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Archive for July, 2019

Haughty, that’s the word. Haughty is defined by Merriam-Webster as “blatantly and disdainfully proud¬†:¬†having or showing an attitude of superiority and contempt for people or things perceived to be inferior.”

Interestingly, synonyms include a long list including; proud, vain, arrogant, conceited, snobbish, stuck-up, pompous, self-important, superior, egotistical, supercilious, condescending, lofty, patronizing, smug, scornful, contemptuous, disdainful, overweening, overbearing, imperious, lordly, cavalier, high-handed and the list goes on.

That’s a lot of name calling for one person The difficulty with all these descriptions is when it’s time to counsel a narcissist. Name calling is a shaming practice and should be avoided. Yes, narc’s have a hard exterior shell and defend themselves well, usually with anger, but underneath that shell actually lies a very emotionally vulnerable person. This is why their ego defenses are so high. They build a high wall around their inner self to keep everyone at a safe distance.

To an outsider or someone who is in relationship with a narc, this shows up as lack of empathy and callousness toward others. They keep themselves elevated as this lofty place provides for them a place of comfort.

So where does this come from and how do they develop this? Ofte it stems from a difficult childhood. Abuse or neglect teaches the child that the only person available to them for safety and trust is themselves. So they begin to develop an internal fascination with themselves that turns into an act of self love. External relationships no longer matter unless the other person reflects the narc’s way of being. If you don’t match them, you are no concern to them.

Being in relationship with a narc is exhausting and confusing. Most narcs don’t realize there is a problem until they find themselves very alone one day and then ask themselves where everyone went. This is often the first time that a narcissist asks an insight related question for themselves. If they are able to figure it out from here they may stand a chance to heal. If not, then they may have a very long and lonely end of life experience.

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Borderline Personality Disorder, BPD, is highlighted by strong emotional issues. They become especially prevalent surrounding relationships. At the core, the person with BPD has a deep fear of abandonment, identity issues and is often prone to self-harm practices and suicidal ideation. People who are in relationship with someone who has BPD are often manipulated into staying into the relationship because the radical behavior of the disorder. Feeling trapped and bound by guilt and manipulation, people often stay in the relationship with a BPD longer than they should.

As a therapist who specializes in working with BPD, I have noticed that there are quite a few intriguing behaviors that borderlines commonly have that are not listed as a symptom in the DSM-5. The first is they have a history of sexual trauma. Almost every borderline I have treated has this somewhere in their history, usually in childhood or early adolescence. The second has to deal with the concept of love and healthy attachment.

I have often said that borderlines love too hard. They want to be in a relationship with someone so bad they are willing to threaten to kill themselves. This is an example of an unhealthy attachment. We can’t expect to have a healthy relationship when we are working from a position of fear.

Borderlines often reveal that most of their behavioral difficulties began after they suffered some sort of sexual trauma either through intercourse or molestation. For some reason, it appears that most of them never put this together in their minds. They get so wrapped up in emotional survival that the idea that they feel this way isn’t tied to what happened to them. Their identify of who they are as a person has been completely altered.

In therapy I don’t turn my clients into victims. Things happen to people and then we choose how to continue to react to them. With borderlines and other trauma clients, I cannot do that. Trauma has a cause and effect on the brain that must be treated at its core root. The memory of the trauma event builds a tie-in to the motional center, henceforth, borderlines are very emotional especially when a relationship issue triggers their fear that someone is going to do something bad, like leave them. Internally, they are freaking out.

At this level, Borderline Personality Disorder cannot be treated simply by helping someone change their thoughts that lead to better emotions. The trauma has to be treated in order to disconnect the emotions from the trauma memory.

Because this is happening at the subconscious level, a psychoanalytical approach is required. This approach comes in many forms such as schema therapy which is one of my favorite approaches. Schema identifies which mode a person is operating from. There are 18 modes and a borderline can be one or all them. Therapy can then be tailored to address these specific modes. Most borderlines are operating from multiple modes which create a complex dynamic that even the most savvy therapist can struggle with.

However, with any successful plan, put first things first. Before the mode is addressed I prefer to address the existing trauma as this is often the culprit. If the trauma is resolved, then we’ll see which modes got resolved with it. The result of treating the trauma is like the clearing of a storm. At this point it is safe to say that that the client was suffering from Post Traumatic Stress Disorder, or PTSD, comorbid with borderline features. An organic borderline doesn’t have trauma and so schema must be worked out which becomes a long haul for client and therapist alike. I utilize Accelerated Resolution Therapy for the trauma which proves very effective with quick results, typically within 1-5 sessions. This is enough to disconnect the memory from the emotion.

Another popular approach for treating borderlines is Dialectical Behavioral Therapy or DBT. While I am also trained in DBT, I still prefer the schema approach as it uses a reparenting approach instead of a soothing your feelings approach. It’s rare that I see a borderline come from a decent functional family, sexual trauma or not. Reparenting can be one of the most useful tools to help borderlines attain healthy relational attachments. It also helps them understand and gain insight into their behaviors. When we gain insight into why we do what we do, we gain power over the problem.

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