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Section 14
Assessment of Emotional Response to Borderline Personality Disorder
Psychologist CEs, Counselor CEUs, Social Worker CEUs, MFT CEUs

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On the last track, we discussed active response choices for BPD clients. These response choices include  expressing a specific need; negotiating; and ultimatums.

As you know, passive response choices are designed to understand the other person’s needs rather than express the BPD client’s own needs.  By doing this, the client can better understand the other’s person’s motives and resort to understanding rather than aggression

On this track, we will discuss passive response choices, which include  getting information; acknowledging; and withdrawal.  Also, we will include Guidelines for All Response Choices.

Three Passive Response Choices

Choice #1 - Getting Information
The first passive response is getting information.  This is actually an effective salesman technique.  When a customer blatantly says no, the salesman uses a line of questioning to understand the feelings and needs that lie behind the resistance. Such Questions include the following.

            1. "What do you need in this situation?"
            2. "What concerns/worries you in this situation?"
            3. "What’s hurting/bothering you in this situation?"

I ask my BPD clients to use one of the above questions to begin to engage the other person in the resolution of the conflict.  If the person does not want to talk about his or her needs, I ask the client to question their feelings and vice versa.  Sophia was a BPD client who also worked as a nurse.  One of Sophia’s co-workers frequently criticized her about various forms of inefficiency. 

After a few times of this reoccurring, Sophia began to feel enraged, but instead of lashing out at her coworker, simply asked her, "I understand your point, but what bothers you about my being slow?"  To which her coworker answered, "These people should have been bathed hours ago."  Not satisfied, Sophia again asked her, "I understand, but what bothers you about that?"  The coworker went on to tell Sophia that when the hospital gets late admissions, Sophia could never take them because she was so far behind.  As a result, her coworker was swamped with more work than she felt she could handle. 

From this point on, Sophia could negotiate with her coworker on the terms of the work load.  As you can see, by requesting information about the other person’s feelings, Sophia could diffuse the frustration of her coworker and of herself. 

Choice #2 - Acknowledging
The second passive response is acknowledging. I have found that acknowledging the other person’s needs is a useful tool in de-escalating the conflict. As I explain to my BPD clients, like themselves, many people just need to know that they’re understood. I ask them to restate the other person’s needs or feelings using the following statements.

            1."So what you want is _____"
            2. "So what concerns/worries you is ______"
            3. "So what hurts/bothers you is ______"

I express to my BPD client’s the need to refrain from describing the other person’s needs in a sarcastic, exasperated, or judgmental tone of voice.  Neutrality is the most effective way to convince the other person that you are sincere in getting to the bottom of the conflict.  Tori was a 35 year old client whose mother, Julie, repeatedly harassed her to date and marry soon. 

In the past, Tori had met her mother’s urgings with biting tones and sarcastic remarks.  However, I asked Tori to try acknowledging her mother’s position in order to avoid a conflict.  The next time Julie said, "You really need to get out more and find yourself a man.  Your body can’t wait forever."  Tori responded with, "What’s worrying you is that I will end up alone and regretting that I never took a chance." 

By expressing understanding instead of sarcasm, Tori was able to avoid lashing out at her mother.  By reducing this extra pressure, Tori felt more free to live her life in her own way.  Think of your Tori.  Could he or she benefit from acknowledging?

Choice #3 - Withdrawal
In addition to getting information and acknowledging, I find that the third passive response choice is withdrawal.  This is, in effect, Time Out, in which the BPD client decides that he or she must withdraw from the other person to avoid a full blow-out.  You can find more information on Time-Out or withdrawal on track 9.

Guidelines for All Response Choices
Now that we’ve discussed active response choices on track 13 and passive response choices on this track, we will discuss the guidelines for response choices.  These are specific techniques I ask my BPD clients to practice in order to make using these response choices easier and more effective.  The guidelines include the following.

  1. Memorize the response choice statements.  Each response choice comes with a specific statement that can be filled in by the client.  I ask my clients to memorize each statement so that when the time comes to use them, he or she does not have to make an effort, but rather does so naturally. 
  2. Whenever possible, rehearse in advance active responses 1 and 3.  These are the expressing a need and ultimatum response choices.  Refer back to track 12 to read further about these response choices.  These active responses might require you to express your feelings.  Decide whether you are wise to include your feelings about the situation.  Then formulate your request and your fallback position.  Make sure that your request is behavioral and specific.  Also, try to generate a self-care response.  Ask yourself how you can take care of the problem without the other person’s cooperation.
  3. Continued anger or escalation are your signals to switch responses.  Don’t get stuck if a response isn’t working.  Move on to what you feel intuitively is the next best option.
  4. Don’t be afraid to repeat responses.  You may wish to return several times to questions that get more information.   You may wish to acknowledge what you’re learning about the other person’s experience.  And as the discussion progresses you may wish to invite another round of negotiation.
  5. If you don’t know what to do next, try shifting from active to passive responses (or vice versa).  If you’ve been focusing on getting information, try expressing your own needs now.  If you’re stuck in fruitless negotiation, consider asking for information.
  6. Keep shifting among responses until the problem feels resolved or further communication appears pointless.  If you’re still angry and stuck, go to one of the exit responses.  Stop talking and physically leave the situation.

I have found that clients who practice their response choices in the above ways have a much easier time with switching from the aggressive response to the active or passive response.  Think of your BPD client.  Could he or she benefit from these guidelines for response choices?

On this track, we presented passive response choices, which included  getting information; acknowledging; and withdrawal.  Also, we included Guidelines for All Response Choices.

Peer-Reviewed Journal Article References:
DeShong, H. L., Grant, D. M., & Mullins-Sweatt, S. N. (2019). Precursors of the emotional cascade model of borderline personality disorder: The role of neuroticism, childhood emotional vulnerability, and parental invalidation. Personality Disorders: Theory, Research, and Treatment, 10(4), 317–329.

Gratz, K. L., Richmond, J. R., Dixon-Gordon, K. L., Chapman, A. L., & Tull, M. T. (2019). Multimodal assessment of emotional reactivity and regulation in response to social rejection among self-harming adults with and without borderline personality disorder. Personality Disorders: Theory, Research, and Treatment, 10(5), 395–405. 

Sauer-Zavala, S., Cassiello-Robbins, C., Woods, B. K., Curreri, A., Wilner Tirpak, J., & Rassaby, M. (2020). Countering emotional behaviors in the treatment of borderline personality disorder. Personality Disorders: Theory, Research, and Treatment. Advance online publication.

What are three passive response choices? To select and enter your answer go to Test.

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