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The Essential Family Guide to Borderline Personality Disorder: New Tools and Techniques to Stop Walking on Eggshells
The Essential Family Guide to Borderline Personality Disorder: New Tools and Techniques to Stop Walking on Eggshells
by Randi Kreger
Edition: Paperback
Price: $13.46
107 used & new from $7.19

379 of 426 people found the following review helpful
2.0 out of 5 stars Almost but not quite, May 1, 2009
My wife, I suspect, has BPD, and I read Randi's book, "Stop Walking on Eggshells", about a year and a half ago. I then participated in Randi's on-line support groups, and generally attempted to follow some of the advice in that book and on that site, without much success, frankly. This new book is helping me much more in understanding and empathizing with my wife, but I still think it doesn't quite get what is the most effective means for interacting with a borderline.

It's hard for me to explain the overarching problem I see with the book so I'll focus on one example. "Power tool #5: reinforcing right behavior" makes the point that, when a BP's traditional behavior does not get the reward they seek, they frantically repeat the behavior in an effort to get the reward (which Randi refers to as an *extinction burst*). My impression is that, for Randi, the "reward" is that the non complies with the borderline's desires, or accepts the abuse, or gets attention, and so on.

Rather than a focus on what is the actual emotion that the borderline is trying to communicate (albeit very ineffectively--that is why they call this a disorder, and specifically a disorder of emotion regulation), Randi is focused in this section on the behavior that one might want to stop, using "limits." She provides several examples of borderline behavior that one might want to stop, such as them calling you at work many times a day, or saying hurtful things to you. She describes "setting a limit" for each (for the first, explaining that you can take a maximum of 3 calls per day from the BP aside from emergency calls, for the second explaining to your BP that the conversation is uncomfortable and that "I'm going to my room. If and when you are ready to treat me with respect, let me know and we can talk").

Randi is clearly a strong believer that the loved one of a borderline can effectively extinguish problematic behaviors by either not rewarding them or even providing negative reinforcement for them, and she is influenced by and references Susan Pryor's "Don't shoot the dog," a book that I enjoyed immensely. She says that it may take a long time for the BP to get past the extinction burst phase, but once they do, the behavior is extinguished.

I have 3 issues with this approach.

1) Randi defines "setting a limit" as engaging in a behavior that is completely under one's own control (ie not answering the phone, or leaving the room for the above examples) but quickly ties this together with using this "limit" as positive or negative reinforcement (and clearly not punishment--she describes negative reinforcement correctly) to elicit behavioral change in the borderline.

This has helped clarify for me how Randi thinks about limits and boundaries, and explains why there is so much confusion about what these actually are. For Randi, I think, a limit is about our own behavior, but it is also intended to act as a positive or (more often) negative reinforcer of the BP's behavior. No wonder people are often confused about who a limit actually is supposed to apply to.

Boundaries are a standard tool used by folks at Randi's internet support group. They are meant to apply to the behavior of our own selves. Sometimes, however, people assume that the borderline is "supposed" to not "cross" these boundaries, which has never made sense to me since boundaries are supposed to apply to ourselves, not others. But I guess they are really talking about limits, which, again, seem to be similar to boundaries but are used as reinforcement tools to elicit change in other people's behavior. So I think it would be very helpful to clarify the difference between boundaries, limits, reinforcement strategies, etc--these all tend to get jumbled togather in a confusing way both in the book and on the internet support groups created by Randi.

2) People who follow this advice without paying heed to validation FIRST may (or may not, as I talk about below) eventually extinguish behaviors that they don't like, but I believe that they'll also likely end up with a borderline who feels deep-seated anger and shame, and who will find new ineffective behavioral outlets for this anger and shame. Randi does talk about the importance of validation (she appears to prefer the term "empathic acknowledging") and she even emphasizes that it is important to do so BEFORE and WHILE "setting limits" (something she didn't do in "Stop walking on eggshells"), but she doesn't integrate the tools. Her examples illustrate one "power tool" at a time.

For example, the example about the BP saying abusive things to her mother makes it look as if simple negative reinforcement (leaving the room) results, after "many years and lots of practice", in a BP that has learned to recognize that they're about to be emotionally dysregulated and trying their best to control their behavior, and apologizing in advance for anything hurtful they might say or do. She seems to imply that this is the expected end result of simple limit-setting, unless you accidentally intermittently reinforce the wrong behavior (which will result in a very intense reappearance of the behavior, because intermittent reinforcement is the most satisfying reward of all--think of gambling as an example, or the rat frantically pressing the lever: if you reward only intermittently, the behavior will be more intense).

The argument seems to be that, sure, things are going to become hellish for a long time as a result, but if you consistently implement the limits then, one day, things will improve. If things DON'T improve, then it's probably because you didn't consistently implement the limits (and thus provided intermittent reinforcement). This is risky, in my opinion, even WITH the use of validation. Such thinking can almost become like religious belief--you might never see the positive results but still be undeterred and believe that it is the correct process. This belief in the power of limit-setting as a means to extinguish BP behaviors that we don't like (using negative reinforcement) is almost untestable once you throw in the caveats that things will likely get worse before they get better, that it might take years to see results, and intermittent reinforcement might muck up the whole process.

Even if one does use validation, using negative reinforcement to elicit behavioral change is very risky, in my opinion, for somebody with an emotional disorder. Negative reinforcement can result in unpleasant feelings in anybody; for borderlines, you can multiply this by at least a hundred, I think. Positive reinforcement is great--it results in behavioral change AND helps people feel good. But negative reinforcement is risky. It may have its place as a tool, but I don't think it's a wise *first* approach for effecting behavioral change with borderlines. I do strongly believe that boundaries are sometimes needed to protect loved ones, but I think that these should not be confused with tools for eliciting behavioral change in a borderline. In other words, boundaries should not be used habitually as reinforcement tools, in my opinion. One has to be very careful in order to do this in a way that does not seem invalidating and judgmental to the very sensitive and very shame-filled borderline mind, and personally I doubt that it's possible. My impression is that those who treat Randi's books as the "bibles of BPD" consistently try this repeatedly and consistently fail to pull off "limit-setting" successfully, because they tend to not understand, empathize with, or validate the underlying emotional content, and because negative reinforcement by its very nature uses an unpleasant stimulus to effect behavioral change.

Meanwhile, you have a borderline whose feelings get more and more intense due to their frustration at not being heard and understood that it's their *feelings* that they are trying to communicate using their behaviors (albeit not very effectively). This brings me to my 3rd issue.

3) I don't believe that the "reward" that a borderline is seeking is simply to be able to get away with yelling at you, calling you names, being able to call you on the phone repeatedly, and so on. The "reward" is not that the loved one complies with the borderline's desires, or accepts abuse, or gives up control of their life, or whatever.

This is a quote from another internet support group that approaches the same issue differently:

"When someone with BPD talks to you, asks you to do something, or asks you to help, or when they behave in a certain fashion, they are really trying to communicate their feelings about things. They might not even really know that this is the motivation for action, because it is so built into their lives. It is conditioned. When a borderline does not get the desired result from the interaction (that is, the feeling is not properly acknowledged and validated, etc.), then the next step is to escalate. It's as if a rat has been pushing a button for a while and gotten fed, and suddenly, the button doesn't work. The rat will frantically push the button, over-and-over, until the rat's brain gets re-trained that the button doesn't work anymore. There is a period of confusion in the rat's brain, when their emotional expectations are not met by conditioned behavior. They try and escalate the behavior to see if the expectation can get met."

The expectation that they are looking to get met is that their feelings are understood. The author of this quote is Bon Dobbs, who writes a blog and runs a list for those with loved ones with BPD [...] Bon encourages loved ones to see past the behavior and to understand what emotional content the borderline is trying to communicate. BPD is a disorder of emotional regulation; the behaviors are simply a manifestation of this. That is why it is so important to validate the emotions of a borderline.
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