This is Part IX of an ongoing series of posts. Before reading this one, particularly if you are going to try this at home with a real adult family member with borderline personality disorder, or BPD (which is not recommended without the help of a therapist), please read Part I, Part II, and Part III.
I will continue to run down specific countermeasures for use on those occasions when they are trying to distance and/or invalidate you, or to make you feel anxiously helpless, anxiously guilty, or hostile.
Keep in mind that if you are someone who continually tries to fix someone with the disorder, or who keeps reacting to them out of guilt, anger, or helplessness, then they are just giving you what you seem to need. They are doing you a favor. You may need psychotherapy yourself at least as much as they do.
Also, the behaviors under discussion usually draw negativity back to the patient with BPD, so ultimately they are self-destructive.
In the last post in the series, Part VIII, I discussed how to handle those times when other people seem to start fighting with each other over how to respond to the person with the disorder. Today I discuss statements made by individuals which sound hostile or critical but which may or may not actually be as critical or hostile as they sound.
A lot of psychotherapists recommend responding more to an individual's tone of voice and body language than to the content of what that person actually says. We all have a tendency to do that anyway - most likely because voice tone and body language preceded verbal language in the evolutionary development of the brains of primates like ourselves. Chimps, for example, know how to determine whether another chimp is coming to fight with them or mate with them throught the approaching chimp's posturing and the noises it makes. (And if you injure a certain part of the chimp's brains called the amygdala, they completely lose the ability to make this call).
Nonetheless, I recommend precisely the opposite: listen to the words (the lexical content) and more or less ignore the tone and posturing, as well as any seeming insinuations implied by what is said that are not clearly and overtly stated.
If you respond only to the words, the individual with BPD will usually change to a friendlier tone.
For example, a client I diagnosed with panic disorder responded to my recommendation for anti-depressant medication for her panic attacks with the sarcastic-sounding remark, "Oh, so you want to mess with my brain chemistry?" It sounded as though she was accusing me of being a devious, malicious mad scientist. Some anti-psychiatry types might agree with that interpretation of my recommendation, but I digress.
We don't exactly know how antidpressants work, but guess what? They do in fact alter brain chemistry. So I nonchalantly responded, "Yes, anti-depressants do alter brain chemistry, although we don't know exactly how they work," and I went on to describe what symptoms they seem to to work on just as one might do with any other patient. She then agreed to the drug trial. (Of course she went off the meds the very next day, but that's another issue altogether).
The structure of all human language is such that ambiguity is extremely easy to generate. Any sentence in any language can refer to a multiple of unclear attributes or objects, or can be interpreted in exactly opposite (antithetical) ways. Negative judgments can come out sounding positive and vice versa through changes in body language, tone of voice, or even choice of synonym.
For example, almost any adjective with a positive or a negative connotation has a synonym with precisely the opposite valence. An optimist, for instance, can be called a Pollyanna. People can be described as stubborn or tenacious, loyal or as being lap dogs, and so forth. A complete discussion of the antithetical nature of language is beyond the scope of this post, but can be found in my book, Deciphering Motivation in Psychotherapy.
Another trick that people with BPD are especially adept at employing is to create ambiguity through the use of unvoiced implications, as I alluded to earlier. Individuals imply something without stating it explicitly, thusly creating opportunities for plausible deniability of having made those implications at a later date.
For example, a mother may admire or even envy her daughter in some way, but make it sound as if she were critical about the very behavior that she really admires.
A good illustration of this process occurred in a conversation between a nurse and her mother. The mother was discussing the daughter’s rather assertive (some might say even aggressive) stance towards the mostly male physicians with whom the daughter worked. The mother said, “I can’t believe you talk to doctors that way!”
The patient took this to mean that the mother believed that she should not engage in this behavior. In one sense this was an accurate assessment of the mother’s view, but it was only part of the whole truth. The mother indeed was worried that the daughter might get fired. Such would have been the case during earlier times, when the mother was younger.
As it turned out, however, the mother was also expressing covert admiration for the nurse’s bravery, assertiveness, and feminist leanings. What Mom had difficulty "believing" was that the patient had the audacious nerve that the mother lacked.
Her critical tone of voice obscured the admiration. The actual lexical content of the comment has no positive or negative valence at all! It merely expressed surprise. The nurse perhaps should have responded, "Well, is that a good thing or a bad thing?"
In the next and final installment of this series, I will discuss what to do in cases in which, no matter what you say, the family member with BPD continues to escalate with more and more outrageous accusations or oppositionalism, as well as what to do when on infrequent occasions you find yourself having fallen back into old, counterproductive response habits.