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Understanding Borderline Personality Disorder: Part 2—BPD Treatment and How to Use It

Understanding Borderline Personality Disorder: Part 2—BPD Treatment and How to Use It

Photography by      Joanna Rosciszewska

Photography by Joanna Rosciszewska

In part I, I wrote about receiving a BPD diagnosis. A diagnosis opens the door to treatments that fit. This is an important first step, but what’s next? What do we know about treatments and how can they be helpful?

What we know about working with BPD

At its heart, BPD is pattern of strained relationships. This means that people with BPD have difficulty with relationships within themselves, with others, and with the world. At the root of these problems is a troubled relationship with emotions. People with BPD experience their feelings as more intense, urgent, and often unbearable. It is common for these individuals to experience a lot of distress, and come to mental health professionals feeling desperate for some relief.

As mentioned in Part 1, the intensity of the distress can have an impact on the relationship with health care professionals, leaving the parties involved feeling frustrated and helpless. As a result, and in an attempt to reduce the suffering, the person seeking help may end up being prescribed lots of different medications—many with unpleasant side effects. Although in some cases, certain medications might help with some of the symptoms, we have more recently learned that the best approach for treating BPD is not pharmacological, but rather involves effective psychotherapy (Paris, 2017).

In the 1990s, Marsha Linehan developed a treatment specifically to help individuals with BPD understand and change their relationship with themselves and the emotions they experience as mixed and intense. She called it Dialectical Behaviour Therapy (DBT), to highlight the importance of the “dialectical”, or “the plaid” which refers to working with opposite forces. For example, this can mean accepting one’s emotions and experiences as valid, while simultaneously working to change behaviours that have negative consequences (to read more about the “Plaid” and DBT, check out Michelle’s Blog post). With robust research support, DBT has gained significant recognition. It is effective, accessible, and popular, which has led many health care professionals and people seeking therapy to equate BPD treatment with DBT.

Although DBT has virtually become synonymous with BPD treatment, it is not the only psychological treatment available and appropriate for BPD. Many other approaches to therapy use other lenses to address BPD difficulties and have been shown to be effective. Mentalization-based therapy (MBT) is a particularly good fit because it aims to help people understand their internal experiences in order to change their relationships with themselves, with others, and the world. Similarly, approaches that focus on emotions (e.g., Emotion-Focused Therapy-EFT) or relationships (e.g., Transference-Focused Psychotherapy-TFP) have also garnered research support as effective in addressing the challenges that arise with BPD (Paris, 2017).

While there are lots of 3-letter treatment options, each with its own angle, there is not much evidence to suggest that one unique type of therapy addressing personality-related difficulties is actually superior than others for BPD (Livesley, Dimaggio & Clarkin, 2015). Among many researchers and clinicians specializing in BPD, there is some consensus that the best approach is to offer therapy that integrates relevant ideas from all approaches (Livesley, 2017; Nelson et al., 2017). When it comes to therapies addressing personality disorders, no one “brand name” does better than others (Paris, 2017). This is good news, because it means most therapy approaches for BPD work, and integrating more than one is even better.

Photography by      Joanna Rosciszewska

Photography by Joanna Rosciszewska

What’s important in BPD treatment

Knowing that integrating relevant ideas from different approaches is what seems to work best, how do we know which ideas to integrate?

First, since an intense experience of emotions is often what drives a lot of the difficulties, working to identify, understand and manage emotions is critical. Managing emotions might mean learning to take a step back, observe, and experience—survive the emotion without reacting. This process also helps reduce impulsivity by creating a space to be purposeful rather than immediately acting on urge. I like to think of it as having conversations with emotions. With time, these conversations shift the relationship with one’s internal experience and reduce the chaos.

Another piece of the puzzle is shifting one’s relationship with other people. This may involve learning about other people’s emotions and intentions, and about the subtleties of relationships more broadly. It often involves understanding physical, personal, and emotional boundaries (For more on boundaries, check out this blog post) as well as what makes a relationship sustainable.

There are other elements that we know contribute to progress in therapy for BPD regardless of the content of therapy or approach. This list includes having a consistent and predictable structure (e.g., regular, weekly therapy sessions), building motivation for change, and working toward self-reflection (Livesley, 2017).

Beyond all these factors, if you are looking for therapy that works, good fit with a therapist and investment in the journey itself are crucial to making therapy work. What does this therapeutic effort look like and what does this all mean about being in therapy when you have BPD?

How to be in therapy when you have BPD

  1. Give the process a chance. Lots of big feelings might come up as you begin, challenge yourself to get started even when it’s a substantial effort that feels uncomfortable at first.

  2. Once you’ve found a fit, stick to it and be consistent in order to build momentum. At the beginning, go weekly—even when you don’t feel like it, or if you have some other reason not to go. Therapy is a big investment of time, money, and emotional energy. If you allow yourself to build momentum and persevere, you will make it a valuable (and cost-effective) experience of personal growth.

  3. Tolerate difficult emotions as they come up: Showing yourself you can survive intense and difficult emotions is an important part of the process.

  4. Trust your gut, yet still challenge yourself. Ask yourself what your emotion is telling you, and whether rolling with the discomfort could possibly be beneficial to you. For example, it might look like facing your fear, giving a person a chance even if you’re angry, or getting out of bed even though you’re sad.

  5. Focus less on the what and more on the how. Listen to the words of your stories and take a step back to understand the big picture in what’s going on. Use this often in your therapy.

  6. Open up to talking about your emotions in therapy, especially when they have to do with your therapist. Tell them if you’re scared to talk about something, if you’ve felt sad or hurt after they said something, if you’re angry with them, etc. Lots of old and new feelings can come up in the therapeutic relationship. It’s your opportunity to work out the messy parts with someone who is qualified to help you.


Danit Nitka received her PhD from the Clinical and Research Psychology program at Concordia University in Montreal, Quebec, and is a psychologist at Connecte Montreal Psychology Group. The team at Connecte loves writing about ways to boost our mental health and bring psychology into our everyday lives. For more helpful tips, check out Connecte’s blogspodcast, follow @connectepsychology on Instagram or like us on Facebook.


References

Livesley, W. J., Dimaggio, G., & Clarkin, J. F. (Eds.). (2015). Integrated treatment for personality disorder: A modular approach. Guilford Publications.

Livesley, W. J. (2017). Integrated modular treatment for borderline personality disorder: A practical guide to combining effective treatment methods. Cambridge University Press.

Nelson, D. L., Beutler, L. E., & Castonguay, L. G. (2012). Psychotherapy integration in the treatment of personality disorders: A commentary. Journal of personality disorders, 26(1), 7-16.

Paris, J. (2017). Stepped care for borderline personality disorder: making treatment brief, effective, and accessible. Academic Press.



 Understanding Borderline Personality Disorder: Part 1—What is BPD and How to Get Help That Fits

Understanding Borderline Personality Disorder: Part 1—What is BPD and How to Get Help That Fits

Photography by      Joanna Rosciszewska

Photography by Joanna Rosciszewska

In my July Blog post, I referred to what happens when certain personality traits are too high or too low, causing life difficulties. Borderline Personality Disorder (BPD) is one psychological diagnosis or label that mental health care professionals and clinicians use to describe a specific pattern of problems. Typically, this pattern involves intense, chaotic relationships with both the self and others. Even though some of the traits involved are amplified versions of normal personality traits, many people with BPD will experience problems that are serious, and that most people never experience (Paris, 2017). Although there are some commonalities and a general pattern, individuals with BPD do not all have the same problems or experiences.

Let’s think of Jessica for example. She was recently diagnosed with BPD. She’s always felt something was “off”. She suspected early in life that she wasn’t feeling the way others around her felt: her emotions have always been so intense, it was as though she was walking around with no skin. She’s noticed she reacts impulsively to these intense feelings, which change from one moment to another. One moment she can be thrilled, the next, filled with sadness or rage. Along with these strong emotions is also an emptiness inside that she’s not sure how to describe to others.

Sometimes she feels her life is not real and asks herself “what’s the point?”. She often thinks of suicide, wondering if it’s the only way to stop her suffering. She’s even attempted to end her life a few times by taking pills, with mixed feelings when hospitalized and treated for these overdoses. She questions who she is, often feeling like a bad person who isn’t worthy of love. When she gets into a relationship, she’s afraid the person will leave and looks for ways to prevent this, or to have her partner reassure her that they won’t. Eventually, the ups and downs and efforts to avoid being broken up with cause a lot of stress in the relationship and it ends.

Jessica has received many diagnoses by health professionals in the past, including Generalized Anxiety, Depression, Attention Deficit and Hyperactivity Disorder, and Bipolar Disorder. She has tried therapy numerous times and felt frustrated because nothing seemed to “stick”. Recently, a new psychiatrist she was seeing diagnosed her with BPD.

Receiving a BPD diagnosis

It’s important to remember that a diagnosis, especially one of BPD, is not an identity: it describes a cluster of problems in someone’s life—what’s not working for them. Receiving the BPD diagnosis can be the key to getting the right help. When Jessica first got diagnosed, she went home and looked it up online. She was angered to find that much of what she was reading suggested there is something wrong with her personality and that she would be “difficult to treat”. She felt ashamed and angry with her psychiatrist, who she had no intention to return to see. She felt as though another health professional had let her down.

Despite this, she also felt some relief that she could make sense of what’s been going on, and eventually decided she would go for another visit to ask a few questions. Although she was hesitant, she told her psychiatrist how angry she was and was surprised that this led to a conversation during which she felt understood and even hopeful about the future.

Jessica learned that this diagnosis would allow her to get more specialized help, and together she and her psychiatrist came up with a plan. With treatment that fits (and some patience), Jessica can go from being diagnosed with BPD to no longer meeting any of the criteria and leading a more satisfying life. It’s also important to remember that when the label no longer describes someone’s current problems, it no longer applies.

Unfortunately, because of stigma around BPD, many people are reluctant to accept or disclose their diagnosis, which can get in the way of receiving appropriate help.

Photography by      Joanna Rosciszewska

Photography by Joanna Rosciszewska

Why the stigma?

Compared to other disorders, BPD is a fairly new diagnosis, with treatments having only been developed in recent decades. There are times individuals with BPD feel like their experience is unbearable. Their symptoms often reflect the intensity of their distress; When Jessica went to see the psychiatrist, she had cut herself badly and said she wanted to give up on life. Although her psychiatrist identified her diagnosis, some health care professionals may not recognize BPD or know how to help, leaving all parties feeling frustrated. In fact, people with BPD are often not diagnosed or treated at all. Sometimes, they are offered treatments that do not fit their problems. Since intense emotions are part of the experience, speaking about what’s most painful with a health care professional, who is often a stranger, can be quite challenging.

It is not surprising that there would be friction between someone consulting for a situation that feels urgent and impossible, and a health care professional who isn’t sure how to help. Sometimes, the clinician may themselves react unfavourably when feeling unsure or helpless. As you can imagine, these reactions would not be well-received by someone in distress who already feels let down.

In fact, it is likely that someone seeking help for these symptoms has already had many frustrating experiences in the health care system. As a result, they might express anger (even rage) or withdraw from treatment, which in turn might lead to the clinician distancing themselves even more. This can become a continuous self-fulfilling cycle and can help explain some of the frustrations that people with BPD as well as clinicians face (Aviram, Brodsky & Stanley, 2006). Unfortunately, cycles like this one perpetuate the stigma and contribute to a reluctance toward both pursuing treatment (on the part of those seeking help) and providing treatment (on the part of clinicians).

Maybe you relate with parts of (or all of) Jessica’s experience, and you’ve experienced these frustrations yourself. If you’ve been feeling helpless, hopeless, and chaotic on the inside (and maybe outside too), or like no diagnosis has made sense so far: Remember there is the right kind of help out there—help you can use to help yourself.

What to do if you think you might have BPD and want to consult:

1- Take a deep breath. Remember these are words to describe problems you are experiencing, and that having these words means you can communicate to get the help you need.

2- Look for someone who is qualified to assess and work with personality in therapy, or ask for a referral to someone who does. You can look online, or ask your GP or most health care professionals.

3- Be prepared to speak with someone by taking note of what’s most important to share about what you are experiencing.

4- When meeting a health care professional, observe whether you are feeling intense emotions, and challenge yourself to be open—to stick around and share your experience as best as you can, even if lots of uncomfortable emotions rise to the surface. Ask yourself: how can I help this person help me? Sharing your difficulties and what you are looking to work on are some ways to collaborate.

5- Give the person time to get to know you and figure out how to help. They may not know right away.

Don’t give up on getting the help you’re looking for. Sometimes, it takes meeting with a few different professionals before you feel you’re on the right track.


Danit Nitka received her PhD from the Clinical and Research Psychology program at Concordia University in Montreal, Quebec, and is a psychologist at Connecte Montreal Psychology Group. The team at Connecte loves writing about ways to boost our mental health and bring psychology into our everyday lives. For more helpful tips, check out Connecte’s blogspodcast, follow @connectepsychology on Instagram or like us on Facebook.


References

Aviram, R. B., Brodsky, B. S., & Stanley, B. (2006). Borderline personality disorder, stigma, and treatment implications. Harvard review of psychiatry, 14(5), 249-256.

Paris, J. (2017). Stepped care for borderline personality disorder: making treatment brief, effective, and accessible. Academic Press.

Personality Disorders: What’s a “Disordered” Personality Anyway?

Personality Disorders: What’s a “Disordered” Personality Anyway?

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We all have personalities. What makes someone’s personality “disordered?”. Personality is made up of traits; ways of being that make each individual unique. For example, those high on introversion (see Dr. Samuel’s post) feel most gratified when creating space to delve into their thoughts or activities on their own, whereas extroverts feel energized and at their best around other people. Another example: some people think and ruminate for a long time before they make a move, whereas others, who are more impulsive, make the move with little thought of outcome or consequence. Traits like these give rise to patterns of emotions, thoughts, behaviours, and relationships. Now picture these traits like an equalizer on your music player. Imagine the bass being at such a high level that you could hear nothing else and barely recognize the song. Or (perhaps worse?), imagine a song with only treble—no depth. The song could not be heard at its best without a balance of treble and bass. I like to think of personality as formed by the collection of traits at different intensity levels on our own personal equalizer. When a trait is so high or so low that it creates difficulties, it becomes a personality-related issue. For example, Joe often acts before thinking, constantly doing things he regrets and gets into trouble for. Joanne is the opposite; thinking and ruminating about each choice for so long, that she ends up getting nothing done!

When groups of traits are off balance, it can create a pattern of difficulties that can be described as a personality disorder. This is because being extremely high or low on certain traits can lead to day-to-day problems as well as complications with relating and connecting with others. These dysfunctional patterns originate and evolve from an interaction between genetic predisposition and life environment, often becoming more apparent as we reach adolescence. Some of these combinations of trait patterns and resulting problems have been categorized by psychiatrists in the manual of psychiatric disorders (DSM-5; American Psychiatric Association, 2013). These “personality disorders” are essentially specific groups of traits that whether too high or too low, have come to cause life difficulties.  

So what does that mean?

Is a disordered personality destined to be disordered forever? We used to think personality was stable (Costa & McCrae, 1980)—meaning that it does not change over time. More recently, we are learning that this is not entirely true (e.g., Ardelt, 2000; Caspi & Roberts, 2001; Roberts et al., 2017). While Joe isn’t likely to become a self-doubting ruminator, he can learn to pause before he acts (i.e., lower the level of impulsivity on that equalizer). Joanne will never be the reckless thrill-seeker Joe is; she won’t book a last-minute skydiving trip in a foreign country. But she might learn to limit the time she spends ruminating about decisions, taking the chance to act even when she doesn’t feel she’s done all her due diligence. Even though Joe is aiming to reduce his impulsivity, and Joanne’s goal is to be less prohibitively cautious, they would both aim for what’s in between: spontaneity. The in-between, or the grey zone is often where our traits work best for us. Most people can learn to bring their traits into balance and be more in-between (in Joe’s case, going from reckless impulsivity to reasonable spontaneity). Learning to move away from extremes to a reasonable and workable middle is the key to making personality our best asset. 

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So, how do you begin to make your personality work for you?

  1. Notice which traits might be too high or too low. Ask yourself: What’s working? What’s not? Use your emotions and life experiences to guide you here.

  2. Experiment behaving as though the traits were higher or lower to see what the outcomes would be. This will give you more information about what works for you and what does not. What would it be like to be more in the middle with traits that are too high or too low? Does that work better?

  3. Seek professional help with someone specializing in personality work. It can be difficult to see the big picture when you’ve always done things a certain way in the day-to-day. This is not a journey you have to take on alone. Although self-help books are an option, having a professional along your side can help you fine tune your equalizer.


Danit Nitka received her PhD from the Clinical and Research Psychology program at Concordia University in Montreal, Quebec, and is a psychologist at Connecte Montreal Psychology Group. The team at Connecte loves writing about ways to boost our mental health and bring psychology into our everyday lives. For more helpful tips, check out Connecte’s blogspodcast, follow @connectepsychology on Instagram or like us on Facebook.


References and Resources

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub.

Ardelt, M. (2000). Still stable after all these years? Personality stability theory revisited. Social Psychology Quarterly, 392-405.

Caspi, A., & Roberts, B. W. (2001). Personality development across the life course: The argument for change and continuity. Psychological Inquiry, 12(2), 49-66.

Costa Jr, P. T., & McCrae, R. R. (1980). Still stable after all these years: Personality as a key to some issues in adulthood and old age. Life-span development and behavior.

Roberts, B. W., Luo, J., Briley, D. A., Chow, P. I., Su, R., & Hill, P. L. (2017). A systematic review of personality trait change through intervention. Psychological Bulletin, 143(2), 117.

A shout out to Simply Noticing

A shout out to Simply Noticing

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When we feel like something’s not working for us, we want change. Whether you take this on alone or in the context of therapy, the process of change can feel daunting! Creating a space to look inside ourselves and our lives paves the way for reflection on our patterns. For example, you might tend to agree to doing things you really don’t want to do, or overcommit and regret (see Tobey’s latest blog post). Perhaps there are situations in which you consistently react in a way that makes things worse. You might go over what you have done after the fact thinking “I wish I hadn’t done that”. You want to change your reaction but it all seems to happen so fast—you feel like you are not in charge.

In Monthly Picks I posted about Shenpa, which is a Tibetan concept that refers to “getting hooked”—being caught up in something and scratching the itch. In the moment, we rarely notice that this is happening. Often if we’re not noticing, we react and feel powerless to change. When our mind wanders from the present, we allow important choices to be determined by external forces and receive consequences passively.  While mind-wandering can be beneficial in some contexts, it can also interfere with our ability to process information from the environment (Schooler et al., 2011). Wandering away from the moment without noticing can lead down a slippery slope. The risk is that life becomes a series of events we feel helpless over, leading to sadness, anger, anxiety or other uncomfortable sensations that communicate to us that something is not working.

So what’s the first step to taking charge? How do we become more of the driver and less of the passenger in our lives? This endeavour is especially difficult because sticky situations often seem to happen so fast. Taking back your power to participate actively in your life isn’t always easy but starts with simply noticing. Simply noticing is a key element of mindfulness-based meditations (Hölzel et al., 2011). Meditation and other practices based in awareness and noticing (vs. doing) have been associated with improvements in anxiety, depression, perceived stress, emotional well-being and overall mental health (Carmody & Baer, 2008). Simply noticing allows us to live our experiences as they are, rather than through the filters of our biases (Price et al., 2002). The idea is to step back and create space before we choose a response to a situation rather than reacting as we otherwise would (Baer & Krietemeyer 2006).

So how does one simply notice?

1-  Choose your target.

Pick one behaviour that you engage in that doesn’t seem work for you in the long term.  Do you often say “yes” when you mean “no”? Do you often feel compelled to assert yourself but stay quiet instead? Do you beat yourself up for making mistakes at work (or elsewhere)? Perhaps you react angrily when frustrated and say things you later regret? Choose one thing to simply notice.  

2-  Use your emotions as a guide.

When we do something that doesn’t work for us in the long term, it’s often in response to feeling an uncomfortable emotion in the moment. It may be avoiding something that we know is right for us because we’re afraid (e.g., job interview), it may be having one drink too many when we’re feeling sad or anxious. Tune in to those emotions. Ask yourself—is there a pattern here? Is there an emotion that I consistently react to in this way? In what situations do I tend to do this?

3-  Slow the tape down.

Imagine the situation as a scene in a movie. Then imagine playing the scene in slow motion. Although it feels quick in life, slow it down so you can take the time to look at each part of it. Even though time seems to be moving so much faster in these instances, you can slow down your experience and perception of the situation by paying attention.

4-  Simply notice.

Now take special notice of all the elements in the situation—and do this with purpose. Notice your Shenpa (that hook you might feel the urge to bite). Notice your urge to do something. Be present and observe the situation as though you were an outside observer.  Simply take note of what is happening, resisting any urge to do. You may choose to do afterwards, but in the first few moments, catch yourself not noticing, and instead, notice.

You might ask, “I noticed. Now what?”

Noticing is only a first step. However, it’s a powerful one: simply noticing is associated with changes in attentional functions and cognitive flexibility, which are linked to mental balance and well-being (Moore & Malinowski, 2009).  It is a step to ensuring your freedom and becoming aware enough to refrain from biting that hook. Over time, the practice of noticing will empower you to choose your life path through individual choices—ones that may have not been apparent before you slowed the tape down.


Danit Nitka received her PhD from the Clinical and Research Psychology program at Concordia University in Montreal, Quebec, and is a psychologist at Connecte Montreal Psychology Group. The team at Connecte loves writing about ways to boost our mental health and bring psychology into our everyday lives. For more helpful tips, check out Connecte’s blogspodcast, follow @connectepsychology on Instagram or like us on Facebook.


References

Carmody, J., & Baer, R. A. (2008). Relationships between mindfulness practice and levels of mindfulness, medical and psychological symptoms and well-being in a mindfulness-based stress reduction program. Journal of Behavioral Medicine, 31(1), 23–33.

Hölzel, B. K., Lazar, S. W., Gard, T., Schuman-Olivier, Z., Vago, D. R., & Ott, U. (2011). How does mindfulness meditation work? Proposing mechanisms of action from a conceptual and neural perspective. Perspectives on psychological science, 6(6), 537-559.

Moore, A., & Malinowski, P. (2009). Meditation, mindfulness and cognitive flexibility. Consciousness and cognition, 18(1), 176-186.

Price, D. D., Barrell, J. J., & Rainville, P. (2002). Integrating experiential–phenomenological methods and neuroscience to study neural mechanisms of pain and consciousness. Consciousness and Cognition, 11(4), 593-608.

Baer, R. A., & Krietemeyer, J. (2006). Overview of mindfulness- and acceptance-based treatment approaches. In R. A. Baer (Ed.), Mindfulness-based treatment approaches: Clinician’s guide to evidence base and applications (pp. 3–27). San Diego, CA: Elsevier

Schooler, J. W., Smallwood, J., Christoff, K., Handy, T. C., Reichle, E. D., & Sayette, M. A. (2011). Meta-awareness, perceptual decoupling and the wandering mind. Trends in cognitive sciences, 15(7), 319-326.

The importance of setting boundaries

The importance of setting boundaries

Recently, boundary-setting has been coming up often in conversations, in and outside the office. I noticed that for many, “boundaries” as a concept seems to be ambiguous—yet it plays out in so many domains of life. If you’re asking yourself whether your own boundaries may need a check-up, here are some hints.

Do you ever feel like you invest more than your return in relationships with partners, family, friends, or even strangers? Perhaps you feel resentful, or that you are being taken advantage of. You might feel a little bit annoyed all the time, or you might feel outright mistreated! You worry about the disapproval from others if you were to choose to say no or do what’s right for you.

Perhaps you often feel compelled to “fix things” for those who are close to you (emotionally, or otherwise). Maybe you worry they won’t think you’re a good friend, partner, son, daughter, (etc) if you don’t do what they are asking from you. Maybe worse, you fear that setting a limit would lead to argument or confrontation. So you might say “yes” when you mean “no”—out of habit, or just to avoid unpleasant interactions. At work, or elsewhere, you go above and beyond to ensure that another person’s comforts, wants, and needs are satisfied in a situation (but at the expense of your own!). Although it may feel “unselfish”, you eventually come to feel anger and resentment towards others. In fact, despite your efforts to ensure the other person is happy, relationships may not be working so well. While most people occasionally struggle with boundary questions, if it sounds a little bit too familiar too often, it might help to give your boundaries some reflection.

So what are boundaries?

In the context of psychology, boundaries are a conceptual limit between you and the other person. Simply put, it’s about knowing where you end and others begin. Knowing what’s yours and what’s not. Acknowledging that every adult is responsible for themselves. Having a functional boundary (one that works) means taking responsibility for your own actions and emotions, and NOT taking responsible for the actions and emotions of others. Of course, this plays out a little differently when you ARE actually responsible for someone else (like a dependent or a child).

According to personal space theory (Scott, 1993), we have boundaries, and can regulate how permeable they are—meaning what we let in and out—when it comes to the physical, mental and spiritual environment.

Maintaining boundaries is about being the gatekeeper of your life in order to keep yourself safe and well. Imagine you are a castle, with front door, moat, and drawbridge which you can lower open or raise shut at your will (Peck, 1997). If you keep your front door unlocked and drawbridge laid open all the time, anyone is free to walk in, do as they please, and stay as long as they like. On the other extreme, if you keep the door shut and locked, and the drawbridge up, you end up isolated, and miss out on connecting with others. Many go from one of these extremes to the other. However, we know that the healthiest type of boundary is one that is appropriately and purposefully open to some people, in some situations, some of the time, and closed to others, at other times (Scott, 1993). In our day-to-day, how well we communicate these boundaries can either protect or jeopardize relationships (Scott & Dumas, 1995). Think of times you did something you did not want to do because someone asked you and you felt obliged. The simmering anger that ensues could damage the relationship; if you let it boil over, you might say something passive aggressive or even fully lash out. 

How do I keep my boundaries in check?

The first step is to create time to get to know yourself, and practice feeling worthy. Often when we allow our boundaries to be crossed, we feel as though we are being generous. Perhaps because we feel (or have been taught) it’s the only way to ensure being a “good person” or the only way to confirm our worth or value. Practice feeling worthy. Not because of your achievements or generosity toward others, but because like every person—you are!  Show yourself you are worthy by being kind and compassionate toward yourself and taking good care of your emotional well-being (to start, see Andrea’s daily mental health boost tips on Instagram), Lisa’s blog posts about the critical vs compassionate voice here and here, or Miss psychlife’s tips on self-care here. It may feel as though a good relationship means you take care of others at your own expense, and you hope that in return, they will take care of you in the same way. This is what creates boundary chaos. Instead, respect and nurture yourself by taking care of you first. You may be asking yourself whether doing this is selfish—it is not. By meeting your own needs, you respect yourself and the other by taking responsibility for your own well-being. You preserve your integrity so that you can communicate your boundaries to others and maintain equal, respectful, and resentment-free relationships.

The second step is about defining your edges. In each situation, asking yourself what you are responsible for and what is outside your scope. If your partner wants you to do something, asking yourself, “would I like to invest in my relationship in this particular way”? If so, you can do it within your boundary. Then ask yourself, does doing this come at the expense of my well-being in a significant way? And will my resentment grow if I do it? If the answer is yes to either, there is a good chance this is outside the boundary. Give yourself the power to own the choices you make, and avoid doing anything that you will come to resent. Make choices that you feel are right for you—not because you feel like you have to, or fear the consequences, or think “that’s what it takes to be a good person”—but because you feel content with the choice regardless of the outcome. 

The third step is more concrete: Practice assertiveness! First noticing when you want to give in—to do something that would create resentment or come at the expense of your own well-being. Then, communicate your stance respectfully. You can apply this with family, at work, and even with strangers. For example, you might feel guilty because you don’t visit your family as often as they’d like you to. Make a personal choice regarding how often you would like to visit, and express your choice firmly. You are not responsible for how they feel about your choice. At work you might go above and beyond your job requirements at the expense of your own time with friends and family, which can lead you to burnout. Despite your fears (“what if I lose my job?”), you can start by setting limits on how often you work above and beyond (or choosing not to at all) and communicating these assertively (saying “I am not available to work on the weekend”).  To learn more about how to practice assertiveness, check out Lisa’s post here, or these online modules that take you through it in detail.

To summarize, when boundaries are blurry or loose, we do things we don’t want to do, often at the expense of our emotional and physical well-being. This leads to constant frustration within the self and can damage relationships with others. Being responsible for minding our own emotions and actions rather than those of others is essential to keeping our relationships (and ourselves!) healthy. Of course, boundaries are not always simple and can look a little different for everyone, so explore this with your therapist to learn about how it all plays out for you.


Danit Nitka received her PhD from the Clinical and Research Psychology program at Concordia University in Montreal, Quebec, and is a psychologist at Connecte Montreal Psychology Group. The team at Connecte loves writing about ways to boost our mental health and bring psychology into our everyday lives. For more helpful tips, check out Connecte’s blogspodcast, follow @connectepsychology on Instagram or like us on Facebook.


References

Peck, M.S. (1997). The road less traveled and beyond: Spiritual growth in an age of anxiety. New York: Simon & Schuster.

Scott, A. (1993). A beginning theory of personal space boundaries. Perspectives in Psychiatric Care, 29(2), 12-20.

Scott, A., & Dumas, R. (1995). Personal space boundaries: Clinical applications in psychiatric nursing. Perspectives in Psychiatric Care, 31(3), 14-21.

Scott, A. (1998). Psychometric evaluation of the personal space boundary questionnaire. Journal of Theory Construction and Testing, 1(2), 46-53.