On the last track, we discussed the various triggers of defensive anger in BPD clients. These triggers are criticism; fear of unworthiness; and helplessness.
As you already know, anger for most BPD clients results from a certain need not being met. The pain that the client feels will most often produce angry outbursts because the client has not yet learned a less aggressive response. To remedy this, I give my clients response choices to express their needs without resorting to anger.
On this track, we will discuss active response choices. These response choices help the client to fully express the need or want that is not being met. I feel that these response choices are effective when the client knows the other person well. Active response choices, although rational, may also seem slightly aggressive or needy to someone the client has just met. The various active response choices include expressing a specific need; negotiating; and ultimatums.
Three Active Response Choices
#1 Expressing a Specific Need
The first active response is expressing a specific need. I ask my clients to open up with this line, filling in the blanks: "I’m feeling ______. And what I think I need/want/would like in this situation is ______." Lucy was a 24 year old BPD client. I asked Lucy to memorize this line the next time she was feeling hurt or upset, the emotional triggers for her anger. I asked Lucy to keep her requests behavioral rather than attitudinal.
To ask someone to be more loving, responsible, or caring is a broad request and, I have found, frequently leads to disappointment and miscommunication. Instead, I asked Lucy to be specific about the certain actions she wishes the other person to take. Also, I asked Lucy to have a fallback position, or the minimal behavioral change she would compromise with. Lucy was upset with her boyfriend because he kept setting up dates with friends that she did not like.
Lucy stated, "I always feel pressured around them, and unsure of myself. I really wish John wouldn’t invite them along." To express to John her feelings without the use of anger, Lucy stated, "What bothers me is you’re making dates with people I’m not sure I want to see. What I’d like is for you to check with me first before making any arrangements." As a fallback position, Lucy asked John to at least tell his friends that she might not be able to come along. As you can see, by stating her needs rationally rather than aggressively, Lucy accomplished her goal and her relationship remained intact.
I find that the second active response is negotiating. This active response is helpful when the BPD client and the other person have reached an impasse. It is designed to engage the other person in problem-solving, not conflict. Jill was a 31 year old BPD client whose brother was not participating in the care of their invalid mother. Jill was feeling used and upset that Kyle constantly made excuses to not see her. When expressing a specific need did not work, I asked Jill to move on to this line: "What would you propose to solve this problem?"
I asked Jill to remember that when working toward a compromise, each person’s needs must be met. I suggested to Jill that if Kyle suggested a worthless or resistant position, to offer a fallback proposal. However, if his suggestion had potential, to begin to negotiate. I gave Jill some suggestions to keep in mind when negotiating.
"My way this time, your way next time."
"Meeting halfway, or splitting the difference."
"Try it my way for a week and see. If you don’t like it, we’ll go back to the old way."
When Jill confronted her brother Kyle, she told him she felt overwhelmed and asked him to visit their mother twice a week, bringing her a meal, cleaning up her place, and staying long enough for a meaningful conversation. Kyle met her suggestion with resistance, stating, "I’ve got a full life, Jill. A law practice, two kids, I can’t do that." Jill then stated, "OK. What would you propose to solve this problem?"
Again, Kyle resisted. Jill then presented her fallback position, "How about at least visiting twice a week, forget bringing dinner?" Again Kyle refused, but suggested paying a service to bring their mother dinner. Jill consented to this, but also stated, "But she also needs to see you. How about you pay for someone two nights a week, and you visit once a week?" Kyle consented to this.
Jill later stated to me, "It was great. I didn’t get angry because I knew the whole time something was actually going to get done. I had to tell myself that this way was better, even though I still kind of wanted to get angry." As you can see, Jill also accomplished her goal through an active response.
Think of your Jill. Could he or she benefit from negotiating?
In addition to expressing a specific need and negotiating, the third active response choice is an ultimatum. If the other person in the conflict is not willing to compromise or fulfill the BPD client’s need, I ask the client to state the steps he or she would have to take to fulfill his or her own need. However, to avoid sounding as though the client is trying to punish or take revenge on the other person, I ask him or her to frame the statement as a step towards self-care. For instance, I ask my BPD clients to use the following statement when stating an ultimatum: If the problem goes on, I’ll have to _____ in order to take care of myself."
Typical ways which this response can be used is: paying someone else to do it; doing it themselves; getting the help of an authority figure; withdrawing from the relationship (either temporarily or permanently); or getting the need met elsewhere. Toby was a 23 year old BPD client who responded to peer pressure with anger.
Toby stated, "Around my friend Jared, I always feel pressured to impress him. I know he doesn’t mean it, but when I feel like he’s going too far, I get angry and call him a bastard and whatnot." I asked Toby to try issuing an ultimatum the next time he felt Jared was encroaching on Toby’s self-esteem. This occurred when, during dinner, Jared began to pressure Toby to go to a strip-club.
Toby found this distasteful, and told Jared he did not want to go. Jared began to taunt Toby, calling him a faggot and questioning his sexuality. At last, Toby issued this ultimatum, "Jared, if you press me again about the strip club, I’m going to just pay the bill and leave. We’ll go bowling tomorrow, but I’ll pack it in for the night." Jared took Toby at his word and dropped the matter. By issuing an ultimatum in this case, Toby was able to retain his anger from flaring up. Think of your Toby. Could he or she benefit from issuing an ultimatum?
On this track, we presented active response choices for BPD clients, which included expressing a specific need; negotiating; and ultimatums.
On the next track, we will examine passive response choices for BPD clients, which include getting information; acknowledging; and withdrawal. Also, we will include Guidelines for All Response Choices.
Peer-Reviewed Journal Article References:
Gratz, K. L., Dixon-Gordon, K. L., & Tull, M. T. (2014). Predictors of treatment response to an adjunctive emotion regulation group therapy for deliberate self-harm among women with borderline personality disorder. Personality Disorders: Theory, Research, and Treatment, 5(1), 97–107.
Gratz, K. L., Richmond, J. R., Dixon-Gordon, K. L., Chapman, A. L., & Tull, M. T. (2019). Multimodal assessment of emotional reactivity and regulation in response to social rejection among self-harming adults with and without borderline personality disorder. Personality Disorders: Theory, Research, and Treatment, 10(5), 395–405.
Ruocco, A. C., Laporte, L., Russell, J., Guttman, H., & Paris, J. (2012). Response inhibition deficits in unaffected first-degree relatives of patients with borderline personality disorder. Neuropsychology, 26(4), 473–482.
What are three active response choices?
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