue is. As you listen, be a detective. Just what is going on here? Take note of her feelings—not just the obvious ones, but the ones that might lie deeper. (In the next step, you’ll be rephrasing what your BP is saying, so pay attention.)

  Don’t interrupt. In fact, don’t talk at all unless safety is an issue or you’re confused and need clarification. Bookbinder says, “Advising, comforting, encouraging, and other help-oriented verbalizations interfere with more than the other person’s talking because these verbalizations stem from our thinking about how to help, which interferes with an essential activity of empathic acknowledging—thinking about what the talker’s words mean to her” [italics mine].15If you’re male, watch your tendency to want to jump in and solve problems.

  VERBAL ACKNOWLEDGMENT

  According to validation enthusiasts Gary and Joy Lundberg, the authors of I Don’t Have to Make Everything All Better, responses should be kind, gentle, and respectful with the intent of understanding the other person.16 For example:

  • Use verbal encouragers: “Oh,” “Hmm,” “Really,” “Wow,” “That’s interesting,” “Cool,” or “I see.” These responses show you’re listening.

  • Reflect their feelings: “That sounds (frustrating, sad, scary, wonderful, difficult, exciting).” “I bet that was (difficult, etc.).”

  • Show involvement: “I’m (happy, sad, glad) for you.” “I would feel (confused, lonely, happy), too.”

  • Punctuate intense emotions: “I can’t believe that!” “Oh no!” “How wonderful!” “I’m so sorry that happened to you.”

  Asking validating questions is another form of acknowledgment. The Lundbergs say:

  Asking the right question is vitally important in helping someone discover the solutions to their own problems. Without these questions, they will fall back on, “What should I do?” Remember you don’t have to solve their problem. In fact, you don’t even have the power to solve it.

  You can help, however, by asking the kind of validating questions that will lead them to the exploration of their own feelings and desires, and to their own best solutions.”17

  The Lundbergs, the group NUTS (parents Needing Understanding, Tenderness, and Support to help their child with borderline personality disorder), and others suggest phrases such as the following:

  • What did you do the last time this happened? How did that turn out?

  • What are your options? What are the pros and cons of each one? How does each one make you feel?

  • Would you like me to listen, or are you looking for specific suggestions? How can I help you?

  • Do you have a plan for solving this?

  • What might the first step be in solving this?

  • What does your gut tell you?

  • Is there somewhere you can go or someone you can call to find out more information?

  • What about using a map? The Internet? Going to the library? (and so on)

  • How did you feel the last time this happened?

  • Do you think there could be another way to look at this?

  • You’ve come up with some good solutions in the past. Could something similar work?

  • How would you suggest a friend handle something like this?

  “Why” questions, such as “Why did you do it that way instead of this way?” may bring on defensiveness. Avoid them if you can. Clarifying questions may help you and your family member sift through the splitting-shame-fear spiral to uncover the real issue.

  Ask your family member to be specific, but don’t grill her. You must be genuinely interested, not provoking. Otherwise, you can make things worse. Your sincere willingness to understand her rather than fight her is incredibly validating. It works because it addresses what is most likely the real issue—your family member’s emotional vulnerability. Here are some examples of clarifying questions (put them in your own words):

  • “When you said I sounded angry, what did you mean? Was it the tone of voice or the words?”

  • (When things are vague and you’re just getting raw emotions) “Is there anything I could say or do that would make you feel better?” “What do you think we might do to have less conflict?”

  • (When your BP is making mountains out of molehills) “I really want to understand you, but I’m having trouble appreciating the depth of your feelings about this. Can you try explaining this in another way? I care, I just need to understand better.”

  • (When your BP has been using vague words or phrases such as “You’re selfish” or “You don’t care about me”) “What did you mean when you said that?” “It’s impossible to talk about these in a meaningful way in the abstract. What exactly did I do that showed selfishness? How often did I do it?” “What makes you think I don’t care about you?”

  NONVERBAL ACKNOWLEDGMENT

  Back in the 1970s and 1980s, pioneering professor Albert Mehrabian conducted research that would forever change the way we look at interpersonal communication. He discovered that we overwhelmingly deduce our feelings, attitudes, and beliefs about what someone says not by the words spoken but by body language and tone of voice.

  His research showed that we convey a puny 7 percent of our attitudes and beliefs through the actual words we speak. The rest—a whopping 93 percent—comes from our tone of voice (38 percent) and our facial expressions (55 percent). Furthermore, if our words and body language disagree, listeners will believe the nonverbal communication, not our words.18

  Without nonverbal cues, all we’re left with, essentially, is e-mail—a method so fraught with the possibility of miscommunication that we had to invent the “language” of emoticons to make sure we’re not misunderstood. (For example, typing a sly wink ;) shows we’re just kidding.)

  Research is starting to suggest that people with BPD are better able to read subtle changes in the facial expressions of others.19 Adolescent psychiatrist Blaise Aguirre says, “People with BPD can appear to be incredibly attuned to nonverbal communication to the point where others remark on their intuitiveness.”20

  Nonverbal communication is one of the most powerful—and simplest—ways to communicate with your family member. You can use it by itself to reinforce your verbal message or to correct a mistaken impression. Remember that when it comes to attitudes and beliefs, your body speaks louder than words. Be aware that your body is always communicating something. Make sure you’re “saying” what you mean to.

  Following are some do’s and don’ts for empathetic acknowledging and listening:

  Do’s:

  • Use direct, but unthreatening eye contact that shifts between each eye and the mouth. Your eyes should be soft and steady and show interest.

  • Relax your facial expression (no tightening or scrunching up) with a neutral expression or genuine half-smile—no false smiles that don’t reach the eyes.

  • Uncross your arms.

  • Tilt your head slightly.

  • Nod you
r head slowly to show you’re listening (unless you disagree with what your family member is saying).

  • Relax your body (seated or standing).

  • Keep your arms loose by your sides.

  • If seated, lean slightly forward to show interest. Don’t slouch.

  • Avoid using your legs or feet as a barrier.

  • Be close (avoid having furniture between you), but not too close.

  • When it is your turn to speak, wait a full second and talk at a normal pace.

  • To make your BP feel more comfortable, mirror his body position in a subtle way. (If he’s sitting, you sit. If he’s crossing his leg, cross yours, too.)

  • Touch is the ultimate nonverbal connection. Where and how depends on the type of relationship and the specific situation. Even quick touches are powerful. Take stock of the situation to make sure touching is okay. Be cautious, because it can be misconstrued.

  Don’ts:

  • grit your teeth

  • stare, glare, or look away

  • close your eyes

  • grimace

  • frown or scowl

  • furrow or arch your eyebrows

  • yawn

  • fidget

  • put your leg over the chair

  • tense up your body

  • lean backward

  • look at your watch or the exit

  • tap your foot

  • watch TV, do bills, and so on21

  Don’t Defend

  John G. Gunderson, MD, and Cynthia Berkowitz, MD, say that defensive responses provoke people with BPD because essentially the message is, “Your feelings are wrong.” It is not a good strategy to add feelings of invalidation on top of whatever caused the original upset. They say:

  The natural response to criticism that feels unfair is to defend oneself. But, as anyone who has ever tried to defend oneself in such a situation knows, defending yourself doesn’t work. A person who is enraged is not able to think through an alternative perspective in a cool, rational fashion. Attempts to defend oneself only fuel the fire.

  What that individual wants most is to be heard. Of course, listening without arguing means getting hurt because it is very painful to recognize that someone you love could feel so wronged by you. Sometimes the accusations hurt because they seem to be so frankly false and unfair. Other times, they may hurt because they contain some kernel of truth.22