The Essential Family Guide to Borderline Personality Disorder

by Randi Kreger

  Safety First

  When Ken wrote a letter about limits to his wife, Andrea, she called him up at work. As Ken puts it, “She attacked me for twenty minutes, questioned me like a police interrogator. I felt as if I was in front of a firing squad.” Ken stayed on the phone and tried to reason with his wife—a bad idea, as you now know.

  Safety comes first, as always. Remember, once someone with BPD reaches a six on a one-to-ten measurement of emotional intensity, he may not be able to calm himself down. You can say, “Let’s take a time-out,” or, “I’m not at my best now.” Gunderson and Berkowitz, who are experienced in treating lower-functioning conventional BPs, say:

  Do not tolerate abusive treatment such as tantrums, threats, hitting and spitting. There is a range of ways to set limits on them. A mild gesture would be to walk out of the room to avoid rewarding the tantrum with attention. A more aggressive gesture would be to call an ambulance. Many families fear taking the latter step because they do not want an ambulance in front of their home, or they do not want to incur the wrath of the person having the tantrum.

  When torn by such feelings, one must consider the opposing issues. Safety may be a concern when someone is violent and out of control. Most people would agree that safety takes priority over privacy. Furthermore, by neglecting to get proper medical attention for out-of-control behavior, one may turn a silent ear to it. This only leads to further escalation. The acting out is a cry for help. If a cry for help is not heard, it only becomes louder.16

  Use the DEAR Technique

  Researcher Marsha M. Linehan has developed a set of skills for communication between people with borderline personality disorder and those who care about them. The acronym is DEAR, which stands for Describe, Express, Assert, and Reinforce.

  As you go through these steps, use empathetic acknowledgment and the other communication techniques from the last chapter. It’s vital to keep everything you’ve learned in mind: the biological reasons for the disorder, the shame and fear the BP feels, and so on. You may wish to reread the empathy exercise in Chapter 7.

  If you have been wishy-washy in the past, you may wish to acknowledge that and say something like, “We’ve spoken about this before, but I’ve come to realize I’ve been giving you mixed messages about this. That wasn’t fair to either of us.” Acknowledge that everyone in the family has a right to identify their own limits and needs.

  Describe the situation as you see it in a factual, unemotional manner. “You call me more than a dozen times at work each day. It distracts me and makes it hard to focus. I share an office, so other people can hear, and I’m not supposed to take personal calls at work.”

  Express your feelings or opinions about the situation clearly. “I am feeling really frustrated because I’ve told you before that this can’t continue. When I am at work, I have to stay on task.”

  Assert your limits, making them simple. The limit should be small, attainable, and realistic. “I can take two or three calls a day. I can’t take any more calls than that unless there is an emergency.” Keep repeating this limit until your family member hears you. Come back to it again and again.

  Reinforce the benefits of your limits, if appropriate. This will work much better if you have been able to create a climate of cooperation. “We can talk when I get home. I won’t feel so frustrated because I’ll be able to work, and you will feel less frustrated because I won’t have to tell you I can’t talk.”

  Don’t Ask Permission or Overexplain

  What you don’t say is just as important as what you do say. If, after previous discussions, you felt as though you had been agitated through a washing machine, unsure about why things got off track, you probably made the mistake of asking permission to set the limit instead of stating your expectations. This is by far the most common mistake that people make. It may take some effort and a change in attitude to eliminate the urge to overexplain.

  To avoid being pulled into an argument about your limits, you must let go of your compelling need to make your family member agree with you. Don’t overexplain or defend. To that end, minimize the word because, especially if it seems as though your family member is likely asking questions so she can refute or poke holes into any explanation you give. Don’t get pulled off topic. You can return to discussions about the relationship itself at another time, if you wish.

  You don’t have to answer questions right away. Don’t let yourself be rushed. You can say, “I don’t know,” or “I need time to think about that.” Don’t take insults as an indication of the person’s deepest feelings. If you were as bad a person as she says you are, she wouldn’t want to be around you.

  Be Assertive, Yet Gentle

  Use everything you learned in the last chapter about empathy and validation. Freda Friedman, coauthor of Surviving a Borderline Parent, says, “When the interaction is just focused on limit setting without any validation of the other person’s wishes and needs, then usually neither person feels heard or understood or acknowledged. It might feel like the person with BPD is outrageous or manipulative, but he or she feels misunderstood and invalidated.”17

  Remember that your tone of voice, facial expressions, and other body language communicate much more about your attitudes and beliefs than what you say. At times, you may want to emphasize the gentle side; at other times, the assertive. Body language is an excellent tool, and you can adjust it moment by moment.

  Do’s:

  • Use eye contact; be sincere, but firm and level.

  • If standing, stand straight with feet planted on the ground. Wider stances and bigger mannerisms show more assertiveness.

  • Use a gentle tone that is calm and soothing. Lower (alto, bass) rather than higher (tenor, soprano).

  • Speak at a normal pace, not too fast.

  • Don’t raise your voice—in fact, you may want to lower it a bit to show you’re not in competition and so your family member needs to keep his low to hear you. Make your voice gentle, calm, and soothing.

  • Stay close, but not too close, which can be threatening.

  Don’ts:

  • finger point or jab

  • increase the volume of your voice

  • glare or narrow your eyes

  • snort

  • tighten your jaw muscles

  • press your lips together

  • look down submissively

  • thrust out your chin

  • clench your fingers into a fist with white knuckles

  • run your fingers through your hair

  • cross your arms

  • place your hands on hips

  • stomp

  • sit on the edge of your chair

  • kick the ground

  • invade the person’s intimate space

  • bite your nails

  • pick your cuticles

  • sigh

  • strain your voice

  • wring your hands18

  Make Sure Your Family Member Feels Heard

  Acknowledge the other person’s needs and wishes and how important those feel, while at the same time establishing or reiterating the limits that have been set. Use phrases such as

  • “I’m not trying for one of us to be right or wrong, but for the relationship to be the best it can possibly be. I need . . .”

  • “I’ve given this a lot of thought. I am learning more about myself and what I can and can’t do and what I need. And I need . . .”

  • “I understand you think it means I’m selfish. Still, I need . . .”

  • “I am not trying to be controlling. I am trying to be open and honest about how I feel. I need . . .”

  • “I’m not sure how to answer that. But what I do know is that things can’t go on this way. I need . . .”

  • “It is true that we don’t see things the same way. I wish we did, because this isn’t easy for me either. What I need is . . .”

  Practice, Practice, Practice

  Practice the conversation
as much as you can. Pretend your BP is in an empty chair and run through what you’re going to say. Better yet, role-play with a friend, with your friend playing the role of the BP. If you are not usually assertive, start off by being more assertive in low-stakes situations, for example, telling a server in a restaurant if something is wrong with the food.

  Try Positive Self-Talk

  One way to drown out the roar of the border-lion is to have a steady stream of positive self-talk. Self-talk is the chit-chat within our heads that goes on nearly all the time. Try positive, reassuring thoughts like these:

  • “Setting and observing my limits may feel strange or unfamiliar right now. That’s okay. All things are strange and unfamiliar until you get used to them.”

  • “I’m feeling afraid—but what am I afraid of exactly? Wait—I’ve thought this through. I’ve made it safe for myself. I’m going to be okay.”

  • “I’m working on this because I love my family member so much. She can’t see this, but it’s okay. I will see it for both of us.”

  • “I need to meet my own limits right now so I can meet his needs in the long run.”

  Setting Limits for Children

  Sarah and Joe, who has BPD, have two children. Sarah sets limits for her children as well as herself. She says:

  In the past, my husband used to rage at our teenage boys at the drop of a hat for no good reason (God forbid they should hold their knife the wrong way at the table). At first, I got angry back at him. But that only escalated tensions and led to more problems. Now, either I will leave or ignore him.

  When my husband starts raging at one of the boys, I calmly ask my child to go up to his room for five to ten minutes. I’ve talked with the children separately to let them know that they are not in trouble but that their father needs some time to calm down and deal with his emotions. At that point, he seems able to get himself under control.

  Alternatively, I’ve told the children not to acknowledge or speak to him when he is using his raging voice. They are to ignore him during these times, but only when I am physically present so that they are not endangered. If I’m not going to be home evenings and my husband and children will be alone together, I try to make arrangements for the boys to be elsewhere, or I take them to school with me.

  You can find more information about setting limits for children in Stop Walking on Eggshells.

  Limits and Your Borderline Child

  Parents set limits for their children for practical reasons and to help them learn how to function in the real world. Unfortunately, the kind of limit setting that works for normally functioning children may not have much effect on those who have borderline personality disorder.

  Sharon from NUTS believes the following:

  • Some borderline minors are unable to grasp the concept that their actions have consequences. For example, a child will take a risk and crash the car, unable to visualize that without the car he can’t go places. (Of course, this is true of teens who don’t have BPD, but with BPD children, it’s exaggerated.)

  • When they can visualize consequences, there may be too much of a lag between the act and the consequence.

  • The consequences don’t have the impact the parents wish they would.

  • Because of impulsivity, the child ignores the consequences and does whatever she wants anyway.19

  Although often the limits might not have the effect you intended, it is still important that the limits be set and there be consequences. In addition to limit setting, take a problem-solving approach. Gunderson and Berkowitz say:

  People with BPD have many obvious strengths such as intelligence, ambition, good looks, and artistic talent. Pleased with their progress, they may shoot for grand plans they aren’t ready for. A setback can result in a crashing swing in the opposite direction. Help your child set smaller, more realistic goals where the chances of success are greater. Break goals into steps and be sure to take one step at a time. Ask your child if they want help; don’t just jump in.

  Problems are best tackled through open discussion in the family. People are most likely to do their part when they are asked to participate and their views are respected. Recognize the difficulty of what you are asking and ask if they feel capable of the task before them.

  Family members may have sharply contrasting views about how to handle any given problem behavior in their relative with BPD. Parental inconsistencies fuel severe family conflicts, and siblings also have their opinions on what should be done. Communicate openly about your contrasting views on a problem, hear each other’s perspectives, and then develop a plan that everyone can stick to.20

  Let Your Light Shine

  In her book A Return to Love: Reflections on the Principles of A Course in Miracles, Marianne Williamson says, “Our deepest fear is not that we are inadequate. Our deepest fear is that we are powerful beyond measure.” Many people have heard that part of the quote. However, Williamson then goes on to say, “And as we let our own light shine, we unconsciously give other people permission to do the same.”

  That’s what this chapter has helped you to do. Limits are a powerful tool in restoring balance to a relationship. Now that you have taken responsibility for yourself—the only person you control—it’s up to your family member to do the same: to make her own decisions and to take responsibility for herself.

  In the next chapter, you’ll learn how to respond to your BP’s choices.

  Chapter 11

  Power Tool 5:

  Reinforce the Right Behavior

  The people in my WTO group have found that BPs tend to see the line we draw, touch their toes to it, and if nothing happens, place their foot over the line repeatedly until it gets cut off.

  • Welcome to Oz member •

  Now that you’ve set your limits and communicated them to your family member, the next step is learning how to maintain them. Welcome to Oz and BPDFamily.com members need to develop skills in this area. Here are some typical comments from them:

  • “When I set my boundaries, I had all kinds of newfound resolve. But when he tried to dismantle them, I went soft. Just when I thought I’d reached the end of my rope, the rope got longer.”

  • “When I set limits, he always has some sneaky way of getting around them—even if the purpose of the limits was to help him.”

  • “After I set a boundary, he would improve his behavior for a while—even long periods. But then all hell would break loose. Boundaries set, boundaries broken. The cycle just keeps going.”

  Your family member will test your limits many times to see how seriously you are taking them. This is human nature: We learn as young children that even if Dad wants to spend the day in a hammock, we can get him to take us to Mount Splashmore if we ask enough times in a high, whining tone and refuse to give up.

  When your family member starts testing your limits, all the communication tools you’ve learned take a backseat to your actions. What counts now is what you do, not what you say. To make limits work, reinforce the behavior you want—observance of your limits. Do not inadvertently reinforce breaches of your limits. Most non-BPs do just that, which compromises the limits they’ve tried so hard to set.

  Reinforcement

  Reinforcers are behaviors that, occurring in conjunction with some kind of action, either increase the probability that a person will act that way again or decrease the same.

  Positive and Negative Reinforcers

  Behaviors that increase the likelihood of a repeat performance are called positive reinforcers. Those that decrease the chances are termed negative reinforcers. Here are some examples:

  A one-year-old baby cries.

  Positive reinforcers: Getting picked up and hugged, being given a bottle, or having her diaper changed. These actions make it more likely that when the baby is lonely, hungry, or wet, she will cry again.

  Negative reinforcers: Being ignored. A television news program once showed children in an orphanage in a foreign country who received little adu
lt supervision. When one of the toddlers accidentally banged her head on something, she didn’t cry because she knew from experience it would not bring help.

  Jane is upset and calls her friend Amy.

  Positive reinforcers: Amy listens, makes her laugh, and offers to buy her a cup of coffee the next day. Jane is likely to call her again.

  Negative reinforcers: Amy points out that Jane’s problems aren’t so bad compared to hers, then goes on to tell Jane all her problems. Jane is less likely to call again.

  Reinforcers and Limits

  Whatever you do, do not positively reinforce your family member for not observing (“violating”) your limits. In this example, a mother unknowingly positively reinforces telephone-calling behavior.

  Tacy and Betsy

  Tacy has told her adult daughter Betsy that she cannot call her at work more than three times a day unless there is an emergency. Betsy is living at home and is supposed to be looking for work. This scenario happens the day after Tacy set the limit; Tacy is at work and Betsy is home, not feeling well.

  Find the Positive and Negative Reinforcers

  Now, let’s take away the words and look at the behavior.

  Wow, that is a different way of looking at it! Tacy’s limit was ineffective not because Betsy wasn’t observing it, but because Tacy wasn’t observing her own limit. Always keep in mind that it’s what you do that matters, not what you say. Here is a slow-motion instant replay.

  The 3 p.m. call was The Test. Tacy took the bait and spoke with her daughter, not observing her own limit. She jumped the triangle (see page 210), moving from “persecutor” to “rescuer.” You might think that speaking with Betsy in an annoyed fashion might be negative reinforcement. But here, it’s just the opposite.

  At home, alone, Betsy was feeling lonely, unloved, and invisible. When she called, Tacy spoke with her and gave Betsy her full attention. Even though it was in a negative way, it was reinforcing and made Betsy more likely to call Tacy again.