borderline personality disorder · mbt · mental health · mentalisation · Uncategorized

MBT: Relationships

Difficulty managing emotions, all or nothing thinking, low self esteem and fears of abandonment are all symptoms of Borderline Personality Disorder. As you can imagine, these make relationships very hard to maintain. Common problems faced include switching from loving to hating someone very quickly, pushing people away to avoid dealing with them leaving and a general sense of not understanding why or how someone could possibly want to be around you.

A big part of Mentalization Based Therapy centres on managing our relationships with others. This is often reflected in the dynamics of the group therapy sessions. It is thought that relationships will develop within the group that mirror relationships outside of therapy. I have experienced this on some level – having strong feelings of annoyance with a group member due to them reminding me of a family member. So how is MBT supposed to help relationships?

MBT is focused on the idea that a lot of issues faced in relationships are due to lack of communicating emotions clearly and making assumptions about what others are thinking/feeling. For example, I am prone to assuming that others hate me so my coping mechanism is to push that person away so that I am in control of their leaving me. It is also common for me to think that I know what someone is thinking e.g. knowing that someone is angry/upset about a situation. MBT looks at how we can break these patterns in order to improve our relationships.

BPD often leaves people in a situation as follows: difficult relationship leads to intense emotional distress which leads to non mentalising which causes a difficult relationship. It is another unhelpful cycle which needs to be broken and can be done so by working with tools to reduce emotional distress as well as other mentalisation skills. What are these skills I speak of?

First and foremost, looking at alternatives. This means that, rather than thinking you know what is going on in someone else’s mind, you check it out with them or at least consider the alternative possibilities. Maybe they are angry with you but also they might be having a bad day, they might be thinking about something else that happened in the past, they might even just be hangry (anger caused by hunger.) The point is, nobody knows for certain what is going on in someone else’s mind and thinking that you do is damaging to relationships. I barely even know what is going on in my own mind most of the time! These (sometimes incorrect) assumptions affect our own behaviour towards someone which, in turn, can affect their emotions etc.

There are good ways to think about events or situations which can help us manage similar events better. This involves considering what was happening before, during and after an event. This should be from yours and others perspectives. All of this information can help to provide a clearer picture of what emotions and thoughts were involved. Plus, it can be very useful to consider whether or not you were communicating your emotions clearly. Were you shouting even though you were not angry? Did you tell the person how you felt? All of these questions can enable you to figure out how a situation could be approached in a more helpful way.

Of course, it is all well and good thinking about these things and considering alternatives but the only way to find out is to ask. I’ve taken to ask people why they are angry with me. Sometimes they’ll say they’re not and I just explain what led me to believe they were. Other times, they can give an answer which can be helpful. If it is a particular behaviour then I can work on reducing its impact around that person. For example, I get very snappy when I am tired, I now know to warn my partner if I feel I might get a bit short with him as it can upset him. This saves us having petty disagreements that are not helpful for anyone.

The best way I can explain this is in some very dull looking diagrams which push the key message: PAUSE. Take a step back from a situation and really consider all the alternatives. Taking this time will ease the emotional distress in itself. Thinking about the alternatives will allow you to approach a situation differently.

The above diagram shows a common pattern found in people with a BPD diagnosis.
cycle break
The above diagram shows how mentalising can help break the unhealthy cycle.

For example, you get drunk and you kiss a friend. You’re in a committed relationship. You tell your partner as soon as you can. You apologise but they are still hurt and need some time. The guilt is overwhelming, you are certain that this is the end of your relationship and you are going to punish yourself for your actions. You have hurt people too many times and this feels like the final straw. You take an overdose, end up in A&E and everyone around you is worried. You still feel like rubbish.

Alternative: you reach that unbearable guilt and self loathing so you take a step back and pause for a moment. Consider how your partner might be feeling, let yourself wonder about whether this has to be the end, consider what you can do to improve on yourself and make things work. Talk to your partner and see what happens.

Obviously, the latter involves a lot of hard work and strength to not allow emotions to take over and impulsiveness to kick in. However, it is also the less destructive and healthiest option.

If you have difficulties in relationships with others, particularly if you have BPD then this is a skill that can really help you. It is not, by any means, an easy skill to master. Even the mentally well among us fail to mentalise in this way at times. But, it is possible to apply this in life and you will find that your relationships become more stable and your behaviour and emotions less erratic.




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