3 Tips for Working Effectively with BPD

Luke Whitmore

Have you ever had a confusing conversation with someone that left you questioning your own perceptual abilities? As a professional helper, this is often the case when working with people who have Borderline Personality Disorder (BPD). It can be quite an uncomfortable experience for anyone, particularly if you take pride in your strong intuitive and interpersonal skills.

I recently had an interaction with a client who, after I referred to a very strong opinion he had shared with me many times, reacted with, “Are you kidding me? Why would I ever think that?!” Despite the recognition that he lives with several traits of BPD, I was immediately taken aback by his comment and wondered how I could have gotten it so wrong – but it turns out I hadn’t…

BPD is characterized by profound perceptual shifts and disordered reactions to those perceptions. The individual tends to feel a lack of connectedness with others due to constantly perceiving events and personal interactions differently than those around them.

I often explain the experience of living with BPD to my workshop participants in the following way: “Imagine if I told you that you think you are at a borderline personality disorder workshop, but you really aren’t.” The participants consistently give me odd looks, puzzled that anyone could really be that off base.

Although my example is an exaggeration, BPD does impact the way individuals interpret information, primarily as it relates to others’ intentions. Thus, it’s very common for these folks to feel rejected, abandoned, misunderstood, judged, inferior, and isolated. Not surprisingly, conversations can be very ineffective, often leading to conflict and pain for both involved.

The following tips can help you navigate these often-challenging conversations more effectively:

Build Trust

Although trust is required for any healthy relationship, the ability to develop trust with someone with BPD is absolutely essential if you are going to engage in meaningful discussion. As individuals with BPD tend to have highly sensitive personalities and perceive their childhood relationships as invalidating, their ability to be trusting of others can be quite compromised. As a helper, I ensure that I focus on building connection and trust before I start challenging. Being right doesn’t matter if you lose the connection.

One way we can establish trust is to consistently reinforce that we are there to support the individual and will do our best to help them feel safe. This can happen through assuring comments like, “I care about your best interests” and “It’s important to me that you feel heard.”  It’s also vital to keep in mind that trust is something we develop with our actions more than our words. I try to achieve this by being reliable, compassionate, and direct with my clients. They know that I show up for them and that I am on their side, despite our occasional perceptual differences.

Validate

Supporting those with BPD requires us to find a balance between empathy and boundary setting. If we are aware that the individual tends to live in constant emotional pain that distorts their perception of reality, we can learn to use empathy to increase our tolerance. This will allow us to understand that, in the moment, the individual truly does believe their accusations or insults. Validating allows us to demonstrate understanding without necessarily agreeing with their perception.

When I say, “I understand that you feel that way” or “You have a right to your own feelings and opinions,” we let them know that we are making an effort to understand how they see the world. This contributes to trust-building, but also increases our chances of then moving into asserting ourselves around our own needs and perceptions.

Assert Yourself

Providing support and validation to someone with BPD is very different than accepting inappropriate behaviour. It’s vital that you maintain your own sense of reality regardless of how the individual responds. You may need to remind yourself that you have the right to your own thoughts, feelings, and boundaries. After you have reminded someone that you are there for them and have validated their perspective, it’s important to then let them know that you see the situation differently. For example, “Feeling invisible is a terrible feeling. I let you know two weeks ago that we could not meet this week due to other commitments. It’s important to me to be available to my clients and to give them a lot of time if I do need to cancel.”

Supporting those with BPD requires us to find a balance between empathy and boundary setting.

Part of asserting oneself with someone with perceptual difficulties is describing our needs in concrete terms as well as letting them know what the outcome will be when our boundaries are tested. Thus, instead of saying, “I don’t like it when you disrespect my time,” we can use language like, “It is important to me that we end our session at 12:00 because if we meet longer, I have less time with my next client. I then owe that client extra time for their following session, which then needs to come from your time.” The individual may not agree with your boundaries, but the expectation and outcome has been clearly stated so that you avoid disputes over interpretation.

The following statement is an example of how we can communicate while using trust-building, validation, and assertion: “I care about you. I understand that it’s painful for you when I am not available when you phone for support, but my need as a therapist is to ensure that I am reliably available for other clients too. Because of this, I need to keep our communication schedule as is. Your insults and criticisms are hurtful to me and I would like to talk together about other ways that you can communicate your disappointment.”

Strong relationships require trusted connections, the ability to be heard and understood, and honest and clear language around needs and limits. When communicating with someone with BPD traits, these principles are absolutely paramount. If you are in a relationship with someone with perceptual difficulties, do your best to be there for them, but also be sure to protect your own health and wellness.  We really can’t offer people what they need if we’re exhausted and resentful.


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Tricia Klassen, MSW, RSW
Trainer, Crisis & Trauma Resource Institute
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