The Buddy Bench

“Play makes us nimble — neurobiologically, mentally, behaviorally — capable of adapting to a rapidly evolving world.”
~Hara Estroff Marano: A Nation of Wimps
     I’ve heard discussions about something called the Buddy Bench. These are benches for children to sit on when they don’t have any friends to play with. Sitting on this bench is a cue for other children to invite this child to play. There are probably some nuances to the Buddy Bench I’m missing, but this is the basic principle. For more information, please check out the Buddy Bench website. The vision around the Buddy Bench is fantastic. Growing up, I experienced severe bullying and exclusion. Inclusion and friendship are great goals and we should be intentionally providing ways to encourage these behaviors in children. We should also be teaching them to adults! However, I believe the Buddy Bench potentially does more harm than good. Existentially, there are a few reasons this is a bad idea, and I’d like to recommend some alternatives.
     In A Nation of Wimps, Marano claims that parental over-involvement serves to undermine children’s confidence by weakening their psychological resiliency. Maranos’ research based book illustrates the risk of removing reciprocity from relationship (Buber). I will suggest why the Buddy Bench may inadvertently subvert the very ideals it seeks to encourage. Then, I will suggest a more difficult and authentic response to encourage children, and adults, to engage in healthy social relationship.

The Problem

    The primary issue I have with this idea is that it puts the onus of relationship almost entirely on the “other”. It does so through passive, rather than active/assertive communication. Sitting on the bench is making a statement without making a request. This is passive-aggressive communication 101. For example: if someone comes to your house, is sitting down to dinner with everyone, and made the statement, “It sure is hot in here…”, it may be a natural response to turn on a fan, open a window, turn down the AC, apologize for the unseasonably warm weather, or simply agree with them! However, the person making that statement has avoided vulnerability by making a request. Instead of asking if they could turn the AC cooler and risk being told, “No” (a rejection), they can use manipulative statements in an attempt to elicit a behavioral response from someone else.
     The more adept someone is at reading body language, subtle context clues, and implications, the better they will be at accidentally enabling others to continue using passive-aggressive speech. This prevents people from creating actual trust in others, because there’s no vulnerability. Without risking rejection, there can be no trust because no one has had the opportunity to let you down or hurt you!
     You may be saying, “Hey, Nathan! You don’t think sitting on a Buddy Bench is an act of vulnerability? You’re crazy!” Well, you may not be wrong about that last part, but here’s the issue: Sitting on a Buddy Bench automatically shifts the responsibility of connection from self, to others. It is a clear signal of needing support or relationship, but it is a request without risk. Even when the bench works, it doesn’t work, because the child will not know if they have a relationship with another child out of social obligation or due to their own personality, choices, and skills.

The Alternative

     Bullying is not acceptable. Bullying is meaningless, destructive, hurtful, and unhelpful. Anything I suggest from here on out should, in no way, be construed to imply that bullying is useful or healthy. And, just because a child is struggling with friendships/relationship, does not necessarily mean they are being bullied. It’s important to look at the context within which the isolation is occurring. If it’s primarily one or two children, then it’s likely bullying. If the child has almost no friends and is conflict with most other children, then it’s likely the child themselves is the issue.
     The response should not be to request the rest of the world to change to accommodate a lack of social skills/social understanding in one child. If this was the expectation, then it would stand to reason that we should all change in order to acquiesce to the requests of bullies! There are societal expectations and norms. They are not always fair, but they exist. Children are particularly skilled at punishing undesirable social behaviors. There are healthy ways for children (and adults) to learn to adjust their behavior to be more acceptable.
     I am not suggesting we should “go with the crowd”. There should be a sense of self that modulates all interpersonal and intrapersonal behavioral choices. But it is difficult to establish a sense of self by externalizing the locus of control in relationship creation. The better alternative would be to teach social skills in schools. Provide training to educators and administrators about how they can foster resilience in children. Resilience does not come without a certain amount of stress and discomfort. Having faith that our children are capable of learning new and better ways to interact and express themselves is a more difficult and time consuming route, but it is far healthier than a buddy bench.


Buddy Bench
Buddy Bench
(C) Nathan D. Croy, 2016

Mobile ExCommunication: Keeping Tech in Check

“Freedom is thus not the opposite to determinism. Freedom is the individual’s capacity to know that he is the determined one, to pause between stimulus and response and thus to throw his weight, however slight it may be, on the side of one particular response among several possible ones.”
~Rollo May, Psychology and the Human Dilemma (p. 175)
     Mobile technology is nearly ubiquitous and has advanced our ability to access information, people, and ideas in amazing ways. Television, gaming consoles, phones, tablets, e-readers, and even digital paper have transformed the way we connect with one another. Friends are no longer constrained by distance or mobility. Scientific ideas, education, medical advancements, politics, and the majority of the human race is advancing at an unprecedented rate. Tech is no longer an optional luxury, but an integral part of daily life.
     Yet, most family therapists could attest to the increasing frequency of complaints parents and spouses have regarding the feeling of having to compete for attention with electronics. Even though tech has proffered new and easily accessible ways to connect, it seems the art of genuine connection is being threatened.
     Here are a few ways families and individuals can help put technology in its place and foster better offline relationships. We’re going to channel the great chef, Emeril Lagasse, and remember these helpful guidelines with the acronym BAM! Now, let’s take it up a notch!

Boundaries: Does My Tech Have a Place?
     The first step for integrating technology in a healthy way with your family and by establishing healthy boundaries. It is not uncommon to establish boundaries on time/length on television or game-play, but this can be more difficult with phones. They are so easy to access! The phrase “real quick” is the most frequent lie we tell ourselves and others about “just checking” electronics. That is why it is so crucial to establish and agree on boundaries as a family. If the family is not in agreement prior to establishing these expectations, it will become a source of contention rather than an increase in cohesion. There are three areas I encourage people to focus on:

  1. Amount: 
    • Money: The amount of money someone can spend on a device, how they get that money, and how it works into a budget can be a fantastic opportunity to build trust and teach budgeting skills. Dave Ramsey has some great tools to help children learn how to manage money! There are several tools online for this, but this is what I have used.
    • Devices: Confession time! I have three tablets at home that I haven’t meaningfully used in a year. THREE. I even have an extra smart-watch! Older devices can be re-purposed in all kinds of creative ways (children’s tablets, picture frames, security system, etc), sold online, given to friends, used for shooting practice, whatever! The issue is, do we need this stuff to stick around or is it just junking up our life? Prior to getting something new, what are the rules about managing the old? With my wife’s purses, there is a rule: No new purses until you get rid of one old purse. This may sound cruel, but it was born of necessity (love you honey!).
  2. Access: 
    • Length of time: How much time, per day, can we spend on a devices? Does this include time spent for work or school? Does listening to music while exercising count? Be specific!
    • Times of day: Rather than specific times of day, I have found it can be very helpful to identify general times when electronics should not interfere with family. An hour before bedtime, during meals, and after 9:00 at night. This helps people be more intentional about when they’re on their phone and more aware of what is going on at home. 
    • Physical restrictions: Is there a centralized place in the home for electronics? Do they have a house that’s not your pocket? In addition, do electronics go into bedrooms? I would discourage this for EVERYONE. You can use an alarm clock that’s not your phone. Want your children to sleep better? Want to connect with your spouse more? Leave the phones, TV’s, gaming consoles, tablets, iPod’s, laptops, smartwatches, VR units, and whatever else out of the bedroom. 
    • Electronic Restrictions: Security is important and there can be sensitive information on cellphones. However, if there have been breaches of trust in relationship, security may not be an option for you. Discuss this with your spouse or children if it’s necessary for work. Be willing to show what you can, when asked, with a positive attitude. In addition, is there a time of day when the Wi-Fi can be turned off? Do we really need to be connected 24/7?
  3. Age:
    • GPS tracking: This is a really cool feature of new phones! Pull up the right app and you can see exactly where you child/spouse is! If you’re going to use this feature, be honest with your children/spouse. Otherwise, it will serve to break more trust than it creates. Also, remember this: These apps only tell you where the phone is, not the person. A dead battery can result in all kinds of panic when this is the primary way of “knowing” where a loved one is. It’s cool to have and it’s not a substitute for regular communication prior to going somewhere. 
    • Strangers: We teach our children not to talk to strangers, and then we give them a camera and access to the entire planet that’s full of strangers. Educate yourself on dangers and protect your children from catfishing, schemes, and human trafficking. Just like you would in real life!
    • When to buy: Children mature at different rates. Some 7 year old children can handle a full featured phone. Others I wouldn’t trust with a stick. I can tell you the rule in our house is that our children can have a phone when they can afford to pay for a phone and the accompanying plan. That is the level of responsibility we are looking for prior to offering someone unfettered access to anyone with a wifi signal. 

Alternatives: Is There Something Better Than My Tech?
     In an attempt to encourage better engagement in personal relationships, parents and spouses can accidentally engage in a power dynamic that further injures the very attachment they seek to strengthen. Here’s a fictional example:

Jennie: “Tom, why don’t you put the phone down and hang out with me?”

Tom, staring intently at his phone: “I just have to finish this email real quick!”

Jennie: “If you cared about me as much as you did that stupid email, our relationship might be better!”

Tom, looking angry and dejected: “This is for work! The thing I do to bring home money so we can eat and do all the stuff you enjoy doing!” 

     I don’t know an actual Tom and Jennie, but I suspect all of us have been guilty of being a Tom or Jennie at some point. Jennie, focusing on Tom’s engagement with his phone to the exclusion of her, has interpreted his behavior as a rejection of her. She wants Tom to notice her, but has gone about it in a way that makes Tom want to spend even more time in his phone!
     Both Tom and Jennie have this in common: a sense of rejection. Tom feels rejected because, in his mind, he’s working diligently to “bring home the bacon”. Jennie feels rejected because Tom is paying attention to his phone when he could be paying attention to her. Here’s the challenge: What are Tom and Jennie doing to cultivate a relationship where spending time together is a better alternative than spending time on the phone?
     One of the most seducing aspects of technology is its relentless availability. There is a persistent, nonjudgmental, and welcoming invitation to connect. Are families, friends, and couples, working to provide that same welcome? Neither Jennie or Tom are necessarily “at fault” here. We can talk about why Tom shouldn’t be on his phone or why Jennie shouldn’t be yelling at him. But that only solves one problem: boundaries around the phone. There is often an underlying issue of connection! In our relationships, we must be willing to ask what we’re offering that’s an alternative to technology.

Modeling: Do as I Do

     When people are struggling with addictions, it’s not uncommon to enlist the help of family members and the support networks to get involved in with treatment. If a family member is dependent on alcohol, it’s not very fair the rest of the family still gets to drink and keep alcohol in the home. At best, it’s unsupportive; at worst, it provides unnecessary temptation. However, many families regularly, and subconsciously, engage in this undermining behavior when it comes to electronics.
     How often do you ride in the car without listening to the radio? Is the television on just as background noise? Is the phone always within arms reach? There are many subtle ways to communicate the message of tech-dependence. If you want your children or your spouse to engage with technology in healthy ways, we must be willing to model this behavior ourselves!

Conclusion
     Using BAM can help provide a framework where families and individual can put tech in its place in order to encourage healthy relationship with others. We must be willing to implement this framework in our own lives, in an intentional way, and with support from others. Technology, when kept in its proper place, can enrich our lives, work, and relationships.
     Please share how your family has kept tech in check!

Mobile ExCommunication
Nathan D. Croy, (C) 2017

Microdates

“All real living is meeting.” 


     In providing marriage and family therapy, we almost always come to an issue of trust. How do we restore broken trust, how do we maintain healthy trust, and what do we do when we fear our trust will be misplaced? Many people struggle to even know how to create trust. 
     Trust has most often been born out of shared experience. When people spend time together, and there are multiple exposures to positive interactions, trust is created. To quote Buber again, “Man wishes to be confirmed in his being by man, and wishes to have a presence in the being of the other…Secretly and bashfully he watches for a YES which allows him to be and which can come to him only from one human person to another.” In other words, when we receive permission from someone to be ourselves, in a shared experience, trust grows. 
Creating Space
     These days, finding time to intentionally create shared experiences is very difficult. Most families work two jobs, have children, and still need to find time to sleep! Having “date night” is a luxury many people cannot afford. For my wife and I, this became the case. To resolve this, we created something called a microdate. Microdates are just like regular dates, but they last less than 30 minutes. They require some planning, but they’re a fantastic way to ensure we set aside time to be with one another. 
     For us, our microdates happen before we have to pick the kids up from daycare, and after work. We will meet for happy hour, and just talk. Sometimes we talk/vent about the day, tell jokes, talk politics, or just hang out. These shared experiences are crucial to maintaining healthy relationships and trust. Try them out!
Guidelines for Microdates
  • Inexpensive
    • Happy hour specials for appetizers, meeting in a park, or light exercise together
  • Less than 30 minutes
    • This encourages being attentive with our attention
  • Outside the home
    • Reduces distraction or temptation to clean/prep/nap! 
  • Planned
    • This decreases anxiety in those who MUST have things planned out and don’t want to feel rushed
  • No more than once a week
    • Too many microdates and they will become another chore!



Microdate.

(C) Nathan D. Croy, 2017







Subtypes of BPD, Part II

“Your perspective on life comes from the cage you were held captive in.”
― Shannon L. Alder
Introduction
        The first post provided a brief overview of BPD by way of metaphor. Now, I would like to suggest an original way of viewing BPD from an existential viewpoint. This is not based on any research, but professional experience and observation over time.
Subtypes of BPD
    
      From professional experience and observation, there tend to be three types of BPD. BPD shares a similar pathology with diabetes: Type I, Type II, and Gestational. Not only does the pathology tend to match, the treatments are similar as well: Maintenance/Life changes, Life changes, and Monitoring; respectively.

Type I
     The first, and most severe, type of BPD is Type I. Many adults with BPD have a history of trauma and abuse. Often times, a history of trauma is evidenced as a previous or current diagnosis of PTSD, RAD, or Disinhibited Social Engagement Disorder (DSED). Nearly 75 percent of clients with BPD report sexual abuse or trauma (Aguirre, 2007, p. 104). This statistic can be somewhat misleading, as many BPD symptoms involve antisocial, impulsive, and risky behaviors. These behaviors can expose people to situations where sexual abuse/trauma is more likely to occur. In addition, research has shown that people with BPD are more susceptible to developing PTSD (Golier, 2003). Etiology research has identified multiple factors involved in the development of BPD, but early trauma is one of the most common factors for people with BPD (Bandelow, 2003). However, meta-analytic study suggests that anywhere from 20-40 percent of people diagnosed with BPD do not report a history of childhood sexual abuse (CSA) (Fossati, 1999).
     Similar to Type I Diabetes, Type I BPD manifests early in life, will impact multiple systems, and requires medical treatment in addition to lifestyle changes. Type I BPD would be present in the 80-60 percent of cases where CSA, trauma, or neglect are reported. These instances will most likely have multiple diagnoses of PTSD, RAD, or DSED along with BPD (Binks, 2006). The proclivity of comorbidity of Type I BPD can muddy treatment goals and overwhelm resources, providers, and family/social supports.
     It is estimated that 90 percent of people with BPD attempt suicide at a 10 percent completion rate (Aguirre, 2007, p. 201). The rate of death due to diabetes is also 10 percent (National Diabetes Statistics Report, 2014). An additional commonality between Type I BPD and Diabetes is neuropathy. With diabetes, weakness, numbness, and pain from nerve damage, usually in extremities occurs. The resulting numbness can prevent people from noticing when they have a wound or injury. These injuries can then fester, become infected, and result in amputations. An emotional and relational equivalent also occurs in people with Type I BPD. They have experienced an emotional numbness that, when not addressed, can exacerbate relational wounds or injuries which fester to the extent the relationship requires amputation. This does not mean relationship repair is impossible. However, there are times when damage sustained from someone with BPD is so severe, the other person in the relationship is unwilling or unable to risk additional harm.

Initial Treatment
     To summarize, Type I BPD is evident in people who have a history of trauma, complex/compound trauma, unhealthy attachments, self-harm, likely multiple acute psychiatric hospitalizations, and symptoms have been pervasive since adolescents. Type I BPD will require long term treatment due to inherent distrust, emotional lability, and difficulty with attachment/joining. Emotional neuropathy may require multiple specialists to address specific symptoms while an overarching therapy is maintained. This could include EMDR, DBT, CBT, or IOP.

Type II
     In a minority of BPD cases, clients will present with no identifiable history of trauma, CSA, or familial trauma. Parents and family will state the client was a happy child with little to no mood lability, relational stability, and no history of hospitalizations, suicide attempts, or self-harm. Like Type II Diabetes, Type II BPD occurs when natural attempts to identify meaning and meet existential needs are frustrated. This exacerbation of the natural existential vacuum results in what Frankl identified as noogenic neurosis (Crumbaugh, 1964).
     An existential vacuum, a term created by Viktor Frankl, is defined as an emptiness and lack of meaning in our lives. “Frankl suggests that one of the most conspicuous signs of existential vacuum in our society is boredom” (Boeree, 2006). If this is not filled in a meaningful way, people will tend to settle for anything. People with Type II BPD often want for very few things. They tend to be wealthy with access to various supports and seemingly unlimited resources. This strength becomes the weakness which predisposes individuals to this existential form of BPD.
     When people reach out for meaning, belonging, and purpose, but are provided with resources, directions, and expectations, they end up meeting their “wants” without meeting their “needs”. This results in an existential version of “rabbit starvation“. This phenomenon occurs when rabbit meat, which is very lean, is the primary food. There are too few fats to make the meat truly beneficial in these circumstances and, though the hunter may be full from consuming massive amounts of rabbit meat, they starve to death.
     In clients with Type II BPD, they may have been “fed” a steady diet of resources, medications, and treatment, but they have been devoid of genuine relationships and meaning. Suddenly, out of relational desperation, these clients begin to panic. They become hypersensitive to abandonment, react strongly to any form of critique, and symptoms escalate rapidly. The crucial component then, is lack of authenticity and genuineness in relationships accompanied with an awareness of what is lacking. Van Deurzen (2007, p. 45) identifies inauthentic living as “a sense of imposed duty or the experience of discontentment with one’s fate”. The symptoms are exacerbated by a lack of sense of self (Buber, 1996, p. 126).
 
Initial Treatment
     This form of BPD, in my experience, responds remarkably well to existential psychotherapy, EFT, and the humanistic/experiential aspects of DBT. Like Type II Diabetes, Type II BPD can go into remission with lifestyle changes. Clinicians working with this population must be very intentional to avoid exacerbating symptoms. Preparing the client for successfully handling the necessary anxiety this treatment will produce is critical. Basic coping skills, psychoeducation, and planned gradual exposure, built on a solid foundation of the therapeutic relationship, can provide the necessary safety for someone to overtly and intentionally experience authentic relationship. Prognosis in these cases is very positive and could be completed within 12-20 family and individual sessions. Any hospitalizations should be normalized as part of treatment seeking stabilization. This will help clients avoid feeling shameful about their attempts at growth.
 
Summary

     This information is important to help understand and delineate types of BPD in order to specifically target forms of treatment in order to increase positive prognosis. As with any other diagnosis, knowing severity is important to assist in setting expectations and arranging necessary supports. If providers view every BPD case the same way, they may provide too many, or too few, resources. More research needs to be done to help clinically identify forms of BPD. Gestational BPD, a suggestion on how new research can be done, and how it may impact treatment will be covered in part III.

Phi
(C) 2016, Nathan D. Croy

Sources
 


     Aguirre, B. A., M.D. (2007). Borderline Personality Disorder in Adolescents: A complete guide to understanding and coping when your adolescent has BPD (1st ed.). Beverly, MA: Fair Winds Press.

 
     Bandelow, B., Krause, J., Wedekind, D., Broocks, A., Hajak, G., & Rüther, E. (2005). Early traumatic life events, parental attitudes, family history, and birth risk factors in patients with borderline personality disorder and healthy controls. Psychiatry Research, 134(2), 169-179. Retrieved from http://www.fafich.ufmg.br/cogvila/criancaadolescente/bandelow2005.pdf
 
     Binks, C., Fenton, M., Mccarthy, L., Lee, T., Adams, C. E., & Duggan, C. (2006). Psychological therapies for people with borderline personality disorder. Protocols Cochrane Database of Systematic Reviews. Retrieved from LINK.

     Boeree, C. G. (2006). Viktor Frankl. Retrieved February 10, 2016, from http://webspace.ship.edu/cgboer/frankl.html

     Buber, M., & Kaufmann, W. A. (1996). I and Thou: Martin Buber; a new translation with a prologue “I and You” and notes. New York, NY: Simon & Schuster.

     Crumbaugh, J. C., & Maholick, L. T. (1964). An experimental study in existentialism: The psychometric approach to Frankl’s concept of noogenic neurosis. Journal of Clinical Psychology, 20(2), 200-207. Retrieved from http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.505.6866&rep=rep1&type=pdf

    van Deurzen, E. (2012). Existential counselling & psychotherapy in practice. London: SAGE.
 

     Fossati, A., Madeddu, F., & Maffei, C. (1999). Borderline personality disorder and childhood sexual abuse: a meta-analytic study. Journal of personality disorders, 13(3), 268.
 
     Golier, J. A., Yehuda, R., Bierer, L. M., Mitropoulou, V., New, A. S., Schmeidler, J., . . . Siever, L. J. (2003). The Relationship of Borderline Personality Disorder to Posttraumatic Stress Disorder and Traumatic Events. American Journal of Psychiatry AJP, 160(11), 2018-2024. Retrieved from http://ils.unc.edu/bmh/neoref/nrschizophrenia/jsp/review/tmp/482.pdf

     National Diabetes Statistics Report. (2014). Retrieved from http://www.cdc.gov/diabetes/pubs/statsreport14/national-diabetes-report-web.pdf

 

 

 

 

Subtypes of Borderline Personality Disorder, Part I

“People with [Borderline Personality Disorder] are like people with third degree burns over 90% of their bodies. Lacking emotional skin, they feel agony at the slightest touch or movement.” 
― Marsha M. Linehan
     Let me begin by saying I am not an expert on Borderline Personality Disorder (BPD). The information discussed throughout this post, like all my posts, should not be used to diagnose or treat patients. Instead, I would like to share how I’ve come to view BPD throughout my career and how my treatment changes based on that understanding. This, the first post of three, will describe a metaphor I use to help explain BPD to clients and families. The last two posts will describe the specific subtypes (I, II, and gestational) and explore existential treatment options.
     The DSM 5 outlines specific symptoms and diagnostic criteria for BPD. Information can be found here. A few theories on subtypes of BPD already exist. Millon has theorized 4 subtypes, and Lawson identified 4 types of borderline subtypes for mothers. All of these suggestions are useful in long-term treatment. However, I would like to suggest a new alternative to identifying subtypes of BPD from an existential and systemic standpoint.
     Lastly, I may not consistently use person first language throughout this post. This is not to say people with BPD are defined by their diagnoses. Rather; it is important to see this post as my clinical view on BPD rather than the people who suffer with it. 
Borderline Personality Disorder
     Often times, clients with BPD are unaware of their diagnosis or they aren’t sure what their diagnosis means. The DSM 5 describes symptoms in clinical terms which, to the one receiving the diagnosis, may mean very little. When providing treatment for clients with BPD, a primary goal is to help them understand the diagnosis. Therapists would do the same with depression, addiction, or any other diagnosis. As a way of clarifying some of the clinical jargon, a metaphor has often helped to illustrate the critical aspects of the disorder in an approachable way.
The Window Painter

     Imagine we are all born into a room. The architecture of the room has unique and distinct features setting itself apart from other rooms, and is mostly bare without any furniture, paint, window dressings, or decorations. As we mature, we begin to decorate our room as a reflection of who we believe we are. As others look out their perspective window into ours, and as long as the blinds are open, they will see aspects of how we’ve decorated our room. We move past other people’s windows, and sometimes other people, from within their rooms, move past our windows. Regardless of the external changes, we remain in our rooms.
     People with BPD, tend to spend an inordinate amount of time looking out their window without looking into their room. Eventually, they begin to see other rooms are decorated or designed, and they want to appear the same way. Then, instead of working on interior design, they begin to draw on the windows. The window drawing becomes so effortless that, over time, they can change the entire look of a room, nearly on demand. If, when looking into the surrounding rooms, a person with BPD sees primarily pinks, pastels, bows, and trophies, they will paint their windows to match! Then, if there are a new set of rooms appearing out their windows, the paint quickly disappears and a new set of illusions are constructed and painted to match.
     All the while, the inside of the room, the actual room, is nearly devoid of real substance. There are no chairs to relax on, no beds to provide rest, and few lights to illuminate the recesses of the room. After a time, the energy required to maintain a nearly constant vigilance, begins to consume the window painter. When this happens, they start making errors in dressing the window. Someone notices the mistake and asks a harmless question. The Window Painter panics! They turn to see their room and find it empty, save for dust and cobwebs. Consumed with dread and shame, they enable one of the few design pieces in the room: the blinds.
     With the blinds fully closed, the window painting is still very visible, but the Window Painter is hidden. These are not healthy moments of introspection and solitude. These times are when the Window Painter, looking at the back of the blinds, sees no one, no thing, with which to connect. They are utterly alone. Within that instant, thoughts of self-harm and suicide begin to spiral into perseverating patterns of self-destruction.
     This is often when those on the outside, in their own rooms, feel so disconnected and confused. Loving parents cannot understand the source of the destructive behaviors. Friends and social resources begin to be consumed with drama and crises. People begin to distance themselves from the Window Painter. Then, when they peek through the blinds, their worst fears are confirmed: everyone really was leaving!
    Enraged and unable to engage, the Window Painter scratches and claws at the illusion on the window. They throw the blinds open and show the world the cultivated emptiness of their room. This only happens for a few brief moments before the Window Painter sees into the room of another. The connection becomes a juncture, an opportunity, for the Window Painter to bare their emptiness to another. The alternative is to resume painting, pretending, pantomiming, and hoping others interpret their real needs without risking exposing the bare walls.

Diagnosis

     The primary criteria for diagnosing BPD is “frantic efforts to avoid real or imagined abandonment” (Sperry, 2003. p.93). In the metaphor of the Window Painter, there is a dim awareness of the emptiness of the room. The compulsion to look outward, to the exclusion of personal insight, is fed by the overwhelming fear and dread which awaits those who look inward. This places the Window Painter in an existential dilemma: They want nothing more than to connect with others, to see and be seen. However, their greatest fear is abandonment. If the connections they experience are superficial and communication is primarily passive-aggressive manipulation, then very little rejection is risked. After all, how can someone truly reject someone they don’t really know?
     The sacrifice for this perceived safety is true intimacy. They are not fully known by anyone and therefore unable to truly connect. Behaviors emerging from fearful attachment (Agrawal, 2004) ultimately serve to confirm the greatest fear: Everyone leaves. This cycle repeats over and over again until the person struggling with BPD is truly alone. The mechanisms by which we come to know our selves (insight), our reactions (awareness), and others (empathy), all interact to help form relationships.

About the Doodle

      The Greek letter Phi is used to symbolize many things, including the “strength (or resistance) reduction factor in structural engineering, used to account for statistical [variability] in materials and construction methods” (Bulleit, 2008). While it should not be inferred that people with BPD have reduced strength, Phi is ideal to indicate a certain statistical variability in how BPD reacts to attachment and threats to attachment. In regards to the reactivity of those with BPD, there is a level of uncertainty which is almost always certain. Reactivity, self-harm, manipulation, low insight, and various other factors should be taken into consideration when entering into a personal or professional relationship with someone diagnosed with BPD.
     This is not to imply that people with BPD are too unstable to participate meaningfully in relationships. Rather, there is a greater degree of variability in mood, affect, and reactivity, all of which can add stress to any relationship. Therefore, to have successful, healthy, supportive, and strong relationships, we must take into account this variability and anticipate the need for additional supports. These may include therapy, hospitalizations, group therapy, medications, and education.



Phi
(c) Nathan D. Croy, 2016

   

Sources

     Agrawal, H. R., Gunderson, J., Holmes, B. M., & Lyons-Ruth, K. (2004). Attachment Studies with Borderline Patients: A Review. Harvard Review of Psychiatry, 12(2), 94–104. http://doi.org/10.1080/10673220490447218

     Bulleit, W. M. (2008). Uncertainty in Structural Engineering. Pract. Period. Struct. Des. Constr. Practice Periodical on Structural Design and Construction, 13(1), 24-30. Retrieved from http://www.ce.berkeley.edu/~mahin/CE227web/UncertaintyInStructuralEngineering-Bulleit_Feb08_ASCEJofEP.pdf

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