Please Note: The ideas contained in this FAQ are the opinions of the writer and are communicated without reference to supporting documentation in most cases. Other inspiration and influence for the writing came through consultation with other mental health professionals but the writer “Peter Quintano” is also fully qualified in DBT making him qualified to talk about the things discussed in this article.
Thank you for reading my words, and in that sense, “hearing me.” I appreciate your curiosity and interest in learning more about Borderline Personality Disorder (BPD)… about what can be done to enhance the quality of life and to preserve life. It is only through artful expression, ongoing learning about CBT and DBT skills, and careful use of medication that I have been able to hold myself together through the daily emotional challenges of BPD. I hope my words and expression about living with mental illness can help you progress in the ways you need at this time.
The phrase “the way out is through” applies very well to Borderline Personality Disorder in most situations because “facing” raw emotion without avoidance while also attempting to understand (validate) the feeling can help to ease emotional suffering and reduce all associated damage to self and relationships. On the other hand, there are some life situations where purposeful distraction from emotion is a wiser approach to take. It is a skill to know the difference between when to apply the different strategies for the best possible life outcomes.
Before learning more about when to use different approaches, it’s good to elaborate on the meaning of “the way out is through,” even if it seems self-explanatory on the surface. There are at least a couple of ways to understand and practice doing this, and both are essential to learning and regularly practising to adjust the BPD pattern, at least in my experience.
On the one hand, to “work through” means to learn mindful observance of thought, emotion, and body experience. To mindfully observe means to take the time out of regular life to “see what’s happening” on the inside, to non-judgmentally note to self what has been observed, and then to bring attention back to a focal point (e.g., the breath) again and again. This process is mindfulness in a nutshell, and many practice variations follow this general format (e.g., walking mindfulness, sitting mindfulness, eating mindfulness, etc.).
On the other hand, to “work through” means to make attempts to notice (to stay with, not avoid) real emotion as it may arise in everyday life. I say “real emotion” because people often don’t dig deep enough to, for example, realize that they are feeling shame and that their anger is only secondary to the shame. So for instance, if someone makes a comment that you interpret as meaning you “are bad,” then the moment has arrived that you can choose to notice (to stay with, not avoid) the real emotion and wait for it to resolve. Many potential practice opportunities like this can show up moment-to-moment as life unfolds, and these are often the moments that can turn into BPD drama or otherwise stay in you as unresolved emotional energy.
I believe this in-the-moment type of “working through” becomes more and more possible after time has been taken to practice the first type of “working through” (mindfulness), only because mindfulness seems to make it easier “to see” what’s happening when it’s happening in-the-moment. Not to suggest that “working through” is at any point easy, because it requires both purposefulness and willingness to follow through with “working through” when the opportunities arise. In other words, without understanding why you’re doing it and without powerful motivation for doing it, the chances are excellent that it won’t be chosen for use.
The point in “working through” is to come out on the other side of the emotional challenge being more regulated (emotionally settled) and having more capacity for rational thought. Trusting that noticing, staying with, and not avoiding emotion will bring you to this place of rationality requires some faith and courage – not necessarily easy to come by when you have spent a lifetime avoiding raw emotion. The reality of choosing things like faith and courage is why it is always a matter of choice to start mastering Borderline Personality Disorder or otherwise remain stuck in dysfunction.
Most life experiences are fit for practising “working through” emotions, meaning that staying stuck in certain emotions (e.g., guilt, shame, fear, sadness, abandonment) is not necessary. Most of the time in cases of BPD, the suffering person winds up misinterpreting life situations and therefore gets stuck in these painful emotions. Therefore, to get good at getting unstuck from unnecessary feelings is the essence of mastering BPD.
The tricky part in all of this is knowing when your interpretation is accurate, the feeling state remains hard, and the wiser approach is to avoid the feeling rather than use “working through.” These are the rare situations in life where it makes sense to, for instance, feel incredible sadness (e.g., someone close to you dies). Another example may be that someone close to you goes missing and so you are scared, and the feeling goes on and on. Situations like this do not offer much in the way of control, and to remain functional, it becomes essential to get breaks from intense feelings.
Emotions that arise from uncontrollable and stressful situations usually resolve when the situations resolve., or through the passage of time. Until then, it is good to have a list of distress tolerance activities to get the breaks from feeling that are needed to continue functioning. These activities can be anything from exercising to reading, to watching movies, to playing an instrument. Part of the point of using these activities, of course, is that they are not toxic or destructive in any way, just that they work well to get a break from the natural feeling of the life situation. Lastly, it is wise not to overuse distress tolerance activities since that would defeat the purpose and potentially cause harm or consequences in some other way.
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