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Section 2
Dialectical Behavior Therapy for Borderline Personality Disorder

Question 2 | Test | Table of Contents | Borderline CEU Courses
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On this track we will discuss communication in treating faulty perception. Three aspects of communication as related to the BPD client include reflex communication verses conscious communication and the connection between shame and blame. We will also cover the "Three Steps to Conscious Communication" technique. 

Three Aspects of Communication

Aspect #1 - Reflex Communication
Remember Leah from the last track? As I found from Leah’s diagnostic interview, she experienced conflict in interpersonal relationships. Leah’s difficulties with relationships obviously resulted from her inability to realistically evaluate herself and others. As a result, Leah frequently engaged in reflex communication. Leah communicated her mixed up feelings without stopping to think about emotional situations.  

Aspect #2 - Conscious Communication
Clearly, Leah’s borderline personality would be more tolerable to those close to her if she engaged in conscious communication rather than reflex communication. I discussed Leah’s communication in terms of her goals in communicating. I stated, "Let’s forget about everyone else for a moment and concentrate on you. Do you think that learning how to hear and be heard depends on achieving clarity about your own feelings, fears, and defense mechanisms?" 

Reluctantly, Leah agreed that to communicate more effectively, she needed to learn about what motivated her to speak and behave in non-productive ways. Essentially, when Leah decided to learn more about how and why she reacted in certain ways, she decided to become more conscious about herself. Do you agree that by focusing on themselves rather than faults in others, BPD clients like Leah can begin to depend less on reflex and more on conscious communication?

Aspect #3 - The Connection Between Shame and Blame
In addition to conscious communication and reflex communication, the third aspect of communication regarding BPD clients is the connection between shame and blame. Leah’s borderline personality disorder was characterized by mild paranoia. Does your BPD client display signs of paranoia? The result for Leah was immediate manifestations of defense mechanisms whenever she felt shame. One defense mechanism Leah used which hindered her ability to communicate was blaming.

For example, Leah’s boyfriend, Mike, mentioned Leah’s adolescent drug abuse problem. Leah felt shame because she was not proud of her previous chemical addiction. The result was reflex communication when Leah lashed out at Mike and accused him of not supporting him. Leah stated, "I hate it when Mike brings up the past. The other day he referred to me as an addict and I got so mad. I said, ‘Well you don’t know what you’re talking about!  It’s people like you that push people like me into using drugs in the first place!’"  

Clearly, for Leah, the connection between shame and blame led to ineffective communication.   Think of your Leah. Is shame and blame a recurring problem for your BPD client? If so, you might consider the Three Steps to Conscious Communication technique to be explained next.

Technique:  3 Steps to Conscious Communication
To help her break her habit of reflex communication, I explained the "Three Steps to Conscious Communication" technique with Leah.  This technique gives the borderline personality disorder client a method to overcome or at least question the urge to react emotionally and without forethought to a situation or comment. 

--Step 1 - The first step in the "Three Steps to Conscious Communication" technique was for Leah to recognize the tension. In an earlier session Leah had stated that she sometimes felt her blood surge before she began to use her defense mechanisms. I stated to Leah, "Whenever you feel your blood surge, you can recognize the tension. If you know it’s coming, it might be easier to deal with." 
-- Step 2 - The second step was for Leah to realistically evaluate the situation. Clearly, this step is difficult and may require weeks or months for a BPD client to even begin. However, I  found that by testing Leah’s ability to realistically evaluate the situation early in treatment, I could continually assess her progression. 
-- Step 3 - In addition to recognizing the tension and realistically evaluating the situation, the third step in the "Three Steps to Conscious Communication" technique was for Leah to empathize. 

Leah stated, "If I know why something is happening or if I know why someone says something, I can better understand it. But sometimes I just get so confused." If your BPD client, like Leah, has trouble empathizing due to an altered perception of reality, later in this course we discuss additional techniques. However, by giving clients like Leah the tools for conscious communication early, I have found that techniques for implementation of the "Three Steps to Conscious Communication" technique are sometimes accepted easier in later sessions.  Would you agree? 

On this track... we have discussed communication.  Three aspects of communication as related to the BPD client include reflex communication verses conscious communication and the connection between shame and blame.

On the next track we will discuss rejection concepts.  Three common rejection concepts regarding BPD clients are personal attacks, perceived judgment, and self deprecation. 

Peer-Reviewed Journal Article References:
Bedics, J. D., Atkins, D. C., Comtois, K. A., & Linehan, M. M. (2012). Treatment differences in the therapeutic relationship and introject during a 2-year randomized controlled trial of dialectical behavior therapy versus nonbehavioral psychotherapy experts for borderline personality disorder.Journal of Consulting and Clinical Psychology, 80(1), 66–77. 

Bedics, J. D., Atkins, D. C., Harned, M. S., & Linehan, M. M. (2015). The therapeutic alliance as a predictor of outcome in dialectical behavior therapy versus nonbehavioral psychotherapy by experts for borderline personality disorder. Psychotherapy, 52(1), 67–77. 

Kliem, S., Kröger, C., & Kosfelder, J. (2010). Dialectical behavior therapy for borderline personality disorder: A meta-analysis using mixed-effects modeling. Journal of Consulting and Clinical Psychology, 78(6), 936–951.

What are three aspects of communication as related to the BPD client? To select and enter your answer go to Test.

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