Wednesday, January 12, 2011

How to Disarm a Borderline Part V: You ARE Helpless

Before reading this post, particularly if you are going to try this at home with a real adult family member with borderline personality disorder (BPD) (which is not recommended without the help of a therapist), please read my previous posts Part I (October 6), Part II (October 29), Part III (November 24), and Part IV (December 8).  The countermeasures described in this post do not work in isolation but must be part of a complex, consistent, and ongoing strategy. 

This post will continue with specific countermeasures to the usual strategies in the BPD bag of tricks used by them to distance and/or invalidate you, as well as to make you feel anxiously helpless, anxiously guilty, or hostile. 

Today we discuss #2, countering escalating demands on you to do more and more.

Back in the days of the Vietnam War, protesters used to recommend that the country just "declare victory and then get out."  To paraphrase this for our purposes, the advice here is to declare helplessness and get out. 

Remember, the individual with BPD is not only trying to make any potential "helpers" feel helpless, but also to make them feel upset about being helpless.  If you are fine with being helpless when you are in fact helpless, this goal of the BPD individual will be frustrated.  Of course, you have to remain fine with it consistently.

This point was driven home to me back when I was in private practice in California and was covering for another psychiatrist who was on vacation.  One of his patients with BPD frantically called, seemingly in crisis.  Of course, I knew absolutely nothing about her case.

"I've missed so much work that if I am out sick any more, I'll be fired," she told me.  "But I'm so depressed I can't do the job, and my boss says if I screw up again, I'll be fired!" she quickly added.  "What should I do?"

I'm no Klaatu

The way she described her plight, she was going to be fired for sure.  No doubt about it.  Too late to do anything about it now. That ship had sailed.  It did not take a genius to see that, and she was not a stupid woman.  If I even attempted to suggest a solution for her, she would immediately know that I was full of sh*t!

There was nothing I could do to help her save her job.  Nothing anyone could do, for that matter.  If she was speaking the truth, the whole truth, and nothing but the truth, that is.  What to do?  Declare helplessness and get out?  But how do you do that without invalidating her?
The first thing I did was to be empathic with her horrible dilemma.  "What an awful bind you're in!" I said in a warm voice.  "It sounds like you're going to be fired no matter what!" 
"A lot of help you are," she replied sarcastically.  Then she hung up on me. 

Oh well.  She was right.  I was no help. 
It did not bother me at all.  If she had been my patient, I'm guessing that she would still have shown up for her next appointment.  Although she sounded like she was upset with me, she knew that I would not be a help to her all along.  The importance of listening to words and not reacting to tone and body language will be a subject of a later post.
But what if she had still pressed me for a solution to her bind?  What if instead of hanging up on me she said, "Yeah, but I need you to tell me what to do.  You're a psychiatrist!  There must be something I can do!"
Well, there wasn't.  Sorry.  Reality and all that.  I was absolutely, incontrovertably, and in all ways helpless to solve her conundrum.  I'm supposed to be upset about that?  Hits me right in the God, you know.
Of course, if I said that to her, it would have sounded sarcastic, and that would be a hostile response.  That's one of the three no-no's in dealing with BPD.  In response to hostility , she would continue to find new and ingenious ways to infuriate me.
Time to declare helplessness outright:  "I sure wish I knew of a way to solve this for you."  I can say that with deep sincerity, because it is true.  I really do wish I could quickly solve impossible dilemmas for people on the spot.  I would love to be able to get people out of bad situations after they have already made it impossible to dig themselves out.  If I could, people would be willing to pay me thousands of dollars to give them advice.  They would  come from all over the world to see me.  I would be famous and wealthy beyond belief. 

But alas, it is not to be.
If  BPD individuals are in a stubborn mood, however, they might come back with a statement that strongly implied that I really knew of a solution, but was refusing to share it with them because I was being an A-hole.  Or they could accuse me of being incompetent, because surely other psychiatrists would know what they should do. 
To the first, I would say, "I'm glad you have such faith in me, but I really don't know what to tell you."  And refuse to argue further.  To the second, I would say, "Maybe you're right."  In order to continue to sound as conciliatory as possible, you must be willing to concede that maybe someone else could be smarter than you are in this situation, and not be threatened by that possibility.  Who really knows? 
An individual with BPD could also respond with, "Well, then, I might as well just kill myself."  I'll have to leave what to do about that one for a future post about how to handle suicide threats.
Trying to be helpful when doing so makes you miserable is another potential pitfall.  The best example of this is the middle-of-the-night phone call.  The BPD person just had, say, a spat with his or her lover, and wants to cry on your shoulder about it.  All night long.  For hours. 
I used to handle this with a declaration of helplessness: "Well there probably is not going to be any way I can make you feel better over the phone, but what happened?"
Sometimes they would reply, "I guess you're right.  I'll talk to you later."  Quite often actually.  Alternatively, they might just go into their spiel, rambling on and on about their latest crisis.  If so, I would interrupt them and say, "Is there anything I can do for you right now?"  They would often agree that there was not. 
If they still kept on, I would say, "I wish I could talk to you longer, but I really have to go."  No explanations, no alibies, just, "I have to go."  "OK then, GOODBYE!" they might shout in response, and then wait expectantly to see what I'll do next.  Works for me.  Getting them off the phone was my goal, and I achieved it. 

I knew they were not really all that angry about it.  It was merely a ploy to get me to say, "But please don't go away MAD."   Do not bite.  Just say goodnight to them and hang up.  But do say goodnight.  Otherwise you are being rude, a sure sign of hostility.
Later I came up with a much better response to the late night phone call.  I would say, as earnestly as possible,  "Hey, could you do me a really big favor and call me back after 9 AM?  I'd really appreciate it."
They would say, "OH! Did I wake you?"  I'd reply nicely, "Well, yes."  I'd then hear, "I'm sorry.  I'll call back later."  Worked like a charm.  A lot of times, they never even called me back the next day.

1 comment:

  1. It frustrates borderlines when their psychiatrists remember 'House of God" Rule #4: THE PATIENT IS THE ONE WITH THE DISEASE.

    An attending of mine reinforced that with me often throughout training. After a frazzling session with a patient, he'd remind me: "Kevin, that's *their* crap, not yours."