Chapter Five
Communicating with the Borderline
Alright . . . what do you want me to say? Do you want me to say it’s funny, so you can contradict me and say it’s sad? Or do you want me to say it’s sad so you can turn around and say no, it’s funny. You can play that damn little game any way you want to, you know!
—From Who’s Afraid of Virginia Woolf?, by Edward Albee
The borderline shifts her personality like a rotating kaleidoscope, rearranging the fragmented glass of her being into different formations—each collage different, yet each, her. Like a chameleon, the borderline transforms herself into any shape that she imagines will please the viewer.
Dealing with borderline behavior can be frustrating for everyone in regular contact with the borderline personality because, as we have seen, their explosions of anger, rapid mood swings, suspiciousness, impulsive actions, unpredictable outbursts, self-destructive actions, and inconsistent communications are understandably upsetting to all around them.
In this chapter we will describe a consistent, structured method of communicating with borderlines—the SET-UP system—that can be easily understood and adopted by family, friends, and therapists for use on a daily basis, and which may help in convincing a borderline to consider treatment (see chapter 7).
The SET-UP system evolved as a structured framework of communication with the borderline in crisis. During such times, communication with the borderline is hindered by his impenetrable, chaotic internal force field, characterized by three major feeling states: terrifying aloneness, feeling misunderstood, and overwhelming helplessness.
As a result, concerned individuals are often unable to reason calmly with the borderline and instead are forced to confront outbursts of rage, impulsive destructiveness, self-harming threats or gestures, and unreasonable demands for caretaking. SET-UP responses can serve to address the underlying fears, dilute the borderline conflagration, and prevent a “meltdown” into greater conflict.
Although SET-UP was developed for the borderline in crisis, it can also be useful for others who require concise, consistent communication, even when not in crisis.
SET Communication
“SET”—Support, Empathy, Truth—is a three-part system of communication (see Figure 5-1). During confrontations of destructive behavior, important decision-making sessions, or other crises, interactions with the borderline should invoke all three elements. UP stands for Understanding and Perseverance—the goals that all parties try to achieve.
The S stage of this system, Support, invokes a personal, “I” statement of concern. “I am sincerely worried about how you are feeling” is an example of a Support statement. The emphasis is on the speaker’s own feelings and is essentially a personal pledge to try to be of help.
With the Empathy segment, one attempts to acknowledge the borderline’s chaotic feelings with a “You” statement: “How awful you must be feeling.” It is important not to confuse empathy with sympathy (“I feel so sorry for you . . .”), which may elicit rage over perceived condescension. Also, Empathy should be expressed in a neutral way with minimal personal reference to the speaker’s own feelings. The emphasis here is on the borderline’s painful experience, not the speaker’s. A statement like “I know just how bad you are feeling” invites a mocking rejoinder that, indeed, you do not know, and only aggravates conflict.
FIGURE 5-1
The T statement, representing Truth or reality, emphasizes that the borderline is ultimately accountable for his life and that others’ attempts to help cannot preempt this primary responsibility. While Support and Empathy are subjective statements confirming how the principals feel, Truth statements acknowledge that a problem exists and address the practical, objective issue of what can be done to solve it. “Well, what are you going to do about it?” is one essential Truth response. Other characteristic Truth expressions refer to actions that the speaker feels compelled to take in response to the borderline’s behaviors, which should be expressed in a matter-of-fact, neutral fashion (“Here’s what happened . . . These are the consequences . . . This is what I can do . . . What are you going to do?”). But they should be stated in a way that avoids blaming and sadistic punishing (“This is a fine mess you’ve gotten us into!” “You made your bed; now lie in it!”). The Truth part of the SET system is the most important and the most difficult for the borderline to accept since so much of his world excludes or rejects realistic consequences.
Communication with the borderline should attempt to include all three messages. However, even if all three parts are stated, the borderline may not integrate all of them. Predictable responses result when one of these levels is either not clearly stated or is not “heard.”
For example, when the Support stage of this system is bypassed (see Figure 5-2), the borderline characteristically accuses the other of not caring or not wanting to be involved with him. The borderline then tends to tune out further exchanges on the basis that the other person does not care, or may even wish him harm. The borderline’s accusation that “You don’t care!” usually suggests that the Support statement is not being integrated.
FIGURE 5-2
The inability to communicate the Empathy part of the message (see Figure 5-3) leads to feelings that the other person does not understand what the borderline is going through. (“You don’t know how I feel!”) Here, the borderline will justify his rejection of the communication by saying he is misunderstood. Since the other person cannot appreciate the pain, his responses can be devalued. When either the Support or the Empathy overtures are not accepted by the borderline, further communications are not heard.
FIGURE 5-3
When the Truth element is not clearly expressed (see Figure 5-4), a more dangerous situation emerges. The borderline interprets others’ acquiescence in ways he finds most comfortable for his needs, usually as confirmation that others really can be responsible for him, or that his own perceptions are universally shared and supported. The borderline’s fragile merger with these other people eventually disintegrates when the relationship is unable to sustain the weight of his unrealistic expectations. Without clearly stated Truth and confrontation, the borderline continues to be overly entangled with others. His needs gratified, the borderline will insist that all is well or, at least, that things will get better. Indeed, the evidence for this enmeshment is often a striking, temporary absence of conflict: The borderline will exhibit less hostility and anger. However, when his unrealistic expectations are eventually frustrated, the relationship collapses in a fiery maelstrom of anger and disappointment.
FIGURE 5-4
Borderline Dilemmas
The SET-UP principles can be used in a variety of settings in attempts to defuse unstable situations. Following are some typical borderline predicaments in which the SET strategy may be used.
Damned If You Do, and Damned If You Don’t
Borderline confusion often results in contradictory messages to others. Frequently, the borderline will communicate one position with words, but express a contradictory message with behavior. Although the borderline may not be consciously aware of this dilemma, he frequently places a friend or relation in a no-win situation in which the other person is condemned no matter which way he goes.
CASE 1: GLORIA AND ALEX. Gloria tells her husband Alex that she is forlorn and depressed. She says she plans to kill herself but forbids him from seeking help for her.
In this situation, Alex is confronted with two contradictory messages: (1) Gloria’s overt message, which essentially states, “If you care about me, you will respect my wishes and not challenge my autonomy to control my own destiny and even die, if I choose”; and (2) the opposite message, conveyed in the very act of announcing her intentions, which says, “For God’s sake, if you care about me, help me, and don’t let me die.”
If Alex ignores Gloria’s statements, she will accuse him of being cold and uncaring. If he attempts to list reasons why she should not kill herself, she will frustrate him with relentless counter-arguments and will ultimately condemn him for not truly understanding her pain. If he calls the police or her doctor, he will be rejecting her requests and proving that she cannot trust him.
Because Gloria doesn’t feel strong enough to take responsibility for her own life, she looks to Alex to take on this burden. She feels overwhelmed and helpless in the wake of her depression. By drawing Alex into this drama, she is making him a character in her own scripted play, with an uncertain ending to be resolved not by herself, but by Alex. She faces her ambivalence about suicide by turning over to him the responsibility for her fate.
Further, Gloria splits off the negative portions of her available choices and projects them onto Alex, preserving for herself the positive side of the ambivalence. No matter how Alex responds, he will be criticized. If he does not actively intercede, he is uncaring and heartless and she is “tragically misunderstood.” If he tries to stop her suicide attempts, he is controlling and insensitive, while she is bereft of her self-respect.
Either way, Gloria envisions herself a helpless and self-righteous martyr—a victim who has been deprived by Alex of achieving her full potential. As for Alex, he is damned if he does and damned if he doesn’t!
SET-UP principles may be helpful in confronting a difficult situation like this. Ideally, Alex’s responses should embrace all three sides of the SET triangle. Alex’s S statement should be a declaration of his commitment to Gloria and his wish to help her: “I am very concerned about how bad you are feeling and want to help because I love you.” If the couple can identify the specific areas of concern that are adding to her anguish, he could suggest solutions and proclaim his willingness to help: “I think some of this might be related to the problems you’ve been having with your boss. Let’s discuss some of the alternatives. Maybe you could ask for a transfer. Or if the job is causing you this much difficulty, I want you to know that’s okay with me if you want to quit and look for another job.”
The E statement should attempt to convey Alex’s awareness of Gloria’s current pain and his understanding of how such extreme circumstances might lead her to contemplate ending her life: “The pressure you’ve been under these past several months must be getting unbearable. All of this agony must be bringing you to the edge, to a point where you feel like you just can’t go on anymore.”
The most important part of Alex’s T statement should identify his untenable “damned-if-he-does and damned-if-he-doesn’t” dilemma. He should also attempt to clarify Gloria’s ambivalence about dying by acknowledging that in addition to that part of her that wants to end her life, another part of her wishes to be saved and helped. Alex’s T responses might be something like: “I recognize how bad you are feeling and your wish to die. I know you said that if I cared at all for you, I should just leave you alone. But if I cared, how could I possibly sit back and watch you destroy yourself? Your alerting me to your suicidal plans tells me that, as much as you may wish to die, there is at least some part of you that doesn’t want to die. And it is to that part that I feel I must respond. I want you to come with me to see a doctor to help us with these problems.”
Depending on the immediacy of the circumstances, Alex should insist that Gloria be psychiatrically evaluated soon or, if she is in imminent danger, he should take her to an emergency room or seek help from police or paramedics.
At this juncture Gloria’s fury may be exacerbated as she blames Alex for forcing her into the hospital. But Truth statements should remind Gloria that she is there not so much because of what Alex did, but because of what Gloria did—threatening suicide. The borderline may frequently need to be reminded that others’ reactions to him are based primarily on what he does, and that he must take responsibility for the consequences, rather than blaming others for realistic responses to his behavior.
When the immediate danger has passed, subsequent T statements should refer to Gloria’s unproductive patterns of handling stress and the need to develop more effective ways of dealing with her life. Truth considerations should also include how Gloria’s and Alex’s behaviors affect each other and their marriage. Over time they may be able to work out a system of responding to each other, either on their own or within therapy, that will fulfill the needs of both.
This kind of problem is especially common within families of borderlines who display prominent self-destructive behaviors. Delinquent or suicidal adolescents, alcoholics, and anorexics may present similar no-win dilemmas to their families. They actively resist help, while behaving in obviously self-destructive ways. Usually, direct confrontation that precipitates a crisis is the only way to help. Some groups, such as Alcoholics Anonymous, recommend standardized confrontational situations in which family, friends, or coworkers, often together with a counselor, confront the patient with his addictive behavior and demand treatment.
“Tough Love” groups believe that true caring forces the individual to face the consequences of his behaviors rather than protect him from them. “Tough Love” groups for parents of teenagers, for example, may insist that an adolescent drug abuser either be hospitalized or barred from the home. This type of approach emphasizes the Truth element of the SET-UP triangle but may ignore the Support and Empathy segments. Therefore, these systems may be only partially successful for the borderline, who may go through the motions of change that Truth confrontations force on him; underneath, however, the lack of nurturing and trust provided by Support and Empathy hinder his motivation for dedicated and lasting change.
Feeling Bad About Feeling Bad
Borderlines typically respond to depression, anxiety, frustration, or anger with more layers of these same feelings. Because of the borderline’s perfectionism and tendency to perceive things in black-and-white extremes, he attempts to obliterate unpleasant feelings rather than understand or cope with them. When he finds that he cannot simply erase these bad feelings, he becomes even more frustrated or guilty. Since feeling bad is unacceptable, he feels bad about feeling bad. When this makes him feel worse, he becomes caught in a seemingly bottomless downward spiral.
One of the goals for the borderline’s therapists and other close relations is to crack through these successive layers to locate the original feeling and help the borderline accept it as part of himself. The borderline must learn to allow himself the luxury of “bad” feelings without rebuke, guilt, or denial.
CASE 2: NEIL AND FRIENDS. Neil, a fifty-three-year-old bank officer, has had episodes of depression for more than half his life. Neil’s parents died when he was young, and he was reared mostly by his much older, unmarried sister, who was cold and hypercritical. She was a religious zealot who insisted he attend church services daily, and frequently accused him of sinful transgressions.
Neil grew up to become a passive man, dominated by his wife. He was reared to believe that anger was unacceptable and denied ever feeling angry at others. He was hardworking and respected at his job, but received little affection from his wife. She rejected his sexual advances, which frustrated and depressed him. Neil would initially get angry at his wife for her rejections, then feel guilty and get angry at himself for being angry, and then lapse into depression. This process permeated other areas of Neil’s life. Whenever he experienced negative feelings, he would pressure himself to end them. Since he could not control his inner feelings, he became increasingly disappointed and frustrated with himself. His depression worsened.
Neil’s friends tried to comfort him. They told him they were behind him and were available whenever he wanted to talk. They empathized with his discomfort at work and his problems in dealing with his wife. They pointed out that “he was feeling bad over feeling bad,” and that he should straighten up. This advice, however, didn’t help; in fact, Neil felt worse because he now felt he was letting his friends down on top of everything else. The harder he tried to stop his negative feelings, the more he felt like a failure, and the more depressed he became.
SET-UP statements could help Neil confront this dilemma. Neil received much Support and Empathy from his friends, but their Truth messages were not helpful. Rather than trying to erase his unpleasant emotions (an all-or-none proposition), Neil must understand the necessity of accepting them as real and appropriate, within a nonjudgmental context. Instead of adding layers of more self-condemnation, which allows him to continue to wallow in the muck of “woe is me,” he must instead confront the criticism and work to change.
Further Truth statements would acknowledge the reasons for Neil’s passive behavior and the behaviors of his wife and others in his life. He must recognize that, to some degree, he places himself in a position of being abused by others. Although he can work to change this situation in the future, he must now deal with the way things are currently. This means recognizing his anger, that he has reasons to be angry, and that he has no choice but to accept his anger, for he cannot make it disappear, at least not right away. Though he may regret the presence of unacceptable feelings, he is powerless to change them (a dictum similar to those used in Alcoholics Anonymous). Accepting these uncomfortable feelings means accepting himself as an imperfect human being and relinquishing the illusion that he can control uncontrollable factors. If Neil can accept his anger, or his sadness, or any unpleasant feeling, the “feeling bad about feeling bad” phenomenon will be shortcircuited. He can move on to change other aspects of his life.
Much of the success in Neil’s life has resulted from trying harder: Studying harder usually results in better grades. Practicing harder usually results in a better performance. But some situations in life require the opposite. The more you grit your teeth and clench your fists and try to go to sleep, the more likely you will be awake all night. The harder you try to make yourself relax, the more tense you may become.
The borderline trapped in this dilemma will often break free when he least expects it—when he relaxes, becomes less obsessive and self-demanding, and learns to accept himself. It is no coincidence that the borderline who seeks a healthy love relationship more often finds it when he is least desperate for one and more engaged in self-fulfilling activities. For it is at this point that he is more attractive to others and less pressured to grasp at immediate and unrealistic solutions to loneliness.
The Perennial Victim
The borderline frequently involves himself in predicaments in which he becomes a victim. Neil, for example, perceives himself as a helpless character upon whom others act. The borderline frequently is unaware that his behavior is provocative or dangerous, or that it may in some way invite persecution. The woman who continually chooses men who abuse her is typically unaware of the patterns she is repeating. The borderline’s split view of himself includes a special, entitled part and an angry, unworthy part that masochistically deserves punishment, although he may not be consciously aware of one side or the other. In fact, a pattern of this type of “invited” victimization is often a solid indication of BPD pathology.
Although being a victim is most unpleasant, it can also be a very appealing role. A helpless waif, buffeted by the turbulent seas of an unfair world, is very attractive to some people. A match between the helpless waif and one who feels a strong need to rescue and take care of others satisfies needs for both parties. The borderline finds a “kind stranger” who promises complete and total protection. And the partner fulfills his own desire to feel strong, protective, important, and needed—to be the one to “take her away from all this.”
CASE 3: ANNETTE. Born to a poor black family, Annette lost her father at a very young age when he abandoned the household. A succession of other men briefly occupied the “father” chair in the home. Eventually her mother remarried, but her second husband was also a drinker and carouser. When Annette was about eight, her stepfather began sexually abusing her and her sister. Annette was afraid to tell her mother, who gloried in the family’s finally achieving some financial security. So Annette allowed it to continue—“for her mother’s sake.”
At seventeen, Annette became pregnant and married the baby’s father. She managed to graduate from high school, where her grades were generally good, but other aspects of her life were in turmoil: her husband drank and ran with other women. After a while, he began beating her. She continued to bear more of his children, complaining and enduring—“for the children’s sake.”
After six years and three children, Annette’s husband left her. His departure prompted a kind of anxious relief—the wild ride was finally over, but concerns over what to do next loomed ominously.
Annette and the kids tried to make things work, but she felt constantly overwhelmed. Then she met John, who was about twenty-five years older (he refused to tell her his exact age) and seemed to have a genuine desire to take care of her. He became the good father Annette never had. He encouraged and protected her. He advised her on how to dress and how to talk. After a while, Annette became more self-confident, got a good job, and began enjoying her life. A few months later, John moved in—sort of. He lived with her on weekends but slept away during the week because of work assignments that made it “more convenient to sleep at the office.”
Deep inside, Annette knew John was married, but she never asked. When John became less dependable, stayed away more, and generally became more detached, she held in her anger. On the job, however, this anger surfaced, and she was passed over for many promotions. Her supervisors said that she lacked the academic qualifications of others and that she was abrasive, but Annette wouldn’t accept those explanations.
Incensed, she attributed the rejections to racial discrimination. She became more and more depressed and eventually entered the hospital.
In the hospital, Annette’s racial sensitivities exploded. Most of the doctors were white, as were most of the nurses and most of the other patients. The hospital decor was “white” and the meals were “white.” All of the anger built up over the years was now focused on society’s discrimination against blacks. By concentrating exclusively on this global issue, Annette avoided her own personal demons.
Her most challenging target was Harry, a music therapist on staff at the hospital. Annette felt that Harry (who was white) insisted on playing only “white” music, and that his looks and whole demeanor embodied “whiteness.” Annette vented her fury on this therapist, and she would stalk away angrily from the music therapy sessions.
Although Harry was frightened by the outbursts, he sought out Annette. His Support statement reflected his personal concern about Annette’s progress in the hospital program. Harry expressed his Empathy for Annette by voicing his recognition of how frustrating it feels to be discriminated against, and cited his own experiences as one of the only Jews in his educational program. Then Harry attempted to confront the Truth, or reality, issues in Annette’s life, pointing out that railing against racial discrimination was useless without a commitment to work toward changing it. Annette’s need to remain a victim, Harry said, shielded her from assuming any responsibility for what happened in her life. She could feel justified in cursing the fates rather than bravely investigating her own role in continuing to be used by others. By wrapping herself in a veil of righteous anger, Annette was avoiding any kind of frightening self-examination or confrontation that might induce change, and thereby was perpetuating her impotency and helplessness. This left her incapable of making changes “for her sake.”
At the next music therapy session, Annette did not stalk out of the room. Instead, she confronted Harry and the other patients. She suggested different songs to play. At the following meeting the group agreed to play some civil-rights protest songs of Annette’s choosing.
Harry’s response exemplified SET-UP principles and would have been useful for Annette’s boss, her friends—anyone who faced her angry outbursts on a regular basis.
SET-UP communication can free a borderline or anyone who is locked into a victim role by pointing out the advantages of being a victim (being cared for, appearing blameless for bad results, disavowing responsibility) and the disadvantages (abdicating autonomy, maintaining obsequious dependency, remaining fixated and immobile amid life’s dilemmas). The borderline “victim” must, however, hear all three parts of the message, otherwise the impact of the message will be lost. If “The Truth will set you free,” then Support and Empathy must accompany it to ensure it will be heard.
Quest for Meaning
Much of the borderline’s dramatic behavior is related to his interminable search for something to fill the emptiness that continually haunts him. Relationships and drugs are two of the mechanisms the borderline uses to combat the loneliness and to capture a sense of existing in a world that feels real.
CASE 4:RICH. “I guess I just love too much!” said Rich in describing his problems with his girlfriend. He was a thirty-year-old divorced man who had a succession of disastrous affairs with women. He would cling obsessively to these women, showering them with gifts and attention. Through them he felt whole, alive, and fulfilled. But he demanded from them—and from other friends—total obedience. In this way he felt in control, not only of them but more important of his own existence.
He became distraught when these women acted independently. He cajoled, insisted, and threatened. To stave off the omnipresent sense of emptiness, he attempted to control others; if they refused to comply with his wishes, Rich became seriously depressed and out of control. He would turn to alcohol or drugs to recapture his sense of being or authenticity. Sometimes he would pick fights or cut himself when he feared he was losing touch with his sensory or emotional feelings. When the anger and pain no longer brought changes, he would take up with another woman who perceived him as “misunderstood” and merely needing “the love of a good woman.” Then the process would start all over again.
Rich lacked insight into his dilemma, insisting that it was always “the bitch’s fault.” He dismissed his friends as not caring or not understanding—they were not able to convey Support or Empathy. The women he became involved with were initially sympathetic, but lacked the Truth component. Rich needed to be confronted with all three aspects.
In this situation, the S message would convey caring about Rich. The E part would accept without challenge Rich’s feeling of “loving too much” but would also help him understand his sense of emptiness and his need to fill it.
The Truth message would attempt to point out the patterns in Rich’s life that seem to repeat endlessly. Truth should also help Rich see that he uses women as he does drugs and self-mutilation—as objects or maneuvers to relieve numbness and feel whole. As long as Rich continues to search outside himself for inner contentment, he will remain frustrated and disappointed, because he cannot control outside forces and especially others, as he can control himself. For instance, despite his most frenzied efforts to regulate her, a new girlfriend will retain some independence outside the realm of Rich’s control. Or, he could lose a new job due to economic factors that may eliminate the position. But Rich can control his own creative powers, intellectual curiosity, and so on. Independent personal interests—books, hobbies, arts, sports, exercise—can serve as reliable and enduring sources of satisfaction, which cannot easily be taken away.
Search for Constancy
Adjusting to a world that is continually inconsistent and untrustworthy is a major problem for the borderline. The borderline’s universe lacks pattern and predictability. Friends, jobs, and skills can never be relied upon. The borderline must keep testing and retesting all of these aspects of his life; he is in constant fear that a trusted person or situation will change into the total opposite—absolute betrayal. A hero becomes a devil; the perfect job becomes the bane of his existence. The borderline cannot conceive that individual or situational object constancy can endure. He has no laurels on which to rest. Every day he must begin anew trying desperately to prove to himself that the world can be trusted. Just because the sun has risen in the East for thousands of years does not mean it will happen today. He must see it for himself each and every day.
CASE 5: PAT AND JAKE. Pat was an attractive twenty-nine-year-old woman in the process of divorcing her second husband. As with her first husband, she accused him of being an alcoholic and of abusing her. Her lawyer, Jake, saw her as an unfortunate victim in need of protection. He called her frequently to be sure she was all right. They began to have lunch together. As the case proceeded, they became lovers. Jake moved out of his house and away from his wife and two sons. Though not yet divorced, Pat moved in with him.
At first, Pat admired Jake’s intelligence and expertise. Where she felt weak and defenseless, he seemed “big and strong.” But over time she became increasingly demanding. As long as Jake was protective, Pat cooed. But when he began to make demands, she became hostile. She resented his going to work and particularly his involvement in other divorce cases. She resisted his visits to his children and accused him of choosing them over her. She would initiate brutal arguments that often culminated in her rushing out of the house to spend the night with a male “platonic friend.”
Pat lacked object constancy (see chapter 2 and Appendix B). Friendships and love relationships had to be constantly tested because she never felt secure with any human contact. Her need for reassurance was insatiable. She had been through countless other relationships in which she first appeared ingenuous and in need of caretaking and then tested them with outrageous demands. The relationships all ended with precisely the abandonment she feared, then she would repeat the process in her next romance.
At first, when Pat perceived Jake as supportive and reassuring, she idealized their relationship. But when he exhibited signs of functioning separately, she became enraged, cursing and denigrating him. When he was at the office, she would call him incessantly because, as she said, she was “forgetting him.” To her friends, Jake sounded like two completely different people—for Pat, he was.
SET confrontations of object inconstancy require recognition of this borderline dilemma. Support statements must convey that caring is constant, unconditional. Unfortunately, the borderline has difficulty grasping that she does not need to earn acceptance continuously. She is in constant fear that Support could be withdrawn if at any point she displeases. Thus, attempts at reassurance are never-ending and never enough.
The Empathy message should confirm an understanding that Pat has not yet learned to trust Jake’s continual attempts at comfort. Jake has to communicate his awareness of the horrific anxieties Pat is experiencing and how frightening it is for her to be alone.
Truth declarations must include attempts to reconcile the split parts. Jake has to explain that he cares for Pat all the time, even when he is frustrated by her. He must also declare his intention not to allow himself to be abused. Capitulation to Pat’s demands will only result in more demands. Trying to please and satisfy Pat is an impossible task, for it is never finished—new insecurities will always arise. Truth will probably mandate ongoing therapy for both of them, if their relationship is to continue.
The Rage of Innocence
Borderline rage is often terrifying in its unpredictability and intensity. It may be sparked by relatively insignificant events and explode without warning. It may be directed at previously valued people. The threat of violence frequently accompanies this anger. All of these features make borderline rage much different from typical anger.
In an instant, Pat could transform from a docile, dependent, childlike woman into a demanding, screaming harpy. On one occasion she suggested that she and Jake have a quiet lunch together. But when Jake told her he had to go to the office, she suddenly began screaming at him, inches from his face, accusing him of ignoring her needs. She viciously attacked his manhood, his failures as a husband and father, and his profession. She threatened to report him to the bar association for misconduct. When Jake’s attempts to placate her failed, he would silently leave the scene, which infuriated Pat even more. But when he returned, both would act as if nothing had ever happened.
SET-UP principles must first of all address safety issues. Volatility must be contained. In the scenario above, Jake’s Support and Empathy messages should come first, though Pat will probably reject them as insincere. In such cases it is imprudent for Jake to continue to argue that he cares and understands that she is upset. He must move immediately to Truth statements, which must first mandate that neither of them will physically harm the other. He must firmly tell her to back off, to allow some physical distance. He can inform her of his wish to communicate calmly with her. If she will not allow this, he can state his intention of leaving until the situation quiets down, at which point they can resume discussions. He must try to avoid physical conflict, despite Pat’s provocations. Although unconsciously Pat may actually want Jake to physically overpower her, this need is based on unhealthy experiences from her past, and will likely later be used to criticize him more.
Truth statements made during angry confrontations are often better directed toward the underlying dynamics than toward the specifics of the clash. Further debate about whether taking Pat to lunch is more important than going to the office will probably be unproductive. However, Jake might address Pat’s apparent need to fight and her possible wish to be overpowered and hurt. He might also confront Pat’s behavior as a need to be rejected. Is she so fearful of anticipating rejection that she is precipitating it in order to “hurry up and get it over with”? The primary Truth message is that this behavior is driving Jake away. He may ask if this is really what Pat wants.
The Need for Consistency
All Truth statements must, indeed, be true. For the borderline, already living in a world of inconsistencies, it is much worse to make idle threats about the unenforced consequences of an action than to passively allow inappropriate behaviors to continue. In Fatal Attraction, for example, Alex Forrest, the main female character in the popular 1987 film (played by Glenn Close), exhibited several “textbook” borderline traits in the extreme. Entering into an affair with Dan Gallagher (Michael Douglas), a well-ensconced married man, she refuses to let go, even after it is obvious Dan will never leave his wife. By the end of the movie Dan, his family, and Alex are destroyed or close to it. Alex was used to resisting rejection by manipulating others. For Dan to say he was going to end the relationship without unequivocally doing so was destructive. Of course, he didn’t know that following the termination of an intense relationship, the borderline is unable to “just be friends”—an “in-between” relationship that the borderline finds intolerable.
Because the borderline has such difficulty with equivocation, intentions must be backed up with clear, predictable actions. A parent who threatens his adolescent with revocation of privileges for certain behaviors and then does not carry out his promises exacerbates the problem. A therapist who purports to set limits for therapy—establishing fees, limiting phone calls, etc.—but then does not follow through invites increased borderline testing.
Borderlines are often reared in situations in which threats and dramatic actions are the only ways to achieve what is sought. Just as the borderline perceives acceptance as conditional, so rejection can also be seen this way. The borderline feels that if only he is attractive enough, or smart enough, or rich enough, or demanding enough, he will ultimately get what he wants. The more outrageous behavior is rewarded, the more the borderline will employ such maneuvers.
Although the SET-UP principles were developed for working with borderline patients, they can be useful for dealing with others. When communication is stalled, SET-UP can help focus on messages that are not being successfully transmitted. If an individual feels that he is not supported or respected, or that he is misunderstood, or if he refuses to address realistic problems, specific SET steps can be taken to reinforce these flagging areas. In today’s complex world, a clear set of communication principles that includes both love and reason are necessary to overcome the tribulations of borderline chaos. Productive communication requires Understanding and Perseverence. Understanding the underlying dynamics of the communication and the needs of the partner reinforce SET principles. Perseverance is necessary to effect change. For many borderlines, having a consistent, unflappable figure in their lives (neighbor, friend, therapist) may be one of the most important requirements for healing. Such a figure may contribute little except for his consistency and acceptance (in the face of frequent provocations), yet furnish the borderline with a model of constancy in the borderline’s otherwise chaotic world.
