On the last track, we discussed ways for BPD clients to reflect on their anger in order to understand and prepare for outbursts using the "Anger Journal". These ways were basic entry; four questions; and specific incidents.
I have found that many BPD clients who react with impulsive anger do so because they have should trigger thoughts. These trigger thoughts convince the client that a certain code of conduct is expected from another person.
On this track, we will examine the various forms of should trigger thought. Some of these forms are predetermined rules; conditional assumptions; and punishment fallacy.
Three Forms of Triggering Should Thoughts
Form #1 - Predetermined Rules
I find the first type of triggering should thoughts are predetermined rules. This type of trigger thought is one in which the client has a preconceived set of values and standards that he or she believes other people should adhere to as well. Clients who hold these trigger thoughts judge people according to these predetermined rules and when another person’s own standards conflict with the client’s, it leads to aggravation and anger. In client’s with BPD, this aggravation is doubled because of their already sensitivity to anger and impulsive acts.
When someone does not "play by their rules", they react in a way that will try and make the other person accept their ways. I have found that young, adolescent BPD clients who have a history of bullying have the same set of trigger thoughts, "I’m bigger and stronger, everyone should listen to me and do what I tell them" or "This person is different, they should do what I tell them because my way is better." When a client who has been labeled a "bully" by peers encounters resistance, he or she reacts in what society sees as aggressive or bullying behavior.
Tyrone was a 19 year old client who had experienced bouts of anger in his later years of high school. Tyrone stated, "I was actually a pretty normal kid up until about junior year. Then, for some reason, I started judging people differently. I had always had a strong idea about what was right and what was wrong. Being weak was wrong. Always kissing the teacher’s ass was wrong. Not having enough friends meant that they were too good for other people. There was this kid, Kyle, and he thought he was better than me. He was a little shit, you know? Skinny, but smart. Had no friends though, which should tell you something. He always had this god damn smirk on his face when he passed me in the hall, so everyone once in a while I’d shove him, hard, into the wall or door. He broke his nose once, doing that."
As you can see, Tyrone’s trigger should was "no one should think they’re better than me." When he thought that Kyle was acting superiorly, he would react in anger.
Technique: Empathic Dialogue
To help Tyrone counteract his trigger rules, I asked him to try the "Empathetic Dialogue" exercise. I asked Tyrone to imagine that he is talking to Kyle and in a persuasive, but non-aggressive tone, accuse him of acting superiorly. Once Tyrone had made his argument, I asked him to then switch over and argue Kyle’s point of argument. I encouraged Tyrone to focus on putting himself in Kyle’s shoes and using what he knows about Kyle to form an honest answer.
Tyrone stated, "Ok, Kyle, this is how it is.I felt like you walked around school, owning the place because you got this awesome as shit GPA.You thought you were better than me because I was this huge thug, and you had this brain." Then Tyrone changed over to Kyle’s position and stated, "Ok, Tyrone, I get it. But you gotta know that I was always a little afraid myself. Yeah, I got the grades, but was lacking the brawn. Guess the only way to feel like I had any edge was to put all self-confidence into my grades. It was like, you know, my defense mechanism, just like your pushing me was yours."
Tyrone continued to switch back and forth between arguments. After it was done, Tyrone stated, "I guess I never really thought about Kyle’s side. I mean, he had to look out for his own too. I can’t hate a kid for looking out for himself." As you can see, through the "Empathetic Dialogue", Tyrone could more easily understand that other people have their own set of rules and standards that conflict with his own. However, he also realized that just because one set of values conflicts with the other does not entail an all-out aggressive act.
Think of your BPD client. Could he or she benefit from "Empathetic Dialogue"?
Form #2 - Conditional Assumption
A second type of "should" trigger thought is conditional assumption. BPD clients who hold conditional assumptions believe that if something is true, then this other thing needs to happen. Many times, clients find themselves thinking, "If he/she loved me, he/she would…". The problem with this triggering thought, obviously, is that the other person probably does not hold the same assumptions as the client.
In BPD clients with conditional assumptions, a loved one who does not fulfill the expected criteria does not love them and leaves the client feeling abandoned. John, a 21 year old BPD client, stated, "I had this girlfriend once who never called me. I mean, I was always calling her, asking about her day, and she never called me. Maybe once a day, but not the same amount as I called her. If she had really cared for me, she would have called me more."
Obviously, John’s trigger thoughts required that his girlfriend always stay in contact with him. John never considered that his girlfriend might express her love in a different way.
Technique: Difficult Choices Exercise
To help John, I asked him to try the "Difficult Choice" exercise. I asked John to think back to time in which he had unintentionally disappointed someone he loved or cared for. I asked him to remember the last time he had to make a difficult choice, when he decided to take care of his needs over someone else’s. As he thought back, I also asked him to notice how little his choice had to do with how much he loved, but rather with how much he needed, or was afraid.
John stated, "I guess it would have to be when my mom wanted me to help her with painting the kitchen, but I went out with my friends instead." I asked him, "Why did you go out with your friends instead?" John stated, "I had had a really rough week and I needed to relax and have a good time." I asked him if that meant that he didn’t love his mother and John stated, "No of course not. I made it up to her in the end, because I do love my mom."
As you can see, by thinking back on his own difficult choice, John could better understand why choosing his own need over his mother’s did not indicate a lack of love on his part.
Form #3 - Punishment Fallacy
In addition to predetermined rules and conditional assumptions, the third type of should trigger thought is the punishment fallacy. Clients who experience this type of trigger thought believe that people who hurt them deserve to be punished. In BPD clients, this entails lashing out, shouting, and in severe cases, physical harm. Often, this will result in impulsive and hurtful repercussions. In such cases with BPD clients, the other person may believe that he or she had done nothing seriously wrong, and so does not understand the client’s unexpected rage.
Valerie was a 23 year old client who related to me this incident, "My friends and I were at an amusement park and my friend spilled a drink on me. Everyone started laughing, and I was so mad, I slapped my best friend who spilled the drink. Then I stormed off, and eventually left them because I was so ashamed of my anger."
I asked Valerie to think back to that incident and describe the type of feelings she had during the incident and how she could have handled it better. Valerie stated, "I guess I did it because I was just embarrassed, and didn’t know what to do. I suppose I would have felt better if I had just laughed with them. I mean, it was just soda."
On this track, we discussed the various forms of should trigger thoughts in BPD clients. Some of these thoughts are predetermined rules; conditional assumptions; and punishment fallacy.
On the next track, we will discuss the various types of blaming trigger thoughts in BPD clients. Some of these types are black and white thinking; mind reading; and labeling.
What are three types of should trigger thoughts?
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