Borderline Personality Disorder

  • 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.