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Section 3
Rejection Paradigm in Borderline Personality Disorder

Question 3 | Test | Table of Contents | Borderline CEU Courses
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On the last track we discussed communication.  Three aspects of communication as related to the BPD client include reflex communication verses conscious communication and the connection between shame and blame. We also discussed the "Three Steps to Conscious Communication" technique. 

On this track... we will discuss rejection concepts regarding your BPD client. Three common rejection concepts regarding BPD clients are personal attacks, perceived judgment, and self deprecation. In my practice, rejection concepts are often accompanied by anger. As I describe these three common rejection concepts, evaluate how your client’s anger correlates with each concept.

Three Common Rejection Concepts

Concept #1 - Personal Attacks
Borderline personality disorder clients like Mandy often believe they are the victims of personal attacks. Mandy, age 35, stated, "Life’s just not fair! I’m always getting the short end of the stick and it’s bullshit!" Mandy described her loss of control and quickness to overreact. 

Mandy stated, "For months I had been telling my boss that I needed a new computer. He just kept putting it off, until finally I just brought a computer from home. Two days, just two days later, he installs 4 new computers at other people’s work stations! I was so stunned!  So after the office closed, I broke in and smashed every one of those computers. To hell with that job, anyway!"  

 I am sure you have BPD clients who view what are possibly simple oversights or annoyances as personal attacks like Mandy.  The "Turn It Around" technique will be explained at the end of this track.

Concept #2 - Perceived Judgment
A second common rejection concept that BPD clients have is perceived judgment.  After Mandy had vandalized her workplace, criminal charges were filed.  Mandy stated, "I’m being judged unfairly. If anyone should be blamed, it’s my boss or those bitches that got new computers!"  As you know, when a BPD client like Mandy perceives judgment, they experience anxious and sometimes childlike feelings. Mandy rationalized her behavior due to what she believed were extenuating circumstances which justified her behavior. 

As you can see, Mandy’s defense mechanisms were activated as soon as she began  to perceive judgment. This led to an inability for her to realistically evaluate her behavior. In fact, Mandy later stated, "I really think my boss didn’t get me a computer because everyone in that office talks to him about me behind my back!! They are always in the break room talking about what they think of me. I come in and they get real quiet!  What’s that about?" Like Lewis from the last two tracks, Mandy’s defense mechanisms sometimes brought about paranoia.

Think of your Mandy.  Does your BPD client react negatively when he or she perceives judgment?

Concept #3 - Self Deprecation
In addition to personal attacks and perceived judgment, a third rejection concept is self deprecation. What kind of self concepts does your BPD client have? Are negative physical and psychosocial self images contributing to your client’s self deprecation? During Mandy’s justification of her behavior, she began blaming herself for not waiting two more days to see if she would get a computer. 

Mandy stated, "I’m so stupid.  Every time I try to do anything, even stand up for myself, I screw it up!  I should just stop trying altogether.  I’m such a moron!" Can you see how because Mandy didn’t want to take responsibility for her behavior, she used self deprecation as a way to avoid accountability? A technique I found useful with Mandy was the "Turn It Around" technique. As I describe the application of the "Turn It Around" technique regarding Mandy’s self deprecation, think of how it might possibly benefit your BPD client.

5-Step Technique: "Turn It Around"
To help Mandy increase her self esteem and avoid further self deprecation, I asked her to try the "Turn It Around" technique. 

--Step 1 - First, I explained to Mandy that accusers often project feelings about themselves onto others. I stated, "I feel you are being too hard on yourself and possibly are doing the same thing. Your boss is obviously insensitive and uncaring. Because you perceive his behavior as ignorant, you are projecting your feelings about him onto yourself." 

For the BPD client you are treating who is paranoid or perceives frequent rejection, these ideas can be stated differently.  For example, you might state to your client, "Try to remind yourself that no matter what someone says or thinks about you, you can turn it around.  That person is most likely talking about him or herself."  For Mandy, it was necessary to evaluate each situation thoroughly before she could commit to the "Turn It Around" technique. 

-- Step 2 - Therefore, the second step for Mandy was to describe her problem in observable, non-blaming terms.  Mandy evaluated her behavior at work and stated, "My boss just didn’t give my need for a new computer enough thought." 

-- Step 3 - The third step for Mandy in the "Turn It Around" technique was for her to describe how she felt about the problem.  Looking back on her feelings at the time, Mandy admitted that she felt personally attacked

-- Step 4 - In addition to explaining projection, have the client describe the problem and have the client describe his or her feelings. The fourth step in the "Turn It Around" technique was for Mandy to explain the problem.  Do you agree that when some BPD clients talk in depth about a specific problem, he or she often begins to see how non-productive behavior could have been avoided? 

-- Step 5 - Observations from Mandy’s explanation of her problem led to the fifth step, which was for Mandy to describe how she would have liked the interaction to have played out. Mandy stated, "Well, because it was not my fault my boss didn’t get me a new computer, when I asked, maybe I just could have been more persistent. But I also could have acted differently when I didn’t get the computer and my coworkers did." 

Think of your Mandy.  For your BPD client who experiences rejection could the  "Turn It Around" technique benefit your client as a way to begin to start to think about more realistically evaluating a situation?  Would playing this track for your BPD client help him or her apply the ideas more effectively?

Do you have a BPD client who would benefit from hearing this track during a session?
On this track... we have discussed rejection concepts.  Three common rejection concepts regarding BPD clients are personal attacks, perceived judgment, and self deprecation. 

On the next track we will discuss abandonment.  Two types of abandonment regarding BPD clients we will explore are general abandonment and sexual abandonment.

Peer-Reviewed Journal Article References:
Beeney, J. E., Levy, K. N., Gatzke-Kopp, L. M., & Hallquist, M. N. (2014). EEG asymmetry in borderline personality disorder and depression following rejection. Personality Disorders: Theory, Research, and Treatment, 5(2), 178–185.

Cavicchioli, M., & Maffei, C. (2020). Rejection sensitivity in borderline personality disorder and the cognitive–affective personality system: A meta-analytic review. Personality Disorders: Theory, Research, and Treatment, 11(1), 1–12. 

Richmond, J. R., Edmonds, K. A., Rose, J. P., & Gratz, K. L. (2020). Examining the impact of online rejection among emerging adults with borderline personality pathology: Development of a novel online group chat social rejection paradigm. Personality Disorders: Theory, Research, and Treatment. Advance online publication.

What are three common rejection concepts regarding BPD clients? To select and enter your answer go to Test.

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