Therapeutic strategy may focus on at least three parallel and related strategies: healing the individual with borderline personality disorder's injuries that create his or her experiential trinity of betrayal, abandonment, and rejection fears; training and empowering the partner's and therapist's secure attachment response trinity of caring contractual compliance, intimacy, and availability; and intervening to reduce borderline behaviors. Each of these three strategies facilitates accumulating quantitative changes, which lead eventually to qualitative change. While the partner and the therapist strive to provide a healthier, less reactive, and intimate relationship container for the individual with borderline personality disorder, the individual must accept that he or she will suffer agonizing feelings of betrayal, abandonment, and rejection in the process.
Frieda often felt desperately lonely as a child while her parents battled daily over real and imagined insults. She became a social butterfly as a middle-schooler and high schooler. She was on every sports team, joined clubs, and was involved in student government. Smart and charismatic, she was always involved in or doing something. Like the tree in the forest that falls and no one is there to see or hear it fall, Frieda needed to have someone around to confirm her existence. Try as she might however, sometimes she could not avoid being alone. At night, without a partner or without a lover or alone as a teenager and young adult, the loneliness that originated in her childhood would surge through Frieda. She couldn't stop feeling lonely when she couldn't avoid being alone. Alcohol and online social networking became a way to mute the loneliness and have pseudo-company. Worse yet, when she was lonely she also became desperate. The terror that arose when her parents did not and would not attend to her feelings and needs resurfaced, when she was lonely. When she was desperate especially as a young adult, Frieda made bad choices. She trolled online for gratuitous flirtations with strangers; she had history of one-night stands; she persisted in several romantic relationships before Cliff that were clearly not going to work out, she associated with certain people against her better judgment, and so on. Frieda was more than intelligent enough and aware enough to readily described her process to the therapist. In fact, she described it to Cliff when he was the new partner too. Frieda could see that she often went from having tough feelings to making bad choices in relationships and was doing it again with Cliff.
When the individual accepts that he or she will inevitably and necessarily suffer these feelings, then he or she can work on developing the skills and strength to do so. Focus on developing skills and strength can only occur after he or she gives up avoidance as his or he main strategy against suffering. The sensitivity and support of the partner and therapist will help this process while denying the borderline assertion that he or she cannot suffer and survive… must avoid suffering… and is entitled to and must or cannot help but lash out. The therapist may favor focusing a particular part of the cycle, or the individual think that change must come in one specific aspect. The therapist may find one aspect is most available to intervention, however therapy should work on interrupting at every part of the cycle. In other words, the individual with borderline personality disorder needs to learn how to manage all parts of the cycle.
First, the individual must learn how to feel betrayed, abandoned, or rejected… to be alone without feeling lonely, terrified, or angered. Frieda often could not tolerate being alone. This led her to demand Cliff’s presence at times and ways that he could not comply with. Sometimes being with others would assuage her anxiety. However, sometimes, Frieda just had to be alone. Cliff could not be around and neither could anyone else. Sometimes the individual cannot help but be alone. He or she cannot always be in the company of attentive and nurturing others. When left alone without immediate support, it may be hard not to feel betrayed, abandoned, or rejected; or feel lonely, terrified, or angered. Cliff is relieved of the need to be perfectly or one hundred percent available. Therapy challenges the individual to tolerate being alone because sometimes being alone is necessary to avoid negative and unhealthy people, avoid unproductive toxic interactions, and to calm down, re-center, or find perspective. There were times before meeting Cliff that Frieda hung out with or became intimate with toxic hurtful people because she was afraid to be alone. The individual with borderline personality disorder often has trouble believing that he or she cannot be alone without feeling lonely, anxious or scared, or angered. The partner and the therapist must encourage and require the individual to practice being alone to experience the possibility of not feeling lonely. This would be as stunning but critical reversal for Frieda to contemplate and try. Therapy would attempt to foster mindfulness, meditation, distraction, and self-soothing methods for being alone while keeping loneliness at bay.
Second, the individual must learn how to feel lonely, anxious or scared, or angered without feeling desperate. Sometimes, it is hard not to feel lonely. Previous negative experiences of being alone or of being abandoned predispose these feelings morphing into desperation. Someone such as Frieda often quickly shifted to anger to avoid the desperation from being feeling lonely. However, being lonely, anxious or scared, or angered does not always mean that the individual with borderline personality disorder is under great threat and is doomed to harm. Frieda did not think she could handle it and had avoiding trying through her borderline behaviors. Therapy would add cognitive interventions along with planned sets of behaviors designed to give the individual more effective and appropriate power and control. Therapy should attempt to break the cycle of trigger, intense feelings, negative interpretation, and resultant borderline behavior at each, every, and any point possible.
Third, the individual must learn how to feel desperate without making poor choices that harm oneself, the partner, or the relationship. Although, the individual may suffer desperation, it is not the intense feelings that create harm in his or her life and relationships. It is his or her choices to engage in problematic actions that devastate relationships and life opportunities. Frieda’s desperation burst out in vindictive words and slashing behavior against Cliff. Her borderline behaviors had ruined prior relationships as well as compromised vocational and social opportunities. The individual must be able to feel desperate, that is, suffer intense feelings without acting out his or her pattern of borderline behaviors. Therapy trains the individual to feel desperate and make benign or healthy choices for oneself, the partner, and the relationship. As with all learning, the individual must practice- that is, experience desperation to learn how to avoid making bad choices. Therapy should prepare and plan specific actions or behaviors for the individual and the partner to instigate when desperation strikes. Thus, there are three goals for therapy or for the individual with borderline personality disorder in the relationship and in life:
Learning how to be alone without being lonely,
Learning how to be lonely without becoming desperate, and
Learning how to be desperate without making poor choices and behaving badly
Growth in these areas enables the individual to reduce hypersensitivity to triggering events and allay hyper-vulnerability to borderline decompensation. Therapy with the therapist and life with the partner can become reparative relationships that heal attachment injuries from insecure child-parent experiences. The therapist and the partner must be active in confronting each part of the intense feelings, negative interpretation, and resultant borderline behavior cycle. This is the emotional environment for the individual to discover that he or she is not and has not been betrayed, abandoned, or rejected. The therapist and the partner should identify each part of the cycle as they evolve, offer caring contractual compliance, intimacy, and acceptance with boundaries for acceptable and appropriate behavior. In particular, the therapist and the partner must confront and deny the individual indulging in toxic borderline actions. In addition, the therapist and partner must also recognize the borderline dynamics and not get drawn into dysfunctional interactions.