The Essential Family Guide to Borderline Personality Disorder Page 23

  Always remember, arguing can be reinforcing. Tacy was paying attention to what Betsy was saying (the talk about when she was coming home) and ignoring what Betsy was doing, which was calling again. Writer Amy Sutherland says, “When couples argue, what they say steals the show rather than what they are doing—fighting.”1 Author Karen Pryor agrees: “[Y]ou argue each point into the ground, and you can be dead right about the words being said . . . but you are still not dealing with the [fighting].”2

  So, what should Tacy have done when Betsy called? She should have determined the answer to that question during her planning process (pages 213–218). If Tacy doesn’t have voice mail or a secretary, once she hears Betsy’s voice, she could say in a neutral tone, “We’ll talk when I get home tonight” and then gently put the phone down each time Tacy calls until the behavior is extinguished (see pages 232–233).

  Some limits need to be spelled out in detail to include specific definitions, such as what constitutes an “emergency.”

  Sarah and Joe

  You met Sarah and her borderline husband Joe on page 223. The couple have two sons. Sarah says:

  When my husband, Joe, thinks he’s being “ignored,” he frequently says, “That’s it. We’re done. I’m not living like this!” He threatens divorce, throws a temper tantrum (which nobody acknowledges), and then sulks.

  The very moment he stops sulking and starts acting “normally” and under control, my two children and I come back into the room. We speak kindly to him, offer to get him a glass of water, and so on. As a parent, I have to work to minimize any confusion for the children and to repair any hurt feelings. But things are much calmer at home now. If the relationship ends at some point, I’ll survive, and I’ve made my peace with that. But I will no longer tolerate abuse.

  Intermittent Reinforcement

  If Tacy had hung up gently (or screened her voice mail) the first few times Betsy called, would that cement her limit for all time? No. Tacy will need to keep up her end of the bargain. If Tacy acts consistently, not taking more than three calls each day without fail, Betsy will learn. When the problematic behavior stops, it has been “extinguished.”

  However, let’s suppose that that one day Tacy takes one more call than she said she would. Betsy calls for a fourth time and blurts out, “Bloomingdale’s is having a 50 percent off sale on shoes!” before Tacy says anything. Startled, Tacy starts thinking about shoes and says, “Thanks, I’ll stop by on my way home.” Tacy has just reinforced Betsy’s phone calling behavior in an inconsistent way. This is called “intermittent reinforcement,” and it paves the way for Betsy to call Tacy several times a day to alert her that the local grocery store has a fifteen-cents-off coupon on a box of eggs.

  Intermittent reinforcement makes behavior nearly impossible to extinguish (or, put the opposite way, motivates a subject to keep repeating a behavior even if it is only rewarded every so often). The best example is playing slots: it pays out sometimes, but you can’t predict when that will be. Other examples:

  • Your TV doesn’t work right. When you hit it in just the right place, though, sometimes you can get it working again. You will hit the TV for a long time before you finally concede it’s time to buy a new one.

  • You and your girlfriend fight all the time. But every once in a while, you have a great time together. That keeps you hanging on.

  Once you set a limit, it is critical that you observe it every time a broach occurs. Old habits are hard to break. Being mindful of observing your limits takes a lot of energy at the beginning, which is another reason why you start small. Your BP may even test you a year or two later.

  Extinction Bursts

  In the last chapter, Jack said, “You have to be willing to accept that things will get worse before they get better.” This means that the “testing the limits” phase will be long and hard, as your family member acts out even more in an effort to put things back the way they were before. This phenomenon is called an extinction burst. Keep reminding yourself that it will take even more energy to keep dealing with the problematic behavior.

  Extinction bursts occur when the behavior stops eliciting rewards. The subject wonders what happened and raises the level of the behavior. Still no deal. So the subject takes the behavior to new heights. This happened to Jack when he told Loreen that if she called him names, he would leave and pick up the conversation later. Jack said, at first, “It just fired her up, made things ten times worse.”

  An oft-used example is the elevator button. Every workday, you take the elevator to the fourth floor, where your office is located. Let’s say you ride the same elevator. You get in, you push the button for your floor, and you’re rewarded by the doors closing and the elevator taking you to your destination.

  One day you get in and push the button, and the elevator doesn’t budge. Irritated, you push the button again. Nothing. So you jab it a few times, harder and faster. Finally, you realize the elevator must be broken and decide to walk up. Pressing the buttons several times was the extinction burst.

  The key is to anticipate this heightened activity and to let it run its course. If you rigorously withhold the reinforcement, the actions should then begin to lessen—slowly at first, and then more rapidly. Beware, though. If you let your limit go unobserved sometimes, you will be giving intermittent reinforcement.

  Your planning journal from the last chapter comes in handy at this point. You can read it to remind yourself what not having this limit has cost you in the past and what it could cost you in the future. Keep in mind that the first few weeks or months are going to be the most difficult.

  Sharon and Amanda

  Sharon, mother of Amanda who has BPD, says, “Folks with BPD are used to things happening a certain way. When new limits change old, familiar ways, they will often use stronger or other inappropriate behaviors to get what they need and want thinking, It worked before. If I just do it harder, it’ll work again.” This happened to Sharon when she set a limit on Amanda’s verbal abuse. Sharon explains:

  At first, when Amanda said hurtful things I either argued back or just kept quiet. Then I learned that a better response was, “I’m uncomfortable with this conversation. It is painful to me, so I’m going to my room. If and when you are ready to treat me with respect, let me know and we can talk.” Then I left.

  Amanda would continue to scream at me, sometimes through the closed door to my room. When this didn’t get my attention, she tried to involve me by throwing objects at the door and by threatening to hurt herself.

  After quite a few instances of my going to my room and Amanda acting out, the acting out periods started to get shorter and less intense. Eventually she learned to go to her room (occasionally at my suggestion), calm herself down, and then come out to talk to me. Or, as she would start to escalate, she would see it happening and turn it around on her own.

  It took many years and lots of practice to get to this point, but now Amanda knows herself well enough to warn me about her moods ahead of time. She will say things like, “Mom, I’m really upset and trying my best to control my behavior, but I want to apologize in advance if I say something cruel.”3

  Behavior Communicates

  Several years ago, New York Times writer Amy Sutherland was researching behavioral techniques for a book about animal trainers. After watching the trainers using techniques based on positive reinforcement to demonstrate how they taught baboons to skateboard and hyenas to pirouette on command, she resolved to use some of these methods to deal with her husband’s idiosyncrasies—small things like forgetfulness and hovering over her in the kitchen.

  She wrote an article in the New York Times about it, and it was so well received she turned her findings into the 2008 book What Shamu Taught Me about Love, Life, and Marriage.4 In the book, she describes how understanding the science of behavior changed her views about the way people interact and try to alter each other’s behavior.

  She says, “My outlook is more optimistic. I’m less judgmental. I hav
e vastly more patience and self-control . . . I have peace of mind that comes from the world making so much more sense to me.”5

  A few decades earlier, in 1984, scientist Karen Pryor wrote the book Don’t Shoot the Dog: The New Art of Teaching and Training, which is about how “shaping,” or reinforcing, behavior that is already occurring can make the behavior happen more frequently.6 The principles in the book are being used in a program called TAGteach, which is drawing interest from professionals in the areas of sports, special education, autism, physical education, physical rehabilitation, general classroom, and business management.7

  At first glance, using reinforcement and other behavioral science methods may seem unethical or manipulative. However, in any interaction, we are training others, as is evident from the examples at the beginning of this chapter. Training, Sutherland says, is a form of communication—a more direct method of communication than talk.

  Following are some of the highlights of these women’s work as it applies to nudging behavior in ways that produce more harmonious relationships.

  Untraining Unwanted Behavior

  Interactions between BPs and non-BPs are usually “patterned”; that is, they have been going on for so long that they’re now a reflex. Give yourself time to unlearn these habits.

  The “Least Reinforcing Scenario”

  Animal trainers use the least reinforcing scenario (LRS) when an animal has done something wrong—for example, if a trainer is teaching a dolphin to wave a pectoral fin and the dolphin squirts water, the trainer stands still and remains expressionless because any response might provoke a behavior. Sutherland says to think of it not as the cold shoulder, but a head-to-toe poker face.

  You can use this technique if you’re being provoked by an unpleasant comment that is supposed to grab your attention but not really communicate. Don’t use it with behavior that is abusive or otherwise unsafe.

  LRS is not pointedly ignoring behavior you don’t want; rather, it’s overlooking it, as if it’s too much to even bother with. During the pause, collect yourself and take a deep breath. Ask yourself what might be going on in your loved one’s life or mind that sparked the comment.

  Sutherland gives these examples:

  • When a postal clerk snapped at her for putting a label on incorrectly, Sutherland blankly fixed the label on her package. The clerk backpedaled, wishing her a nice day.

  • When her friends kept trying to get her to try acupuncture after she had made it clear she wasn’t going to do so, she tried using an LRS rather than protesting. Sutherland says, “Their lobbying efforts did not cease but lost their typical zeal and breadth. And the pregnant pause of my LRS usually provided a chance to change the subject.”8

  The urge to respond runs deep, so you will need to muster self-control.

  Incompatible Behavior

  The incompatible behavior technique is based on the premise that when people are doing something you don’t want them to do, it’s easier to redirect them into something else than stop them. Gently steer your BP into another activity that is incompatible with the undesirable behavior. In other words, you can’t do them both at the same time. “Go and play outside” is probably the mother of all incompatible behaviors.

  Sutherland was irritated when her husband crowded her as she cooked on the stove. To lure him away, she set up another area in the kitchen for him to chop vegetables and grate cheese. Other examples might be

  • You notice your borderline mother doesn’t insult you when other people are around. Therefore, when you visit you always bring a friend.

  • Your BP has a hard time being alone on Sunday because you have a part-time job as a church organist. So you invite him to come with you or suggest that he visit friends that morning.

  Rita, whose mother had both narcissistic personality disorder and BPD, used the incompatible behavior technique starting when she was only nine years old.

  I noticed my mother couldn’t rage and laugh at the same time. So when she was in the middle of a rage, as hard as it was, I would compliment her on something that was really important to her. She could go from a red-hot volcanic rage to a discussion about herself in a moment.

  One day she was raging at me outside in her garden. I told her the garden looked like it was orchestrated by God himself. All the flowers were planted to bloom at different times of the year. The colors were chosen to coordinate with each other, and I told her I hoped she at least took some pictures. I asked her to tell me more about her garden and what I could do to get one of mine to look like that and to grow.9

  Reward the Absence of Problematic Behavior

  With this technique, you reinforce anything that isn’t the behavior you don’t want. Karen Pryor used this on her mother, who called her and complained and made accusations that angered Pryor. When her mother was complaining and so on, Pryor used the least reinforcing scenario.

  But when her problematic mother asked questions about her grandchildren or spoke of other things, Pryor chatted enthusiastically. Pryor says, “After twenty years of conflict, within two months, the proportion of tears and distress to chat and laughter in our weekly phone calls became reversed.”10

  One of the most confusing aspects of BPD is that many of those who have it act perfectly normally at times. But from a behavioral standpoint, this gives you plenty of opportunities to reinforce other behaviors. Consider all the things you love about your family member and your relationship.

  It’s great to do it anytime, of course, but research shows that timely reinforcement is more powerful. If you’re in a chosen relationship, remember the compelling reasons you chose to be together. The key to success with this is to provide a reinforcer at the time the behavior is happening. You can say things like

  • “I love it when you . . .”

  • “I’m having a great time with you . . .”

  • “I feel so close to you when we . . .”

  • “Thanks for doing that . . .”

  • “You really tried hard to . . .”

  You can also reinforce behavior nonverbally by touching, moving closer, and so on. Sutherland has a technique she called the Jackpot, which is a “big fat, juicy serving of positive reinforcement” used when things are going particularly well or the person really needs it. Once when her husband had to do a very unpleasant task, she gave him an early Christmas present.

  General Praise

  Whenever you can, build on your family member’s strengths rather than dwelling on the negative. Give your family member attention when things are going well; don’t wait until there is a problem. If you can’t give it now, schedule some time in the future she can look forward to. Structure is always good. Spend time in nature together, enjoying the silence. Take walks or do other kinds of exercise together.

  You can also reward positive healthy coping mechanisms; for example, “The other day when you were upset, you took a walk instead of throwing something at the wall” or “It’s great that you can tell me you’re angry in this way because I understand what’s going on.” When people express an interest in doing something positive, immediately show your support to help build momentum.

  However, John G. Gunderson, MD, and Cynthia Berkowitz, MD, warn parents not to compliment their child too much. They say:

  Countless parents say their child went into crisis just as that person was beginning to function better. When people make progress, they fear that loved ones will pull away, thinking all is well. Messages like “You’ve worked so hard. I’m pleased that you were able to do it, but I’m worried that this is all too stressful for you” are empathic and less risky.

  You also want to be sure you’re not implying that your love is dependent on their behavior (unless it is). You might say something like, “I know you are doing great. I am proud of you. But if you decide to go back to your old ways, I will still love you, no matter what. You have my unconditional support.”11

  Other Methods

  There is much more to behavioral scie
nce than positive and negative reinforcement. Following are a few more techniques:

  Watch for Cues

  Sutherland writes that, before a trainer walks into a cage with a wild animal like a cougar, she looks for signs that the animal is having a bad day. If it is, she may decide to work with a different animal. With cougars, she looks for a head hung low and a slight crouch.

  Human animals also show signs that they best not be disturbed. Certain events may be provoking, as can times of day or days of the week. When you’re caught up in your own little world, it’s easy to forget to consider what’s going on in someone else’s.

  You may also be able to look for physical clues; the earlier, the better. Think nonverbal. If you see any of the following signs of emotional distress, you may be able to distract the person if you catch these signs early enough:

  • a rigid, tense facial expression

  • hand-wringing

  • fidgeting

  • crossed arms

  • overall body and facial tenseness

  • clenching of fists or jaw

  • trembling lips

  • slouching

  • tension in the brow

  Positively Reinforce Yourself

  You can even use positive reinforcement on yourself by noticing and praising yourself when you do something right instead of criticizing yourself when you fall short of your own expectations. Pryor tells the story of a squash-playing lawyer who decided to praise his good shots instead of cursing his errors.

  He told her, “At first I felt like a damned fool . . . [but now I am] four rungs higher on the club ladder than I’ve ever been. I’m whipping people I could hardly take a point from before. And I’m having more fun.”12

  Watch for your own cues, too, to stay in touch with your feelings. Stress tends to pile on, and stress from one area of your life can exacerbate stress in another. If you’re prone to physical and/or emotional problems, know what sets them off. If you’re not at your best, try to avoid challenging situations with your family member.

  To learn more about these techniques and find out about other ones, see “Resources”.