On the last track we discussed three steps to help BPD clients prevent anger as a result of distorted perceptions. The three steps were identifying the problems, clarifying goals, and coping strategies.
On this track... we will explore the BPD client’s cultivation of interpersonal relationships. There are three techniques for BPD clients to cultivate interpersonal relationships that we will explore. The three techniques are Learning from Others, Remembering, and Engaging in Inner Work and Outer Play. As you hear how three BPD clients implemented these techniques, perhaps you can think of ways to adapt them to clients you are currently treating.
Three Techniques to Cultivate Interpersonal Relationships
Technique #1 - 7 Questions for Learning From Others
The first technique for cultivating interpersonal relationships is called Learning From Others. Elsie’s BPD was characterized by very unstable relationships, as it is for many BPD clients, even among her own family. For example, after being kicked out of her mother’s house, losing several jobs, and living on the streets for a while, Elsie was becoming highly motivated to learn how to cultivate interpersonal relationships.
Elsie, age 42, used the Learning From Others technique effectively by beginning to observe everyone with a focus on learning. To learn from others, Elsie asked herself the following 7 questions.
-- Question 1 - What are they doing?
-- Question 2 - What mistakes are they making?
-- Question 3 - How well or badly do they treat others?
-- Question 4 - Do I treat people that way?
-- Question 5 - What qualities does that person have that I would like?
-- Question 6 - What qualities does that person have that I would like to eliminate?
-- Question 7 - If more people were like that, would the world be a better place?
For Elsie, the main idea was making connections between her actions and those of the people she observed. Learning From Others began to provide Elsie with a method for turning her own behaviors in a positive direction. Could the BPD client you are treating benefit from Learning From Others?
Technique #2 - 4 Steps to Remembering
A second technique for a BPD client to cultivate interpersonal relationships could be Remembering. Sheila, age 37, was a BPD client who displayed transient paranoia and periodic anxiety. To enhance her appreciation of other people, and to help foster more trust in others, Sheila used the Remembering technique.
--Step 1 - First, Sheila recalled the time a stranger stopped on the highway to help her change a flat tire. Sheila stated, "I felt good about that for a long time afterward." I asked Sheila to make three columns on a sheet of paper. In the first column, Sheila listed the stranger’s name, which was Ed. In the second column, Sheila listed what he did, change her tire. Sheila used the third column to list how Ed’s kindness affected her. Sheila stated that Ed’s kindness gave her a temporary faith in the goodness of humanity. Next, Sheila began to think of others who had a positive effect on her. Sheila added these people to her list as well.
--Step 2 - Second, Sheila made a similar list on a separate sheet of paper that included those who affected her negatively.
-- Step 3 - In addition to creating a list of neutral people that helped her and people that she felt negatively about, Sheila’s third step was to think about times when she affected someone positively or negatively. Sheila stated, "I guess I’ve also acted in ways that had a powerful effect on people. Sometimes I did it on purpose, but other times I just acted. I really never thought about how powerful my effect was."
--Step 4 - As a concluding step, I asked Sheila to focus on the responsibility of interacting with others. I stated, "Through simple words or actions, people have affected you and you have affected others. Consider that the incidents you thought of in step 3 only represent those that you know about. How many others are there that you don’t know about?"
By focusing on the power of her behavior, Sheila began to have an idea how she affected others. Sheila stated, "Now that I know how easy it is to hurt others without trying, I can understand why it happens. Would you agree that through remembering past interactions, your BPD client may be able to begin to trust others?
Technique #3 - Engaging in Inner Work and Outer Play
In addition to Learning From Others and Remembering, a third technique for cultivating interpersonal relationships I use is engaging in inner work and outer play. As I found with Sabrina, age 41, too much attention to inner work can cause a BPD client to become preoccupied and self absorbed.
Sabrina was spending all of her time outside of therapy recalling and pondering our discussions. This led to an unbalanced and sedentary lifestyle for Sabrina. In order to help Sabrina engage in outer play as well as inner work, I helped her compile a list of 9 observations about activities that we thought could help her. As you listen to Sabrina’s list, evaluate your client’s lifestyle to determine if he or she could benefit from outer play.
Find activities that bring you joy.
Get silly and have fun.
Let your friends know that you are having a hard time.
Help a friend or do some volunteer work.
Consider attending lectures or taking classes that enhance your knowledge.
Pay attention to your diet.
Do something you’ve never done before.
Find ways to experience your spirituality.
An activity that Sabrina tried with some success was scrap booking. Have you considered the therapeutic value attributed to helping others? Think of your BPD client. Could he or she benefit from balancing therapy with healthy activity?
By implementing techniques for cultivating interpersonal relationships, Sabrina, Sheila, and Elsie began to balance therapy, trust others, and regulate behavior. Though these clients still have borderline personality disorders, manifestations of their symptoms have begun to decrease. Combined with other modalities of therapy, I have found that techniques for cultivating interpersonal relationships can be productive.
Would you agree? Can you think of ways to adapt these techniques for your BPD client?
On this track... we have discussed three techniques for cultivating interpersonal relationships. The three techniques are Learning from Others, Remembering, and Engaging in Inner Work and Outer Play.
On the next track we will discuss cognitive distortions used by BPD clients. There are five cognitive distortions commonly seen in BPD clients. These five distortions are polarized thinking, personalization, control fallacies, catastrophizing, and emotional reasoning.
Peer-Reviewed Journal Article References:
Berenson, K. R., Dochat, C., Martin, C. G., Yang, X., Rafaeli, E., & Downey, G. (2018). Identification of mental states and interpersonal functioning in borderline personality disorder. Personality Disorders: Theory, Research, and Treatment, 9(2), 172–181.
Hepp, J., Lane, S. P., Wycoff, A. M., Carpenter, R. W., & Trull, T. J. (2018). Interpersonal stressors and negative affect in individuals with borderline personality disorder and community adults in daily life: A replication and extension. Journal of Abnormal Psychology, 127(2), 183–189.
Stepp, S. D., Hallquist, M. N., Morse, J. Q., & Pilkonis, P. A. (2011). Multimethod investigation of interpersonal functioning in borderline personality disorder. Personality Disorders: Theory, Research, and Treatment, 2(3), 175–192.
What are the three techniques for cultivating interpersonal relationships?
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