- Borderline Personality Disorder (BPD) is marked by a significant pattern of instability of relationships, of self-image, of emotions and with marked impulsivity.
- Dr. Phillips has considerable experience treating difficult cases especially individuals who suffer with BPD. Though many experienced therapists are frustrated in their attempts to manage let alone successfully treat this condition, Dr. Phillips has had success in assisting these individuals to lead happy and productive lives. Part of this positive outcome stems from his unwavering optimism about the patient’s potential and the understanding that in spite of appearances, the patient is doing his or her best.
- Patients with this condition cannot help but to act in counterproductive ways at times. This perspective is not meant to minimize their power but soften the frustrations sometimes felt by those around the borderline client.
- The therapist is nurturing but benevolently insisting of certain changes; accepting but encouraging growth; and flexible but firm when it is required. There is an overt understanding that clients need to observe the limits of the therapeutic relationship. An unconditional relationship between the therapist and the client is not possible, so it is in the client’s best interest to relate to the therapist in such a way that the therapist will want to continue to help. When limits are overstepped, Dr. Phillips points that out and teaches the patient alternative ways of dealing with the feelings which stimulated the boundary violation.
- Dr. Phillips’ experience is that many BPD people do not thrive in group settings. Thus, thetherapy consists of individual treatment once or twice per week as determined by the individual patient’s needs. The client is asked to make a commitment for one year and to attend all sessions as scheduled with few exceptions.
- If life-threatening or physically damaging behaviors exist, the client is asked to work on reducing and eliminating these acts as soon as possible. It is not uncommon for people with BPD to have behaviors which interfere with therapy. These will be identified as soon as they are evident and the patient is asked to place a priority on discussing and addressing these issues.
- A key to resolving BPD is the success a client has in dealing with acting-out behaviors and in being able to modulate emotions. BPD patients experience such intense negative emotional states that their primary objective is to find relief – immediate relief. This causes the individual to DO something to avoid FEELING something. This is referred to as “acting out.” These actions can, to the outsider, look counterproductive, but to the person suffering a feeling so intense that it feels like it will annihilate them, cutting their arms turns the terrible emotion into a more tolerable physical pain which gives them emotional relief. Having promiscuous sex allows a BPD person to feel close if even for a moment rather than intense loneliness.
- To resolve this key issue, clients are encouraged first to become aware of all of their acting-out behaviors and then examine the feelings which drive them. Gradually, they face these emotions in therapy which over time reduces the intensity and provides the feeling of mastery. They learn they can tolerate these emotions and deal with them effectively. When that point is reached, their counterproductive tendencies diminish and they are freer to lead more normal, happier lives.
- To people who do not have this disorder, it is hard for them to understand the degree of intensity of this feeling. Masterson calls it abandonment depression. Dr. Phillips refers to it as annihilation panic. Imagine that someone is about to shoot you; that you are holding on to a flimsy root dangling from a cliff; that you are in combat; or that you are stuck in a crevice underground. The panic in these life-threatening situations is frantic and all-encompassing. Welcome to the feeling state of someone with BPD. Even though the situations are not in fact life-threatening, they are experienced as if they are and as if their psyche is about to be destroyed.
More Information
- The syndrome’s onset is no later than early adulthood.
- It is characterized by a majority of the followingsymptoms: Frantic efforts to avoid real or imagined abandonment; A pattern of intense and unstable relationships characterized by alterations of extreme idealization and devaluation of the other; Extreme and consistent unstable sense of self; Potentially self-damaging impulsivity (e.g., spending, sex, substance abuse, reckless driving, binge eating, etcetera); Recurrent suicidal behavior, gestures, threats or self mutilation; Marked mood reactivity; Chronic feelings of emptiness; Inappropriate and intense anger or difficulty controlling anger; Transient, stress-related paranoid ideation or severe dissociative symptoms.
- An essential ingredient in the treatment of BPD is the real relationship between the therapist and client. For many BPD individuals, their relationship with their parents did not develop in a healthy way and the parent-child attachment was never or only partially achieved. This is either because the parent was abusive, afflicted with the same or other mental disorder, or there was some environmental reason (death of a parent). It can also occur because there were some predispositions within the client. As a result, most BPD individuals have never had a successful emotional or intimate relationship with an adult.
- The task of treatment then is to successfully navigate the relationship between the client and the therapist. Exploring unwitting or intentional interfering actions on the part of the patient to disrupt or dilute the therapeutic relationship is paramount. For example, the patient cannot be told to trust the therapist. Instead, the experience of the person has to lead the way. The client has to discover the therapist as trustworthy. But this can only be achieved through unconscious tests by the patient which the therapist passes and the whole process is noted and discussed to make the experience not only felt but understood by the individual.
- Pharmacotherapy is invariably useful but not curative with BPD patients. Depressive, anxiety and psychotic/paranoid symptoms can be aided with a judicial course of psychiatric medications. Thus, clients are referred to a psychiatrist for medication management only.
