Tuesday, August 2, 2011

How to Disarm a Borderline, Part IX: Listen to the Lyrics, Not the Tune

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), Part IV (December 8), and Part V (January 12), Part VI (March 2), Part VII (April 30) and Part VIII (June 5). 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 describing 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 induce you to feel anxiously helpless, anxiously guilty, or hostile.

Today I discuss statements made by individuals which sound hostile or critical but which may or may not actually be as critical or hostile as they sound.  A lot of psychotherapists recommend responding to an individual's tone of voice and body language over responding to the content of what that person actually says. 

We all have a tendency to do that anyway - most likely because tone and body language preceded verbal language in the evolutionary development of the brains of primates like ourselves.  Chimps, for example, know whether another chimp is coming to fight with them or mate with them throught the approaching chimp's posturing and the noises it makes. (And if you injure a certain part of their brains called the amygdala, they completely lose the ability to make this call).

Nonetheless, I recommend precisely the opposite: listen to the words (the lexical content) and ignore the tone and posturing, as well as any seeming insinuations implied by what is said that are not stated clearly and overtly.

If you respond only to the words, the individual with BPD will usually change to a friendlier tone.

For example, a client with panic disorder responded to my recommendation for anti-depressant medication for her panic attacks with the sarcastic-sounding remark, "Oh, so you want to mess with my brain chemistry?" It sounded as though she was accusing me of being a devious, malicious mad scientist. Some anti-psychiatry types might agree with that interpretation of my recommendation, but I digress.

I nonchalantly responded, "Yes, anti-depressants do alter brain chemistry, although we don't know exactly how they work," and went on to describe their possible mechanism of action just as one might do with any other patient. She agreed to the drug trial.  (Of course she went off the meds the very next day, but that's another issue altogether).

The structure of all human language is such that ambiguity is extremely easy to generate. Any sentence in any language can refer to a multiple of unclear attributes or objects, or can be interpreted in exactly opposite (antithetical) ways. Negative judgments can come out sounding positive and vice versa through changes in body language, tone of voice, or even choice of synonym.

For example, almost any adjective with a positive or a negative connotation has a synonym with precisely the opposite valence. An optimist, for instance, can be called a Pollyanna. People can be described as stubborn or tenacious, loyal or as being lap dogs, and so forth. A complete discussion of the antithetical nature of language is beyond the scope of this post, but can be found in my book, Deciphering Motivation in Psychotherapy.

Another trick that people with BPD are especially adept at employing is to create ambiguity through the use of unvoiced implications, as I alluded to earlier. Individuals imply something without stating it explicitly, thusly creating opportunities for plausible deniability of having made those implications at a later date.

For example, a mother may admire her daughter in some way, but make it sound as if she were critical about the very behavior that she really admires.

A good illustration of this process occurred in a conversation between a nurse and her mother. The mother was discussing the daughter’s rather assertive (some might say even aggressive) stance towards the mostly male physicians with whom the daughter worked. The mother said, “I can’t believe you talk to doctors that way!”

The patient took this to mean that the mother believed that she should not engage in this behavior. In one sense this was an accurate assessment of the mother’s view, but it was only part of the whole truth. The mother indeed was worried that the daughter might get fired. Such would have been the case during earlier times, when the mother was younger.

As it turned out, however, the mother was also expressing covert admiration for the nurse’s bravery, assertiveness, and feminist leanings. What Mom had difficulty "believing" was that the patient had the audacious nerve that the mother lacked.

Her critical tone of voice obscured the admiration. The actual lexical content of the comment has no positive or negative valence at all.  She was merely expressing surprise. The nurse perhaps should have responded, "Well, is that a good thing or a bad thing?"


  1. Ummm... is that it?

    9 parts and it all building to the crescendo of how to disarm a borderline and you answer is "listen to words not tone"???

    I have to say, it sounds like you have completely rushed this and given very little.

    I was under the impression you were going to try and explain how someone who has already rewarded a borderline and thus built up a level of "variable intermittent reinforcement schedule" could actually manage to return to a balanced level, and in fact you had alluded to it in part 2 with your comment "and then finally advise readers about what to do in the inevitable event that they slip up - so that the variable intermittent reinforcement schedule does not kick in."

    Talk about an anti-climax and a psych-tease!

    1. See part X for the bit you're asking about:

  2. I'm not sure I am understanding the direction of proper response in this one.
    If I'd have to summaraise the advice is to consider critique as potentially being hidden positivity. I struggle to make sense of "listen to words not emotions" AND "words are ambiguous". While I accept both concepts as true I don't see them being useful when seen in tandem. Especially the recall towards using the lexical definition. I think what you want to express that our emotional interpretation can easily be wrong, but I am as said not sure.

    The Example with the antidepressants however seems more in sync with the previous tactic of calmly acknowledging the Kernal of truth thus not validating the hyperbole but still validating the valid concerns. That I find actionable, even though it's of course difficult.

    Unrelated to this (or maybe not since it's critique): I had trouble deciphering the last paragraph, because you introduce don't explicitly clarify that the patient is the same person as the nurse-daugther. It took me longer than necessary to get that.

    1. Hi Jan,

      Sorry about the confusion. I should have been clearer about the lexical content itself still being ambiguous, and that the listener should interpret it in the most positive way possible - such as intrepreting an adjective with a negative-sounding valence as really meaning the one with the positive valence.