Borderline personality Disorder and how does it effects the relationship between a mental health professionals and the patient.
Muttahid Shah
Investigative and Forensic Psychologist
Borderline personality disorder:
Borderline personality disorder is a complex personality disorder which is characterized by long term pervasive pattern of instability in interpersonal relationships followed by intense emotional outburst and having acute fear of abandonment. Its a very intense mental health condition that deeply affect a person’s thought pattern, feelings and behaviour. People with Borderline personality tend to trust no one and always hold doubt, this is why they have very complicated relationship with their therapists, mast people with this disorder change multiple therapists because of their very low tolerance or differing opinions and trust issues, this is why therapists try their best to treat them with care and compassion.
Symptoms of Borderline Personality Disorder:
- Intense fear of Abandonment:
There is an intense fear of getting abandoned or being left out or rejected, which lead them make frantic efforts to not get real or perceived abandonment.
- No stability in Maintaining Relationships:
They are unable to maintain long term relationships, they frequently shift from idealizing the person to hating them and often have complaints in every other relationship.
- Act on Impulse:
They often act impulsively, they tend to engage more in substance abuse, eating disorder specifically binge eating and many more.
- Emotional Instability:
Their mood shifts are intense and they hold no control over them, these mood swings last from few hours to days.
- Chronic Feelings of Emptiness:
They have this constant sense of boredom and they feel this numb void inside them which makes them feel empty.
- Anger Outbursts:
They have difficulty controlling their sudden outburst of anger, which often leads to verbal or physical fights.
- Paranoia and dissociation:
Sometimes the feel paranoia, an irrational fear that people are planning to hurt them or they feel disconnected for reality.
Impact of BPD on the Therapist-Patient Relationship:
As people who have borderline personality disorder mostly have complex relationship with their therapists. They usually see therapists as the only person understanding them and listening to them so they start getting attached to them, lack or attention from therapist or any small misunderstanding or even if they perceive criticism, they argue with therapist or discontinue the session, which make most therapists more confuse, this can also be the result of their perceived abandonment fear, as they have get attached, a small criticism or therapist absence due to any reason make them feel like that they are being abandoned by the therapist, which cause them to have emotional outbursts or withdraw from therapy. This is why most therapists carefully try to manage their fears and maintain boundaries by rejecting most advances precisely.
Now, as the therapist try their best to maintain the boundaries’, the patient also try to break those walls of boundaries and test the therapists by making them meet out of the sessions and at random places, asking therapists to respond their queries at any time with immediate response or expect to be provided with special treatment. As they fear that they might get rejected so they try their best to secure their place, which might in result cause stress and pressure to the therapist, this is why their advances should be very precisely and carefully stopped by the therapists, which most of the times require strategic plan. Work with these kind of patients mostly exhaust therapists, casing them emotional burnout and frustration, which is why proper maintenance of therapists own mental health should also be done so that therapist can continue their sessions without being in distress.
Strategies for Strengthening the Therapeutic Relationship:
Use of DBT ( Dialectical Behavioural therapy) should be done as in DBT, patient’s emotional dysregulation is subjected, their tolerance of distress is focused upon and mindfulness plays the key role. Patient should be provided with right amount of trust and validation keeping the bounders intact. There should be clear and intact instructions and boundaries around the session scheduling and meeting places so that no false hopes are fostered, along with healthy and good communication grounds so patient can easily interact and deliver their each and every feelings and emotions honestly. Therapist should also be able to clear misunderstandings first hand so that no future problems are catered.