On the last track we discussed 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.
As you are already aware, even when a client’s BPD is characterized by narcissism, low self-esteem is evident. Two aspects of self-esteem that we will examine are low self-esteem and setting boundaries. We will also review the self-esteem assessment and the ‘LEMON’ Enforcement technique.
#1 Low Self-Esteem
First, let’s examine how low self-esteem might affect the BPD client. Molly, age 39 was a bookkeeper and explained how she felt undeserving. Molly stated, "It comes out in the strangest ways. It’s almost like I’m so convinced I don’t deserve happiness that I do whatever I can to keep myself miserable. Like, I’ve got enough money to buy new clothes, but I don’t do it. Probably because that would make me feel better. I hate myself! I’d do anything just to feel a little better about me!"
For your clients like Molly who was a bookkeepers and could relate well to numbers you might see if she would agree to taking a self-esteem assessment to pinpoint specific areas upon which a session might focus.
Technique: Self-Esteem Assessment
I asked Molly to try the self-esteem assessment. Before beginning, I asked Molly to avoid analyzing each statement in the self-esteem assessment. Instead, I asked her to simply respond with the number representing her initial reaction. On a scale of 0 to 10, Molly rated how closely she agreed with each of the following ten statements. A zero would indicate that Molly did not agree at all. A 10 would indicate that Molly agreed completely.
As I read these ten statements, consider how your client’s thoughts or feelings in these areas may impact his or her self esteem.
I am a valuable person
I possess the qualities I need to live a fulfilling life.
When I look in the mirror, I feel good.
I think of myself as a success.
I’m able to laugh at myself.
I’m happy being me.
Given a choice, I’d choose to be me over someone else.
I treat myself with respect.
I continue to believe in myself, even when others don’t
Overall I’m satisfied with the person I am.
Molly’s score on the self-esteem assessment was 31 out of 100. By specifically analyzing those responses for which Molly answered with a 5 or lower, we could begin to work on some of her self esteem issues.
#2 Setting Boundaries
Second, Molly had a difficult time setting and maintaining personal boundaries. While some BPD clients set unhealthy boundaries, Molly was often involved in relationships that violated her boundaries by being involved in abusive relationships. She stated, "If someone likes me, I date him. It doesn’t matter if I like him or not. My judgment is usually wrong anyway. But, I inevitably wind up with guys who find out how worthless I am. Hell, I think I’ve only been in two relationships where I didn’t get smacked around or cussed at all the time."
Technique: LEMON Enforcement
Molly used the Boundaries Enforcement technique to initiate maintaining healthy boundaries. Molly’s use of this technique consisted of the word LEMON. Here is the description of LEMON as a Boundaries Enforcement technique as I explained it to Molly.
'L’ is for leaving the room or situation. You can leave any situation any time you want.
‘E’ represents emotional distance. Feel free to implement a reduction in the amount of personal information you share. You can also limit the topics of conversations if you feel your boundaries are being threatened.
‘M’ is for move. The sooner you move away from abusive relationships, the less impact they will have on your self-esteem.
‘O’ stands for on your terms. Any visits or interactions you have with others are your choice.
‘N’ allows you to not communicate, or selectively communicate with those who attempt to violate your boundaries. Also, if you feel yourself influenced to violate your boundaries, you can end communication."
Like many BPD clients Molly tended to cling on to abusive relationships, although she was starting to use the ‘LEMON’ technique as an Enforcement to distance herself from violent behavior. Can ‘LEMON’ be adapted for your BPD client who is clinging onto some for fear of abandonment?
On this track... we have discussed self-esteem. Two aspects of self-esteem that we have looked at are low self-esteem and setting boundaries. We have also reviewed the self-esteem assessment and the ‘LEMON’ Enforcement technique.
On the next track we will discuss the difficulty of treating BPD clients. We will examine the reputation of BPD and how to maintain optimism and patience. We will also cover dealing with abusive BPD clients and Steps for Relating to BPD Clients.
Peer-Reviewed Journal Article References:
Dick, A. M., & Suvak, M. K. (2018). Borderline personality disorder affective instability: What you know impacts how you feel. Personality Disorders: Theory, Research, and Treatment, 9(4), 369–378.
Santangelo, P. S., Reinhard, I., Koudela-Hamila, S., Bohus, M., Holtmann, J., Eid, M., & Ebner-Priemer, U. W. (2017). The temporal interplay of self-esteem instability and affective instability in borderline personality disorder patients’ everyday lives. Journal of Abnormal Psychology, 126(8), 1057–1065.
Santangelo, P., Reinhard, I., Mussgay, L., Steil, R., Sawitzki, G., Klein, C., Trull, T. J., Bohus, M., & Ebner-Priemer, U. W. (2014). Specificity of affective instability in patients with borderline personality disorder compared to posttraumatic stress disorder, bulimia nervosa, and healthy controls. Journal of Abnormal Psychology, 123(1), 258–272.
What are two aspects of self-esteem?
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