Treatment is a Goal, not a given

As we continue to develop and enhance our own personal boundaries in all area of of life, we still need more info on how to interact with the Borderline in regular daily life.

I found an article written by Xavier Amador, PhD, Adjunct professor, Columbia University, Board of Directors of NAMI. The intro was written by BPDFamily staff...


Introduction - Caring, loving and wanting to help are all natural feelings to have. It is one thing to care. It is another one thing to be "in love" with someone. It is quite another to try to help them "not be mentally ill".

Hard To Give - Trying to change the behavior and feelings of someone with a mental illness, or get them start a recovery program, no matter how well intended, is not "help". It crosses over healthy relationship boundaries and often leads you to unhealthy enmeshment in your loved one's life. If they enter therapy or alter behavior to please you, or out of fear that you will leave - this is not a motivation that leads to recovery. And frankly, this type of "help" is often born out of a need to control.

Hard to Receive - Often borderlines will see these efforts to help as threatening or condescending. Borderline's are known to have dysfunctional abilities to "cope" with life's challenges. The possibility of mental illness is a serious life challenge.

Pathological exhibits of splitting, projection, and introjection by borderlines are characteristic borderline defenses. At the same time, rationalization and denial can similarly be pathologic defenses. If someone can't cope with the information, you cannot easily overcome that.

Ultimately, change is a choice. Change can only take place when a person chooses it for him/herself. It cannot be imposed. We can only support them in their choices. And if we need something in our lives, or in any relationship to change, we, ourselves, must change. We cannot extend over their personal boundaries and expect them to change for us.


~ I'm not sure if I explained/defined the characteristic defenses listed above - if not, I will do that in the next post.


In his article, Dr. Amador states that a growing body of evidence points to the fact that many people with a mental illness, have "lack of insight" of that illness. "People will come up with illogical and even bizarre explanations for symptoms and life circumstances stemming from their illness, along with a compulsion to prove to others that they are not ill, despite negative consequences associated with doing so."

What is often thought to be immaturity, stubbornness, and defensiveness is a much more complex problem.

Amador and his colleagues found in a 1994 study that nearly 60 percent of a sample of 221 patients with schizophrenia did not believe they were ill.

Amador describes what it is like to work with someone who does not believe they are ill. One patient encountered by Amador was paralyzed on his left side and he had problems writing. When asked to draw a clock the patient thought he did fine, Amador recalled.

However, when Amador pointed out to the patient that the numbers were outside of the circle, the patient became upset. "The more I talked to him [about the drawing], the more flustered he got. . . . Then he got angry and pushed the paper away, saying 'it's not mine-it's not my drawing.' "

Amador finds the same reaction appears when he talks to people with severe mental illness. "Instead of being an ally, I end up being an adversary," he said.

Amador urges family members and mental health professionals to understand that collaboration with treatment by someone who has a severe mental illness is a goal, not a given.

Amador has written about getting people with serious mental illness to accept treatment in a book he coauthored with Anna-Lisa Johanson titled, I am Not Sick, I Don't Need Help: A Practical Guide for Families and Therapists.

~Reminder: Even though we are not talking about a schizophrenia here, you can see how his example rings also true for Borderlines, as well as other mental illness, which is why this article was posted by the BPDfamily.

It is important instead to develop a partnership with the patient around those things that can be agreed upon.

Amador said that family members and clinicians should first listen to the patient's fears.

Empathy with the patient's frustrations and even the patients delusional beliefs is also important, remarked Amador, who said that the phrase "I understand how you feel" can make a world of difference.
The most difficult thing for family members to do in building a trusting relationship, he said, is to restrict discussion only to the problems that the person with mental illness perceives as problems - not to try to convince them of others.


~More to come later on using boundaries, empathetic statements, and reality to prevent conflict.