by Seth Axelrod, PhD
Whether it’s psychotherapy, friendship, or family, maintaining a positive relationship with someone with borderline personality disorder (BPD) can be extremely challenging at times. In my clinical experience I have often listened to family members who, with the very best intentions, fall into an overwhelming sense of frustration and despondency as they struggle to live and care for those with BPD. As patience wears thin, those who were once eager and hopeful about their loved one’s progress begin to experience the all-too-familiar characteristics of burnout. Strong emotional needs, extreme insecurities, and communication skills deficits of a person with BPD can at times make navigating this relationship like walking through a minefield; nearly impossible without a fairly clear map to follow.
Different approaches for navigating through such difficulties have been suggested by BPD experts. Some clinicians and researchers believe that the problem is rooted in poor boundaries (the failure of the person with BPD to respect the appropriate give and take of relationships) or splitting (a defense mechanism in which the person with BPD is unable to tolerate the thought of people having both good and bad qualities at the same time: idealizing someone who satisfies his or her needs one moment and vilifying someone who frustrates them in the next). Both of these models of understanding suggest that caretakers should guard against letting the individual with BPD act on their problematic relationship patterns and should confront these faults when they arise. These proposed solutions, however, can inadvertently harm relationships further. For example, blaming or pointing the finger at the person with BPD often feeds frustration and anger in the caregiver and shame in the individual confronted. Further, by placing responsibility for the problem squarely on the shoulders of the individual with BPD, it is easy for caregivers to become hopeless if things do not improve. So how then might we be able to address both the needs of caretaker and loved one in an effective and productive manner?
An alternative approach can be taken from one of the key elements used in Marsha Linehan’s Dialectical Behavior Therapy (DBT). This approach understands that there may be a mismatch between the needs of the individual with BPD and the capacity of the caregiver. In other words, there is nothing wrong with the individual with BPD wanting to have certain needs met — the problem occurs when satisfying these needs is beyond the preferences and/or capabilities of the family member, partner, or friend. Although we can generally push ourselves to meet the wants or needs of others in the short term (and often need to at times), we become subject to burnout if we continuously push ourselves past our personal limits. Potential frustrations, depressive emotions, hopelessness, and a desire to decrease contact begin to deepen. What we can do instead is regularly assess and assert our own personal limits — a focus on the preferences we each have for the give and take of relationships and for how others approach communication with us. Notice that as personal limits, these limits are understood to vary from person to person, or even within the same person across time or circumstance.
So, how can you effectively observe your personal limits and improve your relationship? Before you speak with the individual you are struggling with, take some time to assess and prepare the following:
- Attend to personal limits. Carefully assess your comfort within and following interactions. Ask yourself if you are comfortable with how the person treats you and with meeting his/her needs.
- Define the behavior that exceeds limits. Get as specific as possible about the individual’s actual behaviors that exceed your limit. Be sure to stick to the facts, and avoid opinions and judgments.
- Assume the best. Consider benevolent reasons why the individual might act as he/she does. Consider his/her needs and difficulties with effective communication and with managing emotional reactions. Be sure to look to your supports for help with this if you can’t come up with an empathic reason for the behavior.
- Prioritize. Notice if there are multiple behaviors that exceed your personal limits. If so, choose one to focus on addressing first. In the meanwhile, be prepared to tolerate stretching your limits around other behaviors, until you can address these in turn.
- Define the desired behavior. Given your best understanding of the individual’s wants and needs, as well as your own personal limits, identify what you would have him/her do differently. Identify a new behavior that responds to his/her need, and that also supports your personal limit.
Assert your personal limit. Once you have identified your personal limits, you are now ready to speak with the individual. Here are a few steps, using a skill from DBT, that will help keep the conversation focused:
- Pick the best time for the conversation. Ask if they are able to sit down and discuss something important with you.
- Describe the problem by reviewing the facts about the other person’s behavior. Be sure to avoid any judging or negative assumptions about their intentions.
- Express your limitation. Be clear in communicating that this limit is about your own needs, wants, or abilities, and the difficulties you’ve experienced by exceeding them.
- Ask the individual to do the new desired behavior. If necessary, show him/her how to practice this new behavior.
- Reinforce your request by explaining how the new behavior will allow you to better support him/her and maintain your relationship.
Here, the issue is not defined by the person’s poor boundaries or splitting, but by identifying and attending to our own individualized preferences and needs. By owning these personal limits, we invite the individual to join us in a positive, open, and mutually respectful relationship of equals — enhancing not only our ability to continue the relationship and reduce conflict, but to actually create a relationship that we would choose to embrace.
Seth Axelrod, PhD, is an Associate Professor at the Yale University School of Medicine, Department of Psychiatry and is the team leader for the Dialectical Behavior Therapy Adult Intensive Outpatient Program at Yale-New Haven Psychiatric Hospital. Dr. Axelrod leads workshops for professionals and family members addressing personal limits and burnout as they relate to BPD.