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TitleBorderline personality disorder
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Table of Contents
Essential notes before reading this book
Information about the authors
Section 1 Borderline personality disorder information
	1 History
	2 How many people have borderline personality disorder?
	3 What is borderline personality disorder?
	4 Understanding borderline personality disorder
	5 Other problems or diagnoses found in association with borderline personality disorder
	6 What causes borderline personality disorder?
	7 Understanding self-harm
	8 Prognosis: do people with borderline personality disorder get better?
	9 Is treatment effective?
Section 2 Recovery frameworks
	10 Change
	11 Psychological treatments
	12 What to expect from treatment
	13 First contact with health professionals
	14 Choosing a therapist (where such a choice exists)
	15 Developing a therapy agreement
	16 Support network
	17 Assessment
	18 Treatment goals and treatment plan
	19 Therapy relationship
	20 Taking charge of your recovery
	21 Power struggles and beyond
	22 Prioritizing your therapy focus
	23 Preparing for crises
	24 Medication
	25 Hospitalization
Section 3 Recovery specifics
	26 Is it our awareness that makes a difference? (Self-reflection, chain analysis, and mindfulness)
	27 Is it what we do that makes a difference?
	28 Is it what we think that makes a difference?
	29 Is it what we feel that makes a difference?
	30 Is it what we do with emotions of anger, guilt, and regret that makes a difference?
	31 Is it what we do with impulsive urges that makes a difference?
	32 Is it taking charge of our personal boundaries that makes a difference?
	33 Is it how we clarify our values and identity that makes a difference?
	34 Is it how we relate to ourselves that makes a difference?
	35 Is it how we relate to others that makes a difference?
	36 Is it how we create pleasure that makes a difference?
	37 Is it how we deal with ‘flashbacks’ that makes a difference?
	38 Is it how we deal with crises that makes a difference?
	39 Is it how we manage our physical health that makes a difference?
	40 Is it our relationship with something ‘larger than ourselves’ that makes a difference?
	41 Notes to family and friends
	42 Concluding comments to the reader
Document Text Contents
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have discussed and agreed upon the boundaries and limits around your
relationship, stick to them or, if unhappy with them, discuss them with your
therapist before breaking the agreement.

One way for therapists to care about you and your relationship is by ensuring
that they don’t burn out. A burnt-out clinician will be de-energized, unenthu-
siastic, have diffi culty retaining necessary hopefulness when things get tough,
and be signifi cantly restricted in their ability to help you heal.

You do not want your clinicians to burn out

You and your therapist will have agreed upon actions for you to take if emer-
gencies occur outside of the agreed upon contact times. Your agreement might
or might not include contacting your therapist during agreed upon hours if
you need to repair your relationship, for skills coaching, or are in crisis. If calls
outside of sessions are part of your agreement, save them for what you have
agreed to—unnecessary overuse can overload your therapist. If your agree-
ment is that you are able to call outside of therapy sessions until 5pm, don’t be
tempted to put it off until three minutes to fi ve, just to see if your therapist
really cares.

It is their job to make sure that they remain energized and enthusiastic (not
burnt out) by staying within boundaries and limits that they can sustain over
the long haul. It is also your job to make sure they don’t burn out by your stay-
ing within agreed upon boundaries and limits. Too much pushing and you
might succeed in pushing them away—the thing you want the very least. Being
in the driver’s seat and taking control of your treatment means sticking to the
agreements that have been made at least until such time as you have been able
to re-negotiate.

On the other hand, insuffi cient use of crisis calls can also be a problem,
preventing you from getting appropriate assistance.

Explore how you can take charge of your recovery

Asserting yourself

Stating your feelings and talking them through to some degree of resolution is
an important process in your healing. If you feel hurt or not understood

Borderline personality disorder · thefacts

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by your therapist, assert yourself and respectfully discuss this with them.
Your therapist is a human being not a magician—the only things they will
know for sure about you are what you tell them.

Do not assume your therapist can read your mind!

Believing that they ‘should’ be able to read your mind or pick up on your
body or facial cues leaves you open to being misunderstood. It is your respon-
sibility to question them if you do not understand what was meant, or to
clarify if you think you have been misunderstood. This is an important rela-
tionship in your healing—we encourage you to raise assertively with your ther-
apist concerns you may have about the relationship. This can be a positive
experience, serving as both practice and a model for relationships outside

Resisting the urge to fi re your therapist

We encourage you to make a commitment to yourself that you are on this
journey of recovery for the long haul, and that if you feel like leaving therapy
you will do it in a planned way, in collaboration with your therapist. Many
people with BPD drop out of therapy prematurely, when feeling misunder-
stood or rejected. Recognizing and acknowledging feeling rejected to oneself
can result in productive discussion and repair with your therapist. Because
feeling rejected is so painful it is understandable that recognizing and acknowl-
edging this feeling will be painful; however, leaving therapy without discussing
the issues will not advance your healing. Unfortunately, you, the person-in-
recovery, are the person who gets hurt in this situation. This is not to say that
you should never leave a therapist unilaterally, rather that any such plans are
considered and thorough except in extraordinary circumstances, such as
where your therapist is in obvious fl agrant breach of ethical codes of practice
such as having sex with you.

Resist the urge to fi re your therapist impulsively
for long enough to refl ect

Chapter 19 · Therapy relationship

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relating to others (cont.)
liking to disliking and back

again 206–7
liking to disliking the therapist and back

again 207–8
personalizing 205
refl ection before permanent rejection of

others 208
repair 208–10
starting slowly 204–5
values, identity and relationships 204

relationships 102
helping 55
repair 207
unstable 13, 203–4

religious beliefs 74, 231–2
repair 156–8, 208–10
respect 74–5, 110–11
reward 56
riding the urge 184
riding the wave 207
risk factors 35
roles 194–5

sadness 7, 172, 174, 175
SAFE (Canada) 184
safe people, characteristics of 188–9
safety 122
schema 242

focused therapy 44, 66
schizophrenia 28, 29, 78, 242
self, sense of 21
self-acceptance 202
self-awareness 72, 127, 130, 204, 207,

self-compassion 180–1, 199–200
self-esteem 33, 69, 200–1, 202
self-harm 14, 22, 25, 33, 37–9, 143–4, 219
self-help 34, 232
self-image 21
self-judgement 169–70
self-re-evaluation 55
self-refl ection 69, 72, 152–4, 183–4, 216
self-talk 67, 166–7, 200
self-worth 69, 209
sensitivity 15, 33
serotonin 32, 45
‘service’ activities 232
services, available 78–9

sexual orientation 74
shame 175
side-effects of medication 137, 138, 139
skills 65, 70, 101–2, 122
sleep 226
smoking 43
‘snags’ 67–8
social phobia 26, 242
social reciprocity 154
social roles 34
societal breakdown 34
socio-cultural factors 5, 34, 35
sodium valproate 45
solution analysis 159
specialist services 78–9
spirituality 231–2
SSRIs 45
staff, unfamiliar 142–3
stages of therapy 121–2
standard treatment, high–quality 71
strengths 101–2
stress 32
substance abuse 14, 25, 26, 34, 219, 241
successes 200, 201
suicidal tendencies 22, 142, 219
suicide 27–8
support network 70, 79, 93–8, 234

development of 94
family and friends, role of 95
‘I’ statements and non–judgemental

assertion 97
involvement in treatment 98
long haul, boundaries and limits 97
people involved 94–5
reinforcing community 98
supporting and rewarding 96
understanding of condition 97–8

supportive accommodation 71
suspicious 14

taking charge 90, 130
telephone calls 65
terror 7
therapist, choice of 83–8

availability 83
changing therapist 87–8
competence, gender, age and culture 84–5
fi rst face-to-face meeting 86–7

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initial phone call 85–6
professional’s background 84

therapy agreement 89–92
collaboration 92
goals 89–90
openness 91–2
power, boundaries and being in charge of

your recovery 90
therapy review 91

therapy focus prioritization 121–5
leaving therapy 125
life outside therapy 125
pacing 124
quality of life 122–3
safety 122
stages of therapy 121–2
trauma work 123–4

therapy relationship 109–13
assertion 112–13
boundaries and limits 111–12
commitment 113
differences from other relationships

getting to know one another 110
openness 111
respect 110–11

thinking 165–70
ineffective 167
JCOB 167–70
self-talk 166–7

thoughts 215
topirimate 45
traits 242
transference 69–70
trappedness 215
trauma work 123–4
treatment, current and past 102
treatment effectiveness 43–5
treatment, expectations from 73–6

clinicians, expectations from 74–6
duration 73–4
frequency 74
gains and setbacks 74
numerous diagnoses and treatments 76

treatment foundation 100
treatment goals 105–7
treatment plan 107–8
trust 100–1, 138

uncontrolled trial 44, 242
understanding BPD 11–24

active passivity 18–19
being romantically dumped analogy 15
black and white (‘all or nothing’)

thinking 15–16
causes 12
competence, fl uctuating 17–18
diagnosis and more 11–12
DSM-IV diagnostic criteria 13–14,

harshness on self (and others) 17
idealization and devaluation 16
justice 17
sensitivity 15

United Kingdom 44
United States 42
unsafe people, characteristics of 188–9

values 193–7, 204
verbal abuse 95, 208
view, long-term 75
vulnerability factors 155

Wellness Action Recovery Plan 98
willingness 19
written plan 130


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