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Section 5 Question 5 | Test
| Table of Contents In the last section, we discussed abandonment. Two types of abandonment regarding clients with BPD we explored are general abandonment and sexual abandonment. In this section... we will discuss methods of control. 4 methods of control commonly used by clients with BPD are manipulation, coercion, autocracy, and disengagement. Clearly, these methods of control are used commonly in society, but the degree to which they are implemented is generally higher in clients with BPD. As you listen to this track, you might consider the appropriateness of playing this track in an upcoming session to foster open discussion regarding your client’s preferred method of control. Four Methods of Control ♦ Method #1 - Manipulation I have found that a common type of manipulation among clients with BPD is supplication or pleading. Clearly, as a mode of influencing behavior, the clients with BPD use of vulnerability, weakness and suffering is well known and often exploited by them. Remember Liz from the last track? Liz’s preferred method of control was supplication. Liz attempted to control her boyfriend Matt by pleading. Liz would beg for Matt’s time, telling him that she was suffering without him. As you have experienced, other ways clients with BPD may use supplication is by acting helpless, inadequate or sick. In extreme cases, if needs aren’t met through supplication, a client with BPD may threaten or become suicidal. Does your client engage in manipulation? If so, perhaps the Looking Glass technique discussed later in this section will be helpful. ♦ Method #2 - Coercion Nicole described her husband, Rich’s attempts to claim ownership of her when she stated, "He would grab my crotch at parties and tell people ‘this is where babies come from and it’s mine! Touch it and die!’ He wasn’t angry when he said it. He just made a point. It was like he wanted it to be known that it was his!" Rich, age 31, was treating his wife as an extension of himself. Do you have a client like Rich who uses coercion? To what extent do you feel his or her psychic or physical bullying is an extension of an unreasonable fear of abandonment? ♦ Method #3 - Autocracy Helen often made comments such as, "I know better than you do" or "It’s to difficult for you to understand." Generally, clients with BPD like Helen engage in dictatorship in every area of discussion, rather than in their specific area of expertise. Think of your Helen. Does your client with BPD claim the last word on anything and everything? Perhaps the Looking Glass discussed later in this section benefit your client. ♦ Method #4 - Disengagement Liz stated, "Sometimes I’ll just sit there staring into space. Matt will ask me what’s wrong. I’ll tell him nothing! Because he should know! After a couple minutes, he’ll ask again. If he really loved me, he wouldn’t have to ask what’s wrong! He should just know!" I explained to Liz that what she was doing was leaving Matt feeling guilty. I asked her how, in that situation, Matt could relieve his guilt or avoid getting stonewalled. Liz responded by saying. "Well, Matt could let me have my way!" After several sessions Liz began to see that she was being, as she put it, "Somewhat controlling." Think of your client with BPD. Could your Liz begin to think about acknowledging her methods of control by evaluating control situations realistically? Could playing this section help your client understand how borderline personality disorder affects methods of control? If so, the following technique may benefit your client in avoiding trying to exercise control. ♦ Technique: Looking Glass --Step 1 - First, in a couples session with Matt and Liz, I asked Liz to look into a mirror for several minutes, focusing on her control issues and then to look at Matt. I asked her to look at Matt for the same length of time she looked at herself in the mirror. I asked Liz to try to imagine how Matt feels about himself and compare it to how he thinks she feels about him. Liz wrote these comparisons down to evaluate with me later. Liz identified her disregard for Matt’s feelings and her emphasis on her desire for continuous reaffirmation regarding the security of the relationship. --Step 2 - Second, we discussed the ways in which Matt’s feelings about himself and her projected feelings toward Matt were similar and different. Matt believed that Liz loved and respected him, but put more importance on how much love he gave her. You may find this technique can also help a client understand how unreasonable certain behavior can be. Liz later stated, "I didn’t know I act so obsessed. I need to start trusting myself and Matt. I also need to stop being so controlling, but I never really knew I was!" Think of your Liz. Does your client with BPD acknowledge methods of control or problem behavior? If he or she is starting to acknowledge methods of control, would your client be receptive to the use of a mirror in the session? In this section... we have discussed methods of control. Four methods of control commonly used by clients with BPD are manipulation, coercion, autocracy, and disengagement. In the next section we will discuss depression co-occurring with borderline personality disorder. We will examine primary depression; primary borderline personality disorder;and the combination of both primary depression and BPD. Peer-Reviewed Journal Article References: |