On the last track we discussed depression co-occurring with borderline personality disorder. We explored primary depression; primary BPD; and when both depression and BPD are primary.
As you know, BPD clients sometimes experience abusive childhoods. Some BPD clients experience other non-productive interpersonal relationships as children. Clearly, negative childhood experiences can create anxiety for the BPD client, leading to increased difficulty in self integration and realistically perceiving reality. Therefore, if your client plans a trip home, you may find it useful to consider the techniques on this track to maintain therapeutic progress and help your client avoid as much as possible self destructive behavior during his or her visit.
On this track... we will discuss revisiting home. Three aspects regarding revisiting home as it relates to the BPD client are tension at home, dealing with residual effects, and maintaining control.
Three Aspects of Revisiting Home
Aspect #1 - Tension at Home
BPD client Nadia, age 28, recalled tension at home. Nadia grew up with an abusive father. Generally, the abuse Nadia experienced was verbal, but incidents of physical abuse filled her childhood memories. Nadia stated, “We all waited for my father to explode! What would set him off this time? At dinner, if he made a sudden move to get the salt or something, we’d all flinch. It was so thick, we could have been eating tension for supper. Anyway, my brother would clown around at the table just to set dad off. That way he’d explode, it would be over, and we could relax instead of sitting on the edge of our seats awaiting his rage.”
Dinner at home still created tension for Nadia. In our session, when she explained her childhood home life, simply talking about it made her feel sick.
Aspect #2 - Dealing With the Residual Effects
To help Nadia deal with the residual effects of her childhood, I gave her some simple ways to analyze and express her feelings.
Four Ways to Express Feelings
--1. First, I stated, “Identify the physical sensation of feeling sick when you recall your childhood. Is it a tightening? A pressure? A knotting? Where is it located?” Nadia described her sickness as an empty feeling in her stomach.
--2. Second, I stated, “Establish the original context. What was the atmosphere? Describe the dialogue. Did you feel exposed or protected?” Often, Nadia’s descriptions of her childhood involved mealtimes in a tense setting. Her brother was the only protection she felt she had.
--3. In addition to identifying sensations and establishing context, the third method the BPD client can use to deal with the residual effects of her childhood is to sympathize with herself. I stated to Nadia, “Sympathize with the child who had those upsetting experiences, but remind yourself that you’re an adult now. And the person who said or did those things can no longer hurt you.”
--4. The fourth method Nadia used to deal with the residual effects of her childhood was to rewrite her earlier experiences. Nadia drew two pictures of her childhood dinner table. In the first picture, her father reigned at the head of the table. In the second picture, Nadia put her brother in her father’s place. Nadia stated that the second drawing made her feel much more comfortable.
Aspect #3 - Maintaining Control
When Nadia stated that she planned to revisit home for her brother’s wedding, she was concerned that she would find herself sitting at her father’s table again. In order to help Nadia in maintaining control, I gave her some suggestions to help her set limits and maintain her therapeutic progress. As a BPD client, Nadia also benefited from these suggestions in that they helped her avoid some of her self destructive behaviors, such as self mutilation. As you listen, consider how your BPD client might apply the information to a visit home.
Here are six suggestions for maintaining control as I gave them to Nadia.
Plan to go for just a few days even though others are staying longer.
Try not to depend on your family. Stay with a friend or sibling, or even consider a hotel room.
If you do stay with your family, consider renting a car for at least part of the visit.
Plan to take a breather and get away. Take long walks, go on a day trip, or visit old friends.
Avoid confronting family members regarding old issues unless you have a clear idea of your goals and expectations. In one of our sessions, we can discuss and practice what you want to say.
Find a way to physically leave if you are too uncomfortable to stay. As a child you felt you couldn’t leave and that you were stuck at your father’s table. As an adult, know that you can leave and give yourself permission to utilize that option.
Do you agree that helping a BPD client like Nadia recognize options benefits treatment? Think of your Nadia. Could learning ways to maintain control during a visit home benefit your client?
On this track... we have discussed revisiting home. Three aspects regarding revisiting home as it relates to the BPD client are tension at home, dealing with residual effects, and maintaining control.
On the next track we will discuss counseling the spouse of a BPD client. Three aspects of counseling the spouse that we will discuss are avoidance and control, BPD reactions, and fear and weakness.
What are three aspects regarding revisiting home as it relates to the BPD client?
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