Treat The Borderline Personality with The Actualizing Equation

For good reason the Borderline Personality Disorder has a reputation for being the most difficult to treat. In some cases the pattern extracts its pound of flesh from the therapist. One of the reasons for this seeming intractability of the pattern has to do with the Actualizing Equation.

The Actualizing Equation

Actualizing Equation

Personality is inextricably bound with relationships. The Actualizing Equation illustrates this dynamic. Counselees can grasp how actualizing growth connects self-identity with community through a bond of reciprocal communication that compass theory calls existential intimacy. In this equation all three components are equally important and intertwined like three cords in a strong rope. The dynamic basis for this way of living is found in many religions and expressed clearly by Christ’s commandment to love God and others as you love yourself.

Therapists can find it useful to see how the Borderline Personality Disorder functions in relationship to the Actualizing Equation:

Borderline Actualizing Equation

As you can see from the graphic, the arrows between identity, intimacy, and community remain intact, ready to carry thoughts and feelings back and forth between the person and others. Yet the Xs strike out identity, intimacy, and community, indicating that what is carried back and forth is chaos, not communication. No wonder the counselee vacillates from feeling like the center of the universe to feeling completely annihilated. 

Borderline Personality Disorder

There is no spiritual core that holds the identity intact, no interior “I am” from which the counselee can think: “I don’t need to approach others in a love-me-or-leave-me mentality. I don’t need to assume every moment that love and hate are the principle forces of the cosmos, or that my existence depends upon another person’s response to me.”

The beginning of growth involves accepting that one indeed has a Borderline pattern, and that one’s own behavior is the true cause of such on-again, off-again, relationships.

As William James observed, life doesn’t change by manipulating outer events or other persons, but by altering one’s inner attitudes. By making a few crucial interior changes, the architecture of the self undergoes a reconstitution. In therapy this may occur very gradually over a long period of time, but sometimes with the Actualizing Equation graphic explained to them, Borderlines can make more rapid progress.

A therapist might say, “Look. You are hard-wired to care deeply about others, and you are very close to solving the equation of loving others as you love yourself. What we need to do is help you develop more realistic interpersonal expectations, coupled with a more relaxed self-presence. You can really make progress in solidifying your identity so that you experience more stable outcomes with intimacy and community.”

Compass Therapy suggests that working toward a health psychology is as important as diagnosing and treating psychopathology. Counselees can understand and transform their personality rigidities within an interpersonal context that helps them develop identity, intimacy, and community. 

For more, read:

COMPASS THERAPY:

Christian Psychology in Action

 

Ethics, Rapport, and Personality Disorders

The utmost delicacy is required in communicating to counselees the nature of their personality rigidities, since they may feel as vulnerable as a dental patient hearing the results of an examination. Yet therapists have an ethical mandate to impart this information when it contributes to understanding psychopathology or helps the counselee participate more effectively in resolving presenting problems.

Consider this as you approach a counselee: 

A good dentist knows to say, “Okay, this poke is going to sting a bit, but then you’ll feel better.” Patients still don’t want the needle and may resent the dentist for the invasiveness of the shot. But they do want the end result of healthy teeth.

So, when you are going to administer some truth serum to a counselee, and you anticipate temporary pain, you can say, “I’ve been pondering something that may represent new information for you…and may be a little shocking. But once we develop the overview, this insight will serve you well. Should I go ahead?”

Rare is the counselee who will stick fingers in both ears and shout, “No!” If you’ve developed decent rapport, something inside the counselee will say, “This is why I’m here.”

Rapport-building Psychotherapy

Here’s an example from my own practice:

“Ron,” I said, “we’ve reviewed pretty thoroughly how your parents left you to your own devices a lot, and didn’t much encourage conversation or activities in your life.”

“Right,” said Ron, waiting for the poke. “I grew up all alone.”

“Well, I’m afraid there are repercussions to that scenario that have lasted to this day.”

“You mean that I don’t like people?”

“Exactly. And more than that, you’ve built a castle around yourself and filled the moat with water and alligators so that nobody can get close to you.”

Ron smiled wryly. “My first wife would agree. She’d pester me for days to talk to her and then I’d bite her head off.”

“The bad news is that this will never go away on its own. The Compass Therapy name for it is the schizoid Loner pattern, or schizoid personality disorder.”

Ron sat up in his chair. “Does that mean I’m schizophrenic?”

“No. Schizophrenia is a genetic illness in which you have hallucinations and live in another reality. The schizoid personality pattern just means that you’ve split off your thoughts from your feelings, and this brings a hollow numbness inside. Then, to keep this loner pattern intact, you detach from people and withdraw into a shell. Does that make sense?”

Schizoid Loner Pattern

Ron nodded. “That’s me. I could stay on my computer for weeks if I didn’t have to go to work.”

“That’s a very honest assessment. Would you like me to tell you more about the consequences of this pattern so you can think over whether you want to keep it or not?”

“Go ahead.”

“The Loner pattern won’t let love in or out, won’t let you seek friendships that involve opening up, and will make you live and die a lonely man. How do you feel about that?”

“I guess I knew deep inside something like this was happening. I just got used to it and figured it was bad karma.”

“Actually, Ron, a fair number of counselees I’ve worked with started out even more schizoid than you. They somehow found the motivation to give life a second chance. You know, trying to see other people as more than just pests to get rid of.”

“Sounds hard to do. I get nervous when anybody’s around. I just like to be quiet with my own thoughts.”

“But isn’t that just what brought you into therapy—that you’re sick of thoughts rolling around like marbles inside your head?”

Marbles Rolling

Ron shifted uncomfortably in his chair. "I do get tired of hearing them."

“Perhaps one of our goals, along with diminishing those repetitive thoughts, can be to enrich your connection to people. There’s no good reason you can’t learn to have feelings and express them like anybody else.”

A look of relief came over Ron’s face. “Okay, but I’m going to need training wheels like a little kid on his first bike.”

“That’s what we’re here for. It’s safe to learn some new things now. And you’ve got plenty of intelligence to help you along.”

By being upfront and direct, I began shifting Ron’s concentration to actualizing growth and laid a foundation for the ongoing transmission of information about his schizoid Loner pattern even as he began to outgrow it. 

For more, read: 

COMPASS THERAPY:

Christian Psychology in Action

Communication: The Heart Pulse of Compass Therapy

Communication is the heart pulse of therapy. The dialogue that develops between a therapist and counselee incorporates body language, emotional nuances, cognitive insight, and spiritual discernment—an interpersonal dynamic that evokes the whole human nature of each person. This is what makes counseling so different from other health professions like medicine, dentistry, or optometry. 

In counseling and psychotherapy you utilize your own personality and human nature as an interactive force in calling forth your counselee’s human potential.

While some therapies set down rules of engagement that keep the therapeutic communication at a strictly clinical level, Compass Therapy suggests that it is wise to build a rhythm between clinical professionalism and personal naturalness that helps a counselee feel at home. Sullivan called this interpersonal posture that of a “participant observer.”

Participant Observer

If the counselee grew up in the town where you spent your last vacation, it’s a natural point of discussion to spend a couple of minutes talking over your mutual impressions of the place. This builds rapport, develops a fellow feeling, and prepares for the next round of therapeutic exploration.

BUILDING EMOTIONAL RAPPORT

Emotional rapport takes top priority throughout therapy. In fact, there is no effective therapy without emotional rapport; there is only talking or questioning or preaching.

Rapport involves curiosity, humor, listening, asking interested questions, exchanging ideas, and speaking in short enough sound bites that counselees can maintain their attention while feeling that you understand them. Whenever this rapport is broken for any reason, you can interrupt what you’re doing and immediately begin reflecting what the counselee is feeling. Before long, trust is restored and the conversation can resume.

Carl Rogers’ original research revealed the considerable role that building and maintaining rapport plays in promoting behavioral change. Rogers especially highlighted the therapist qualities of warmth, genuineness, and empathy that invite a reciprocal authenticity from the counselee. Today these qualities serve just as effectively for deepening the therapeutic conversation and alliance.

In fact, a review of forty years of research shows that a therapist’s main contribution in helping counselees achieve a favorable outcome is through empathetic, affirmative, collaborative, and genuine engagement.

Building Rapport

So rather than exuding an artificially aloof bearing meant to convey clinical objectivity, Compass Therapy suggests that you go ahead and be human, professional role and all. It’s good clinical practice to know how deeply people need attention, support, and caring, and to provide these qualities in no uncertain terms.

When you can say it authentically, you might try something like: 

• “That is a powerful insight.” 
• “I am amazed by the courage you are showing.” 
• “That is the funniest story I’ve heard in a long time.” 
• “You have a fascinating life narrative.”

For more, read:

COMPASS THERAPY:

Christian Psychology In Action

Compass Therapy: Warming Up Clients to The Truth

Diplomatic Warm-up Technique 

Counselees want to be trusted with the truth you perceive about them and their life situation. Yet while they value straight talk, they don’t want to feel embarrassed or emotionally wounded by what you tell them. So take it easy. Stay mindful of their feelings.

Communication should minimize counselee distress. Wachtel suggests that therapists cultivate the art of gentle inquiry, so that exchanges build trust by proceeding in a spirit of exploration rather than interrogation.

Diplomatic Warm-up

In other words, when you are shifting into a phase where you are about to offer realistic but painful information, warm up the counselee and proceed kindly.

Dan: “Ellen, we’ve been talking a lot about how hard you’re trying to make your son behave. But I’m wondering a bit why your husband seems so out of the loop. It’s like you’re doing the disciplining all by yourself.”

Ellen: “Well, that’s more or less true. But Larry is very busy at the bank just now. They’ve opened a new branch and he’s actually saddled with two jobs.”

Dan: “So you empathize with the pressure Larry is under. But I’m wondering who is empathizing for you?”

Ellen: (Looks down, her eyes momentarily tearing). “Maybe that’s why I feel so alone in this. I have to enforce all these boundaries. I didn’t have any brothers, so I don’t know much about teenage boys.”

Proceed kindly

Notice that Ellen has changed the subject. And even though she is deepening her disclosure about her feelings of loneliness and anxiety in handling her son, I need to diplomatically bring Larry into the equation so that he is not completely off the hook.

Dan: “That sounds doubly troubling. Not only are you feeling overwhelmed, but you’re very uncertain about what is appropriate or not in your son’s behavior.”

Ellen: “That’s right. I’m really floundering. But I’m determined to make Jeffrey shape up. If I can’t control him, who will?”

Dan: “Now back to your husband. When was the last time you two had a date, good sex, or a heart-to-heart conversation?” 

I am moving beyond emotional reflection in order to stimulate her thinking about the quality of the marriage bond. My clinical hunch is that Larry may have become so invisible to her as an absentee spouse and father that she is afraid to even broach the topic. However she responds, at least we are laying the foundation for more specific exploration in future sessions.

Ellen: (Looks me directly in the eye). “I’ve gotten so used to how things are at home that I don’t even think about Larry and me. It was good between us until he got this job last year. I don’t think we’ve had sex since then. We never talk about Jeffrey. He doesn’t ask and I don’t want to burden him.”

Without knowing it, Ellen has strengthened my working hypothesis that she is stuck on the Love compass point in the Dependent pattern as far as she and Larry are concerned. But on the other hand, she has become stuck on the Strength compass point in the Compulsive Controlling pattern with regard to the teenage son. I jot this in my notes but do not pursue it for our time is running out. I move into summarizing to help Ellen develop emotional closure for this particular session.

Dan: “Ellen, you are a brave person to single-parent your son, and I appreciate how openly you’ve talked today about the strained relationship with Larry. We’ve got to end for now, but notice how these dynamics are played out this week, and we’ll keep exploring next time.”

Now Ellen’s unconscious can retrieve recent memories that paint in bolder strokes the gap between her and Larry (both how it developed and where it’s headed) and she will become more ready to accept what would otherwise be a startling revelation: that her son Jeffrey has replaced Larry as a surrogate spouse in her life.

For more, read:

Compass Therapy:

Christian Psychology In Action

 

Compass Therapy Growth Strategy for Dependent Personality Disorder

Compass Therapy partners with other theories of counseling so that therapists are encouraged to draw upon their own approaches and clinical experience, even while applying compass tools. This means that therapist creativity, as well as sensitivity to the unique needs of each counselee, work together to determine the growth strategy that a therapist selects.

Psychotherapy

Here is a sample growth strategy that may prove helpful when working with Dependent counselees.

Therapy with the Dependent Pleaser usually starts well and proceeds rapidly for a few sessions, since the Pleaser wants to feel your approval. This is a good time to build rapport and lay the foundation for Strength and Assertion by commending any insights the person expresses or behavioral qualities they show that reveal the least bit of individuality.

The next step is to integrate psychodynamic insights with the kind of parenting they experienced, how they handled any brothers and sisters, and when they first noticed the onset of marked dependent behavior. Now is the time to let them talk about possible advantages of dependency, submissiveness, and non-competitiveness—what they gained from these behaviors and how the behaviors seemed to work for them at the time. This leads naturally into an exploration of the disadvantages of one-sided dependency: the opportunities they missed, the ways certain people took advantage, the lack of social visibility, the secret loneliness that came with a lack of identity, and the lack of assertion and confidence that they admired in others but lacked in themselves. 

Dependent Personailty Disorder

The novice therapist can get trapped in this phase of exploration and discussion by not shifting into the next phase of active coaching and skill building. In other words, while the Pleaser will comply with superficial talking therapy, sometimes giving the therapist what the therapist seems to want, they will begin to resist active strength-enhancement and assertiveness training steps.

Here lies the difference between therapy that meanders in undifferentiated directions and therapy that moves forward in providing counselees what is needed to outgrow defeating patterns.

To move into the action phase of therapy, you maintain rapport and conversational ease, but add the ingredient of behavioral experiments. Just as a coach training athletes, you teach and encourage counselees to handle current interpersonal relationships in new ways that bring gradual advances in personal presence. “What were you feeling when Judy said that to you…How could you have handled her more assertively…?” “When Ben picked you up thirty minutes late, what did you really want to say to him?” “When you wanted to change banks and the teller frowned at you, how might you have held your ground instead of capitulating?”

To outgrow habitual responses, the counselee needs new perceptions to support this risk-taking. For instance, the counselee says, “My buddy Jason wants to borrow my new car, but he’s wrecked two other cars and I don’t trust him. What can I say?” The therapist suggests, “This is probably one of those instances that everybody faces if they’re going to becoming more of an individual. You just tell him the truth and then relax your body and breathing to help counter your usual anxiety. And you say in your head, ‘There, I’ve stood up for myself and Jason can think what he wants about it. But I feel great that my car won’t get wrecked!’”

By now the counselee is getting acclimated to transferring insights and growth suggestions from therapy sessions into real life. Although there will be occasional relapses, you can show patience when they occur, stop long enough to troubleshoot them, and keep focused on complimenting the counselee for any increments of change in the directions of Assertion and Strength.

Dependent Personality Disorder

 Eventually, when the counselee has become fairly adept at self-preservation and self-expression, the question will arise about how to integrate newfound strengths with the lower quadrants of Love and Weakness. After all, the counselee doesn’t want to change from a clinging vine to a know-it-all arrogant bully.

So you now use cognition, emotion, physiology, and spirituality to cover the new ground of how to apologize or make amends if the counselee shows too much aggression, and how to experience forgiveness and caring for those in the counselee’s life who are making behavioral adjustments to the counselee’s use of the LAWS of the Self Compass.

For example, your counselee’s friend Jason may make a promise that he doesn’t keep. You guide your counselee to form a rhythm between Love and Assertion, first by calling Jason on his misbehavior. If Jason develops a reliable track record, then the counselee can move toward trusting again. But if Jason lies or makes another shallow promise, the counselee firms up the self-boundary by assessing whether further trust is warranted. A mature quality of love with discernment replaces the naïve gullibility of the dependent pattern.

You can tell when you are nearing completion of therapy, because there is less need for the therapist to guide sessions, and more autonomy with less distraction in the counselee’s life. At this time you can move from once a week to every two or three weeks, to help the counselee make a successful separation and get on with life beyond therapy. 

For more, read:

COMPASS THERAPY:

CHRISTIAN PSYCHOLOGY IN ACTION