On the last track we 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 this 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. As you listen to this track, you might consider playing it for the spouse of the BPD client you are currently treating.
Three Aspects of Counseling
#1 Avoidance and Control
Angela exerted unconscious avoidance and control over Scott. Scott was married to Angela, age 31. Angela had a borderline personality disorder characterized by affective instability due to a marked reactivity of mood. Scott stated to me, "Angela seems irritated at me several times a week. She’ll deny being angry when she clearly is, and won’t help me try to fix any of our problems! When I try to discuss important issues with her, she says she has no idea what I’m talking about!"
Think of your Angela. Does your BPD client’s spouse feel trapped in the relationship? Does your client, who is the spouse feel trapped in a continuous cycle of avoidance and control?
#2 BPD Reactions
I explained Angela’s BPD reaction when I stated to Scott, "Angela feels weak sometimes. She longs for power, so it appears she builds a mental fortress. To understand you, Angela would be forced to leave her fortress, or comfort zone. Angela feels unprotected when she has to confront her fears and feelings of helplessness. That’s why she reacts to you the way she does."
To help Scott foster an understanding of Angela’s BPD reactions, I implemented the "Exploring Why" technique described later in this track. Are you treating a client whose BPD reactions are directly affecting his or her partner? How can you explain your client’s BPD reactions to the partner?
#3 Fear and Weakness
Scott was still unclear how his wife Angela’s fear and weakness translated to anger and poor communication. I explained Angela’s distorted perception to Scott when I stated, "If you were with her when Angela last felt fear and feelings of weakness, she probably convinced herself it was coming from you. Because she usually experiences those feelings around you, she feels that you are the cause of her fear and feelings of weakness. The reason both of you feel trapped is because Angela probably has a distorted perception of how to fight her threatening feelings."
Think of your Angela. Does your BPD client’s distorted perception lead to feelings of fear and weakness?
Technique: Exploring Why with 5 Questions
To help Scott foster an understanding of why Angela’s borderline personality disorder manifested in such distorted perceptions, I used the "Exploring Why" technique. The "Exploring Why" technique is a technique Scott could use whenever Angela’s behavior seemed irrational or unwarranted. The "Exploring Why" technique consists of five questions that Scott asked himself. His answers allowed Scott to analyze Angela’s behavior and empathize with her without feeling like the target of her irritability.
Question 1 - First, Scott asked himself, "How many different reasons exist for Angela’s behavior?" By looking beyond BPD, Scott realized how identity diffusion, or a poorly integrated self concept, and impulse behavior actually led to his wife’s distorted perceptions of him and their problems.
Question 2 - Scott’s second question was, "How accurate is my perception of this situation with Angela? Regardless of my perception, Angela almost always disagrees with me!" Are you treating a client whose BPD partner disagrees with him or her on a regular basis?
Question 3 - In addition to questioning possible reasons and the accuracy of his own perception, the third question Scott asked himself in the "Exploring Why" technique was, "If I described this situation to someone not connected with us, would that person perceive this situation the same way I do?"
Scott stated, "Hmm. You mean would someone else think Angela’s crazy? No, I don’t always think that an outside observer would see me as a victim of my wife’s irritability or irrational behavior. Probably 15 percent of the time, I incite that behavior in her." Scott was referring to the increase in Angela’s BPD reactions resulting from his unwillingness to cater to her feelings of fear and weakness. Think of the BPD client you are treating. Is your Angela in a relationship which is provoking distorted perceptions rather than preventing them?
Question 4 - Scott’s fourth question was, "How have my emotional reactions shifted as I’ve considered alternative explanations?" Scott stated, "I feel less resentful toward her, but I also feel less hopeful about the future of our relationship."
Question 5 - In addition to questioning possible reasons, the accuracy of his own perception, and changes in his emotional reactions, Scott’s fifth question required him to share Angela’s perspective. Scott asked himself, "How would I behave in Angela’s shoes? Would I engage in similar behaviors?" Scott told me that he couldn’t be sure.
He stated, "I might even be more screwed up than she is. I mean, not knowing what’s real from what’s not, being scared and feeling weak all the time. Hell, I’m amazed that she’s as nice as she is." Think of the spouse of the BPD client you are treating. Could listening to this track and the five questions presented assist with some possible distorted perceptions he or she may have?
On this track... we discussed counseling the spouse of a BPD client. Three aspects of counseling the spouse of a BPD client that we discussed are avoidance and control, BPD reactions, and fear and weakness.
On the next track we will discuss steps to help BPD clients prevent negative anger displays as a result of distorted perceptions. The three steps are identifying the problems, clarifying goals, and coping strategies.
Peer-Reviewed Journal Article References:
Lavner, J. A., Lamkin, J., & Miller, J. D. (2015). Borderline personality disorder symptoms and newlyweds’ observed communication, partner characteristics, and longitudinal marital outcomes. Journal of Abnormal Psychology, 124(4), 975–981.
Lazarus, S. A., Scott, L. N., Beeney, J. E., Wright, A. G. C., Stepp, S. D., & Pilkonis, P. A. (2018). Borderline personality disorder symptoms and affective responding to perceptions of rejection and acceptance from romantic versus nonromantic partners. Personality Disorders: Theory, Research, and Treatment, 9(3), 197–206.
Miano, A., Fertuck, E. A., Roepke, S., & Dziobek, I. (2017). Romantic relationship dysfunction in borderline personality disorder—a naturalistic approach to trustworthiness perception. Personality Disorders: Theory, Research, and Treatment, 8(3), 281–286.
What are three aspects of counseling the spouse?
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