Reconciling Your Relationship With a Sibling Now That You're Both Adults

In a prior article, Overcoming Unresolved Guilt Towards a Sibling, I discussed how guilt that interferes with a sibling relationship can be resolved.  In this article, I'm focusing on a related topic, reconciling a longstanding conflictual relationship between adult siblings that began in childhood.

Reconciling Your Relationship With a Sibling Now That You're Both Adults

Sibling dynamics are usually developed early in childhood with the possibility of many different influences, including overall family dynamics, age, gender, emotional trauma and other factors.

Many siblings, who grew up with conflictual sibling relationships often feel that they want to overcome the pattern of conflict and reconcile these sibling relationships when they become adults, but this can be challenging, especially if these patterns are longstanding.

The following composite scenario, with all identifying information changed to protect confidentiality, is an example of these issues between siblings and how they were able to overcome them:

Bob and Joe
Bob and his younger brother, Joe, spent most of their time as young children with their mother, who was diagnosed by her psychiatrist with major depression and borderline personality disorder.

Their mother spent much of her time in bed, too depressed to rouse to get up to cook or take care of her sons.  Their father, who was a salesman, spent most of his time away on business.  As a result, Bob took on the responsibility of taking care of himself and his younger brother.

Bob and Joe as Children

On those occasions when the mother felt well enough to get out of bed, she favored her younger son, Joe, lavishing him with praise for his looks, his personality, his school work and just about everything about him.

In contrast, she criticized almost everything about Bob, and she told him that no one would ever love him when he grew up.

Not only did she criticize and denigrate Bob, but she instigated Joe against Bob.  At a young age, Joe learned that if he wanted to keep his mother's love, he had to side with her against his brother and so, being too young to understand his mother's emotional problems, he sided with her against Bob.

As a result, this set the dynamic between these two brothers from an early age.  It was deeply hurtful to Bob, who was also too young to understand that his mother's borderline traits were the underlying cause of the problem (see my article:  The Effect of Growing Up With a Parent Who Had Borderline Personality Disorder).

Bob tried to please is mother by trying to help her, making things for her in art class, and trying to be as good as he could be.  He did very well in school.  He won academic and sports awards, always with the hope that he could gain his mother's love.

But his mother didn't changed how she treated her two sons--Joe was the "good one" and Bob was "the bad one," and Joe remained close to his mother by disparaging Bob.

Bob grew up feeling that he was flawed and unlovable in some basic way that he couldn't understand.  Even though he had friends, he was lonely.

On the rare occasions when the father was at home, he distanced himself from Bob, Joe and their mother.  She was disparaging of him too.  Eventually, he left the family to be with a new girlfriend who lived out of state, and he had little contact with Bob and Joe.

Bob went away to college, and he moved to New York City for his first job.  Joe went to a community college near home and continued to live with their mother.  He became a sort of emotional surrogate husband to their mother even in his late teens.

As time went on, Bob saw less and less of his mother and Joe because these visits were very hard emotionally.  He was successful in his career, but he was deeply affected by his mother telling him for many years that he was unlovable and would end up alone.  And, each time that he saw his mother and brother for an occasional family visit, he felt the sting of his mother's disdain which, for him, confirmed that he was unlovable.

Reconciling Your Relationship With a Siblings Now That You're Both Adults

Joe never moved away.  He remained with his mother, taking a local job so he could continue to be live with her rather than moving away for better job opportunities.  None of Joe's attempts to have a  romantic relationship worked out because his mother would come between him and his girlfriend and Joe felt compelled to side with his mother.  Since none of the women wanted to put up with this, these relationships ended quickly.

Bob's sense that he was a deeply flawed individual affected his ability to get into a relationship with a woman.  He was afraid that after a woman got to know him, she would discover how unworthy he was and she would leave him (see my article:  Overcoming the Fear That People Won't Like You If They Discover the "Real You").

But when he was in his mid-20s, he met a woman, Sandy, that he really liked.  Sandy took the initiative to ask Bob out for a date.  As they continued to see each other, even though he liked her, Bob became increasingly afraid of allowing himself to be emotionally vulnerable with her (see my article:  Relationships: Fear of Being Emotionally Vulnerable).

Since Bob felt Sandy was very special and she seemed to like him a lot too, he decided to come to therapy to deal with his fear and confusion.  As we explored his family history, the origins of Bob's fear and feelings of being unlovable became clear.

Although Bob was able to understand intellectually why he felt unlovable, on an emotional level, it didn't change how he felt about himself, so we began to use EMDR (Eye Movement Desensitization and Reprocessing) to help him overcome his traumatic family history and his feelings of being unlovable (see my articles:  What is EMDR? and EMDR: When Talk Therapy Isn't Enough).

Gradually, over time, as Bob processed the emotional trauma of having a unloving, critical mother who played his brother against him, he began to feel better about himself for the first time in his life.  He was able to open up to Sandy in a way that he never believed possible.

He also began to feel that he wanted to try to reconcile his relationship with Joe, if Joe was willing.  Even though he wanted this reconciliation, Bob knew that he couldn't force the issue and that he might have to accept Joe's refusal, especially since Joe remained very close to their mother.

Bob and Joe hadn't been in touch with each other for more than a year when Bob called Joe.  Bob could hear his mother in the background telling Joe to get off the phone after she found out that Bob was calling.  After that, Joe's voice sounded shaky and he ended the conversation abruptly.

We had prepared for this possibility in therapy and although Bob was deeply disappointed, he took Joe's rebuff in stride.  A few months later, feeling that he was doing well and his relationship with Sandy was going smoothly, he left therapy knowing that he could return at any time.

About a year later, Bob contacted me because his mother was diagnosed with advanced cancer and she was already in hospice.  Bob was preparing himself emotionally to see her, possibly for the last time and to see Joe.  So, Bob returned to therapy (see my article:  Returning to Therapy).

We met for a couple of therapy sessions that week before he went home to see his mother and Joe.  His mother, who was heavily sedated, spent time with Bob alone while Joe waited outside.  To Bob's amazement, with tears in her eyes, his mother apologized to him for how cruel she had been over the years.  She asked Bob for his forgiveness and, to Bob's relief, they were able to reconcile just a couple of days before she died.

Although he was relieved to have made amends with his mother, Bob also felt sad for all the time that he and his mother allowed to pass before they reconciled.

After the death of their mother, Joe was so bereft that he asked Bob if he could come stay with him.  Bob realized that, without their mother, Joe felt desperately sad and confused. Joe also expressed shame for the way he treated Bob and said he would understand if Bob refused to have anything to do with him.

Bob hoped this could be the beginning of a reconciliation between them and he took Joe in without hesitation.  It was awkward at first for both of them.  So many years of being at odds with each other couldn't be erased immediately.

After a few weeks, Joe agreed to come to a few sessions of therapy with Bob to try to reconcile their relationship.  He was able to see, for the first time, how their mother influenced the dynamic between them and he felt deeply sorry.  They each expressed sadness, anger, and resentment.  They also felt hopeful, for the first time, that they could have a better relationship now.


When Joe went home, he also began his own individual therapy to deal with the effect of his enmeshed relationship with his mother now that she was gone.  He struggled but, over time, he began to put his life together and he maintained contact with Bob in the context of their new relationship.

Reconciling Sibling Relationships as Adults
The composite scenario above isn't unusual.  Children are often influenced by their need to remain close to a parent who might engage in splitting between siblings.

This is usually an unconscious process for the sibling who sides with a parent against another sibling.  The child's need to have his or her emotional needs met by the parent can overshadow everything else.  And this doesn't automatically change when a person becomes an adult, especially when the sibling remains overly attached to the parent, as in the case with Joe.

Even though the siblings in this scenario weren't able to reconcile until after the mother died, many siblings do work out their relationships as adults before the parent who is engaging in splitting dies.

Reconciling Your Relationship With a Sibling Now That You're Both Adults

This type of reconciliation requires that each sibling has matured enough to be his or her own person; s/he sees the splitting dynamic for the destructive pattern that it is; and s/he is willing to risk the anger of the parent in order to have a better relationship with the sibling as well as to be his or her own person.

Getting Help in Therapy
The scenario that I presented above is one example, among many, of how siblings can grow up to be estranged from each other and how they can reconcile.  There are many variations on this theme.

As adults, many siblings have been helped by seeking the assistance of a licensed mental health professional to help them navigate the emotional difficulties involved with a reconciliation where there has been longstanding animosity or estrangement.

If you and a sibling want to explore the possibility of an emotional reconciliation, you could be helped by a psychotherapist who has experience with this issue.

About Me
I am a licensed NYC psychotherapy, hypnotherapist, EMDR and Somatic Experiencing therapist who works with individual adults and couples.

To find out more about me, visit my website:  Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (917) 742-2624 during business hours or email me.

The Effect of Growing Up With a Parent Who Had Borderline Personality Disorder

This is the third article in a series of articles that looks at the effect of growing up with a parent who had borderline personality disorder.

The Effect of Growing Up With a Parent Who Had Borderline Personality Disorder

In my first article I gave an overview of borderline personality disorder, and in my second article I provided a fictionalized scenario of a young woman, Karen, from the time she was an infant until college, who grew up with mother who suffered with borderline personality.

In this article, I'll discuss how this fictionalized character, Karen, was affected by her mother's problems and how she was able to get psychological help in therapy to overcome these problems.

Karen
As I mentioned in the prior article, Karen grew up in a chaotic home environment with a mother who exhibited many of the symptoms of borderline personality disorder.

Karen often felt anxious because of her mother's anger, depression and unpredictable moods.  She wished that she could help her mother, especially after many of her mother's frequent breakups with men and a suicide attempt.  But Karen was too young, and she often felt helpless.

Fortunately, she had a schoolteacher who took Karen under her wing.  This teacher liked Karen, and she motivated and inspired her to look forward to a future that included college.  This was a new perspective for Karen.

Karen had a lot of inherent strengths and, with the help of this teacher, who helped to mitigate the chaos that was going on in Karen's home, Karen worked hard in school and she eventually got a scholarship to attend an out of state college.

Karen was happy to be away from home.

Initially, Karen's time at college went well.  But in her third year, after a relationship with a young man that she had been dating got serious, she became anxious and ambivalent about the relationship.

The Effect of Growing Up With a Parent Who Had Borderline Personality Disorder

Karen knew that her relationship with Dan was a loving relationship.  Even though they were both young, deep down she knew that they could be happy together--if only she didn't feel like running away when she felt emotionally vulnerable and scared.

She knew she needed to get psychological help before she ruined things between her and Dan so, although she felt hesitant, she went to the student counseling center.

After hearing about Karen's family background, the school counselor, who was an empathetic therapist,  knew that Karen needed more than the short term therapy that the counseling center provided.  So, she provided Karen with psychoeducation about trauma and why it was important to get psychological help (see my article:  Untreated Emotional Trauma is a Serious Issue).  Then, she referred her to a trauma therapist who had an office nearby.

Karen's only experience with therapy was in family therapy when she was a child, after her mother made a suicide attempt.  She remembered liking the family therapist, so she had a favorable memory of family therapy.  But she had never been in individual therapy.

Karen explained to her therapist that she couldn't understand why she was feeling so afraid of being in a relationship with Dan.  After all, Dan treated her well and she knew they loved each other.  She explained that whenever she felt so frightened that she wanted to run away from him, she felt like she was going crazy.

Her individual therapist helped Karen to understand that her current reaction to Dan was being triggered by her early childhood experiences.  She told Karen that she would help her to separate "now" from "then"(see my article:  Working Through Emotional Trauma: Learn to Separate "Then" From "Now" in Therapy).

Her therapist began by helping Karen to develop internal resources to deal with her fears and to cope with working through her early trauma.  These resources included mindfulness meditation, breathing exercises and safe place meditation.

Once Karen developed and used these resources to cope with her fears, her therapist spoke to her about EMDR (Eye Movement Desensitization and Reprocessing) therapy, which is a trauma therapy that has helped many clients who are suffering with trauma.

Karen processed her traumatic memories and fears in EMDR therapy over time.  Gradually, using the EMDR float back technique, they were able to get back to Karen's earliest traumatic memories.

At the end of each EMDR therapy session, her therapist used the last part of the session to help Karen to debrief and to do a meditation to help her to feel calm and safe.

During this time, Karen continued to see Dan and she was feeling much less anxious about the relationship.  Knowing that Karen was getting help, Dan was also patient and understanding.

EMDR isn't a "magic bullet," especially when a person has had the kind of underlying trauma that Karen experienced.  But, over time, Karen was able to work through her trauma and her fears.  She was also able to have a stable and happy relationship with Dan.

Getting Help in Therapy
Growing up with a parent who had borderline personality disorder can be traumatizing and have a negative effect on your adult relationships, especially romantic relationships where core issues tend to surface.

EMDR is one form of therapy that is used by EMDR therapists to help clients to overcome trauma.  Other forms of trauma therapy include Somatic Experiencing and clinical hypnosis, also known as hypnotherapy.

Getting Help in Therapy

If you have underlying trauma that is getting in the way of your having a more fulfilling life, you could benefit from getting help from a licensed mental health professional who is an experienced trauma therapist.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist who has helped many individual adults and couples.

One of my specialties is helping clients to overcome emotional trauma.

To find out more about me, visit my website:  Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (917) 742-2624 during business hours or email me.

The Effect of Growing Up With a Parent Who Had Borderline Personality Disorder - Part 2

In my Part 1 of this topic, I began a discussion about the effect of growing up with a parent who had borderline personality disorder.  In this article, I'm continuing the discussion with a fictionalized scenario as an example of this dynamic.

The Effect of Growing Up With a Parent Who Had Borderline Personality Disorder

Borderline personality disorder, which I defined in the prior article, is a disorder that is a catchall for many similar traits, including chaotic relationships, unpredictable emotional reactions, a fear of abandonment, and a strong ambivalence about close relationships, including a longing for closeness at the same time as the person with this disorder experiences a fear of being rejected, hurt or abandoned.

As I mentioned in the prior article, there are some people who don't necessarily meet the full criteria for borderline personality disorder diagnosis, but they have certain borderline traits.

As I also mentioned in Part 1 of this topic, even though a primary caregiver (usually the mother) might have borderline personality disorder and this usually has a detrimental effect on a child, if a child is lucky, there can be mitigating factors, like other close relationships (another loving parent, a loving sibling, a nurturing grandparent, caring teacher or mentor, concerned coach or so on) that can help to temper the detrimental effect.

We also know now that, due to the neuroplasticity of the brain (the ability of the brain to change), even when there's no one in the child's life to help mitigate the effect or the child doesn't have a particularly resilient nature, as an an adult, s/he is often helped later on in life by having a loving, secure relationship or by getting help in therapy.

The following fictionalized scenario, which is composed of many different cases with all identifying information changed, illustrates how someone who had a parent with borderline personality disorder can be affected as a child and later on as an adult.

Keep in mind that this scenario is only one possible result of this dynamic and there can be many other results.

Karen
Karen's mother, Alice, gave birth to Karen when Alice was only 16.

Alice lived with her single mother, Betty, and Alice's six siblings.  When Betty found out that Alice was pregnant, she became enraged.  She hit her, cursed at her and called her "a whore."

Alice dropped out of high school after her pregnancy became more obvious, and she hoped, eventually, to get her GED.

Alice was confused and had mixed feelings about her pregnancy.  She had some resentful towards her unborn child because she knew her life would be changed forever.  Instead of going to parties with her friends, she knew she would be home taking care of the baby.

At the same time, she didn't want to have an abortion because it was against her and her family's religious beliefs.  So, she grudgingly accepted that she made a mistake and baby was her responsibility.

The baby's father, who was also only 16, was sent away by his parents to live out of state, so Alice was completely dependent upon her mother during her pregnancy and after Karen was born.

The Effect of Growing Up With a Parent Who Had Borderline Personality Disorder

In the meantime, she and her mother were both reliant on public assistance to get by, and life was tough.

When her friends went out, Alice felt left out and lonely because she had to stay home and take care of Karen.  On the one hand, Alice loved Karen.  But, on the other hand, she also resented her because she wanted to be a normal 17 year old by going out and having fun.

Alice also had a lot of resentment towards her mother, Betty, for her verbal abuse and they would often argue.

Even though Alice told herself that she would never treat her daughter, Karen, the way that her mother treated her, she had no awareness of how she (like most children) internalized this dynamic on an unconscious level.  And, as Karen got older, without realizing it, Alice was just as verbally abusive with Karen just as her mother was with her.

Karen grew up to be an anxious child.  As a four year old, she never knew when Alice would fly off the handle and scream at her or slap her.  There were times when Alice would be sweet to Karen and then, for a minor issue (like Karen dropping an ice cream cone) Alice would explode and startle Karen.

Alice had several boyfriends during Karen's childhood.  She had very chaotic on-again/off-again relationships with men.  Karen would start to get close to whomever Alice was seeing at the time, and then he was gone.  This was significant losses for Karen.

Whenever Alice went through a breakup, she became depressed and angry and she would drink a lot.  Without realizing how damaging it was, while, drunk and upset, Alice would tell Karen that men were "no good."

Alice Became Depressed and Angry Whenever She Went Through a Breakup

Karen was very anxious and she wished that she could do something to help her mother.

During one particularly bad breakup, Alice made a suicide attempt by taking a handful of sleeping pills.  Betty called 911 and Alice was rushed to the ER.  Alice was kept in the hospital for observation for 72 hours and, after she assured the psychiatrist that she wasn't going to hurt herself or anyone else, she was released.

While Alice was in the hospital, Betty refused to talk about it with Karen.  She tried to distract her with books and TV, but Karen knew that something was wrong and not knowing made her feel scared.

Alice, Betty and Karen had to attend family counseling after the hospital contacted the bureau of child  welfare.

Things improved for a while during this time.  After they completed family therapy, the counselor recommended that Alice attend individual therapy, but Alice refused and her case was closed.  Then, things went downhill again.

When Karen's elementary school teachers told Alice that Karen was an anxious child, despite their assurances that they were not criticizing her, Alice took their comments personally and felt they were saying that she was a bad mother.  Alice got very angry and moved her to another school.

When Karen was 11, Alice got her GED and got a job where she could support them, so she moved out of Betty's household.  At first, things seemed to be going well.  Alice and the landlady became friends.

But several months later, when the landlady made a comment about Alice not recycling properly, Alice became enraged and moved back in with her Betty until she found another apartment.

The Effect of Growing Up With a Parent Who Had Borderline Personality Disorder

Throughout Karen's childhood, she and her mother moved numerous times because of the arguments that Alice would have with the landlords.  Each time that this happened Alice would uproot Karen from  the neighborhood, her school and the few friends that Karen made.

When Karen went to junior high school, one of her teachers saw something special in Karen and took Karen under her wing.  She spent time with Karen as part of the after school program, helped her with her homework, and took an interest in her.  She encouraged and motivated Karen.  She also gave Karen a sense of hope about the future--something that Karen never had before.

Gradually, Karen came out of her emotional shell and began to enjoy her talks with her teacher.  She never told her mother about this relationship because she was afraid that her mother would get angry and try to come between her and the teacher.

By the time Karen was in high school, she dreamed of going away to college and being on her own.  She worked hard, got good grades and, despite the chaos at home, she was able to go to the college of her choice out of state with a scholarship.

Karen did well in college.  She made friends and dated casually.  She felt happier than she had ever felt.

Growing Up With a Parent With Borderline Personality Disorder

Then, in her last year of college, her relationship with a young man, Dan, at college began getting serious and she felt anxious and scared.

Even though she knew she cared about him and he cared about her, the anxiety and emotional vulnerability that she experienced was so overwhelming that, at times, she wanted to end the relationship just to avoid feeling these emotions.

Karen knew that she needed to get psychological help or she would ruin her relationship with Dan.

In my next article, I'll continue discussing this scenario and how Karen was helped in therapy.

Getting Help in Therapy 
Growing up with a parent who has borderline personality disorder can be traumatic, but working with a licensed mental health professional can help you to free yourself from emotional trauma so you can go on to live a meaningful and fulfilling life.

If you're struggling as an adult with the impact of childhood trauma, you're not alone.  Rather than continuing to struggle alone, take steps to contact a licensed therapist who can help you to overcome unresolved trauma.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist who works with individual adults and couples.

To find out more about me, visit my website:  Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (917) 742-2624 during business hours or email me.

See my article:  The Effect of Growing Up With a Parent Who Had Borderline Personality Disorder - Part 3

he Effect of Growing Up With a Parent Who Has Borderline Personality Disorder - Part 1

In a prior article,  Coping With a Spouse Who Has Borderline Personality Disorder, I discussed the challenges of living with a spouse who has borderline personality disorder.  It is one of the most popular articles on my blog site.  In this article, I'm focusing on the affect of growing up with a parent who has borderline personality disorder.

The Effect of Growing Up With a Parent Who Has Borderline Personality Disorder

Before we go further, let's define borderline personality disorder.

What is Borderline Personality Disorder?

Borderline personality disorder is characterized by a pervasive pattern of unstable interpersonal relationships, self image and emotions.

It is also characterized by impulsivity beginning by early adulthood with five or more of the following:

• frantic efforts to avoid real or imagined abandonment
• a pattern of unstable and intense relationships, alternating between idealization and devaluation
• an unstable self image or sense of self
• impulsivity, including self harm, overspending, substance abuse, binge eating, etc.
• recurrent suicidal behavior, gestures or threats or self mutilation
• highly reactive and unpredictable mood 

As I mentioned above, for someone to be diagnosed with borderline personality, s/he doesn't have to have all of the above traits--they only need to have five or more.

The Effect of Growing Up With a Parent Who Has Borderline Personality Disorder

Even when someone doesn't meet the full criteria for borderline personality, a person can have significant borderline personality traits.

How Does Borderline Personality Disorder Affect Attachment Between the Primary Caregiver and a Child?

A loving bond between a primary caretaker (let's assume for this article that it's the mother) and an infant is crucial for the healthy physical and emotional development of the infant.

There's no such thing as a "perfect bond" between mothers and infants.

The bond between most infants and their mother tends to be "good enough" so that the infants develop a secure attachment (see my article:  Early Bonding Between Mother and Infant).

Secure Attachment Between Mother and Child

A secure attachment generally develops if the mother is receptive to the infant by engaging in caregiving responses like touching, holding and soothing as well as being emotionally in sync with the infant.

As part of healthy, secure attachment, there is a reciprocal relationship between the infant and the mother as they each respond to each other emotionally and physically.

However, infants who are raised with a mother who has borderline personality disorder tend to develop insecure attachment.

As opposed to secure attachments, mothers with borderline personality disorder tend to develop unresolved, preoccupied and fearful attachments with their children.

With insecure (unresolved, preoccupied and fearful) attachment, the person with borderline personality longs for closeness but is also fearful of dependency and rejection at the same time.  T

his ambivalence is communicated to the infant on an unconscious level and it is detrimental to the infant's healthy physical and emotional development.

The Effect of Growing Up With a Parent Who Has Borderline Personality Disorder

For the mother with borderline personality the vacillation between longing and fearing emotional intimacy is an emotional dilemma (see my article:  An Emotional Dilemma: Wanting and Dreading Love).

The infant who is raised by a mother with borderline personality disorder experiences unpredictable emotions, including unpredictable rage.

A mother with borderline personality disorder might also be emotionally and physically abusive with the infant or neglectful.

Children who grow up under these circumstances often have difficulty developing trusting relationships  as children and as adults due to the unpredictable nature of their early childhood experiences.

The negative affect of growing up with a parent who has borderline personality disorder can be mitigated by the loving presence of another adult, like the other parent, an older sibling, a grandparent and so on (more about this in a future article).

In Part 2 of this article, I will continue discussing the affect of growing up with a parent who has borderline personality disorder.

Getting Help in Therapy
You don't need to be psychotherapist to know that growing up in an emotionally unpredictable and chaotic home has a profound effect on you.

Getting Help in Therapy

Many people, who grew up with one or both parents who had borderline personality disorder, fear that they will develop similar dynamics with their children or in their adult relationships, even though they don't want to do this (see my article:  Discovering That You Developed the Same Traits You Didn't Like in Your Parents).

As I will discuss in a future article, the emotional effects of growing up in chaotic and abusive or neglectful household can be overcome in therapy if you work with a licensed mental health professional who understands these dynamics and knows how to help people to overcome them.

It's often hard for people who grew up in unpredictable households to trust coming to therapy, but for those who get psychological help with an experienced therapist, they can learn to live a more fulfilling and meaningful life.

About Me
I am a licensed NYC psychotherapist, hypnotherapist and EMDR therapist who works with individual adults and couples.

To find out more about me, visit my website:  Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (917) 742-2624 during business hours or email me.

Also see:  The Effect of Growing Up With a Parent Who Has Borderline Personality - Part 2

Attention-Seeking Behavior in Therapy: Understanding Factitous Disorder

Factitious disorder (FD) is a complex psychological disorder in which patients either intentionally produce or pretend to have medical or psychological disorders.  The intent is to be in the patient role and to garner sympathy from the medical or psychological practitioner.  This is different from malingering where the patient pretends to have a problem in order to gain some form of external benefit  (e.g., disability payments, Workers Compensation, etc) or to get drugs, like pain killers.

Attention-Seeking Behavior:  Understanding Factitious Disorder

In this blog post, I'll focus on factitious disorder in the psychotherapy office rather than the medical office with the following case example which, as always, is a composite of many different cases and does not identify any one person:

Mary
Mary, who was in her early 40s, had already been in therapy with many therapists in the past.  She rarely remained in therapy for more than a few sessions with most therapists.  She had many complaints about her prior therapists--they didn't understand her, they were shocked by her trauma history, they probably had not dealt with their own trauma history, they said inappropriate and unempathic things to her, and they questioned the authenticity of what she told them.

She told her new therapist in their first session together that she hoped the therapist would be able to handle hearing some horrific things about her early childhood.  She wanted to know, right from the start, if the therapist could deal with hearing about the gruesome details of her childhood sexual and physical abuse.  She was "tired" of having to seek out one therapist after the next in hopes of getting psychological help.

Mary's new therapist, who was an experienced mental health practitioner, listened intently and assured Mary that she had a lot of experience with trauma and she doubted there would be anything that Mary could say that she had not heard before.  The therapist thought to herself that she could form a rapport with Mary in treatment, but Mary's dramatic presentation and the fact that Mary went from one therapist to the next ("therapist hopping") concerned her.  She remained open to listening to Mary in a respectful and empathic way, and she continued to pay attention to her own internal promptings as to what might be going on.

Over the next three sessions, Mary presented her childhood history in a very dramatic way.  She presented everyone in her family (mother, father, siblings, aunts, uncles, grandparents on both sides, cousins, nieces and nephews) in a negative light.  Each one of them had harmed her in some way, either physically, sexually, or emotionally.  Everyone who was in a position to help had been either completely unhelpful, incompetent or somehow aided and abetted in the abuse.  This included teachers, principals, clergy, neighbors, family friends, the police, the court system, and the child welfare system.  Everyone was implicated in some way.

By the fourth session, Mary's therapist, who was following Mary's account very closely and taking notes, began to notice significant inconsistencies in Mary's story from one session to the next.  Mary watched the therapist in a wary sort of way, as if she expected the therapist to say or do something that would upset her.  She needed a lot of assurance that her therapist felt empathic towards her.  When the therapist tactfully asked for clarification about some of the more glaring inconsistencies, Mary exploded. She accused the therapist of being just like all her prior therapists--unempathic and unhelpful.    Then, she said she was ending therapy, she would find another therapist, and she left abruptly.  She was unresponsive to telephone calls from the therapist and, by the next week, she was having her first session with a different therapist.

Factitious disorder is a very difficult disorder to treat.  Aside from it being a complicated diagnosis, people often don't remain in treatment long enough with any one therapist.  They have a tendency to go "therapist hopping," just as people with this disorder tend to do in medical settings.  As soon as they sense that the therapist has doubts about the authenticity of their stories, they're gone.  Their intent is to get as much sympathy as possible and they don't want to be found out.

Attention-Seeking Behavior in Therapy: Understanding Factitous Disorder

Often, people with fictitious disorder do have histories of trauma, but usually not to the extent that they are portraying it.  They also often have a coexisting personality disorder, like borderline personality disorder.

Factitious Disorder:  The Importance of the Therapeutic Alliance
If the client with factitious disorder remains long enough and the therapist has built a therapeutic alliance with the client, broaching the topic of fictitious disorder can be a very delicate but necessary part of the process.  The therapist must have the ability to remain empathic, even while he or she knows the client is not being forthcoming and is trying to manipulate.

The therapist must remain focused on the client's intent--the need to feel cared about.   When the therapist and client have a good enough rapport, the therapist can then bring up the diagnosis of factitious disorder in a tactful, caring, and professional manner.

The goal would be to have the client admit that he or she has been attempting to manipulate and then getting to the underlying psychological issues.   If the client will allow this, there is hope that he or she can overcome this disorder and stop engaging in self sabotaging their treatment and their lives.

About Me

I am a licensed New York City psychotherapist, hypnotherapist, EMDR therapist, and Somatic Experiencing therapist.  I work with individual adults and couples.

To find out more about it, visit my website:  Josephine Ferraro, LCSW - NYC Psychotherapist

To set up a consultation, call me at (917) 742-2624 during business hours or email me.

Coping with a Spouse Who Has Borderline Personality Disorder

Generally, as a psychotherapist, I tend not to think of people in terms of diagnoses. People are more complicated than that, and looking at people only in terms of diagnoses tends to be reductionistic and pathologizing.

Coping With a Spouse Who Has Borderline Personality Disorder

While a mental health diagnosis will not capture the complexity of a particular human being, there are times when it is helpful to understand and cope with people who are close to you who are suffering with emotional problems. It's also important to understand yourself in relation to this person, what's happening to you in this relationship and steps that you might need to take to protect yourself emotionally, physically, and financially.

As I mentioned in my previous post, borderline personality disorder (BPD) is a serious mental health problem. It's often hard to understand for the person who has borderline personality traits as well as his or her loved ones. As with any mental health diagnosis, borderline personality disorder is on a continuum. There are certain people who have various traits and not others, and there are also people who meet the full criteria for the disorder.

Living with a spouse who has borderline personality traits can be extremely challenging. Usually, it means that you're living in a very chaotic emotional environment where you've not sure if you're losing your mind or your spouse is "going crazy."

How Do You Know If Your Spouse Has Borderline Personality Traits?
Listed below are some questions that you can ask yourself. While it's understandable that, if you're not a licensed mental health professional, you're not qualified to diagnosis anyone, but the questions below will help you to begin to understand what you might be dealing with in your relationship:

Does your spouse or partner become irrationally angry or enraged at the drop of a hat over relatively minor issues?

Do you feel like your spouse goes back and forth at various times between idealizing you and devaluing you?

When your spouse becomes angry with you, does he or she "forget" everything that is good about you and your relationship so that you feel that he or she has done a complete "180"?

Does your spouse engage in emotional "cut offs" with you or his or her family members or friends with little provocation?

Do you often feel that you're "walking on egg shells" with your spouse because you fear that things you might say or do will cause him or her to become extremely angry and possibly violent?

Do you often find yourself avoiding certain topics because you're afraid that your spouse will have an angry or violent reaction?

Do you often feel misunderstood by your spouse and your efforts to try to clarify things that you've said or done are not heard or understood by your spouse?

Do you often feel manipulated and controlled by your spouse?

Are you fearful of asking your spouse for what you need emotionally because you're afraid that your spouse will accuse you of being "too demanding"?

Do you often feel that your spouse changes his or her mind a lot so that you're not sure what he or she wants from you?

Does your spouse accuse you of doing or saying things that you never did or said?

Does your spouse seem to go from trusting you to being highly suspicious and distrustful of you for no apparent reason?

Do you often find it difficult to plan social activities because of your spouse's changing moods, impulsivity, and unpredictability?

Over time, do you often feel like you're living with "Dr. Jekyll and Mr. Hyde"?

Does your spouse often seem very charming and engaging to other people, but when you're alone with your spouse, you see a completely different side of him or her that most people don't see?

Does your spouse abuse alcohol or drugs or engage in gambling or sexual addiction as a way to cope?

Does your spouse often accuse you of not caring for him or her so that you feel that no love or caring is ever enough?

Does your spouse vacillate between wanting to be emotionally or financially rescued to cutting you off emotionally?

Do you find that you and your spouse often go through frequent breakups and reconciliations?

Do you find that your spouse engages in a lot of "all or nothing" or "black and white" thinking and there often doesn't seem to be any middle ground in his or her thinking, especially when he or she is angry?

If you've tried to leave the relationship, has your spouse tried to use charm, manipulation or even physical violence to keep you from leaving?

Does he or she threaten to commit suicide or threaten to hurt you if you leave?

It's important to understand that the above characteristics are often common to many different types of emotional problems, not just borderline personality disorder. So that, as a non-mental health practitioner, you're not going to be able to analyze or diagnosis your spouse. Also, while your spouse does not need to have all of these traits, having one or two of these traits does not mean that your spouse has borderline personality disorder. The above list is meant to give you an idea of what you might be dealing with in your relationship.

The following fictionalized scenario, which is not about any particular person, is an example of some of the problems involved in a relationship with someone who has borderline personality disorder traits:

Mary and John:
When Mary met John in their senior year of college, she thought he was one of the most charming and thoughtful people that she had ever met. She felt completely swept off her feet by him. She had also never felt so close to anyone before. No one had ever made her feel so terrific before. He thought that almost everything that she did was wonderful. When her friends met him, they also really liked him and found him to be very charming and engaging. He was funny and very generous. Often, when people met him for the first time, they would say that they felt he was so familiar to them, as if they had known him for a long time.

Before introducing Mary to his family, he warned her that his family tended to be very chaotic. He told her, "In my family, you need a score card to keep track of who's angry with whom and who's not talking to whom, but I'm sure they'll love you just as I do."

When Mary met John's family, which consisted of his parents and five brothers and sisters, Mary realized that what John had told her about them was accurate. Although they welcomed her with open arms, there was a lot of tension in the air between family members. 

She noticed that certain siblings were barely talking to each other and there seemed to be various alliances between certain siblings against other siblings. At various points in her visit, arguments suddenly erupted for no apparent reason, making Mary feel very uncomfortable. 

But, just as quickly as these arguments erupted, they also subsided just as quickly. John's mother said to Mary, "Don't mind us. This is just how we are. We fight, we stop talking to each other for months at a time, but we love each other and we always make up--until we begin fighting again"

Within a few months of having met each other, Mary and John got married. Mary was sure that she had never been happier and she had never felt so loved and appreciated in her life as she felt with John. During the first month or so, Mary felt like she was living with a prince and John treated her like his queen. He brought her flowers. He told her that he thought she was the best wife and lover that a man could ever have. He praised everything that she did.

Then, one day, without warning, all of this seemed to change. John was under a lot of stress at work and he felt that his boss was harassing him. Mary had never seen John in such an anxious and angry state. 

When she got home from work, she found John pacing the room back and forth. He told her that his boss was on his back and he was thinking of quitting his job. Mary was very surprised to hear John say this because during the first few months that John worked with this particular boss, John had nothing but praise for him. John often talked about what a great future he felt he had with the company and how much he loved his job.

Since John would often tell Mary how much he valued her advice, she began to tell John that maybe his boss was in a bad mood that day and things would probably go back to being as good as they usually are tomorrow. She was putting away grocery when she saw John whirl around with a look of rage on his face that she had never seen before. Then, John yelled at her, "Who's side are you on!?! Are you taking my boss's side!?!"

Mary was so shocked and dumbfounded by John's reaction that she dropped the eggs on the floor, which only made John more angry, "Oh God, Mary! What the hell are you doing? Look at this mess! You always make a mess of things! Can't you do anything right!?! And what do you know about my job. You're always putting me down! Why aren't you ever on my side!?!" Then, John suddenly walked out of the apartment, leaving Mary feeling like she was in the middle of a nightmare.

While John was gone, Mary tried to calm herself. She had never seen John like this before. She thought about what he had said. She could not ever remember putting John down or not being on his side. She couldn't understand how or why he would say these things.

About a half hour later, Mary received a call from John's mother. She told Mary that John had come to her house and he was talking to her and the rest of the family about the argument. She told Mary, "You know, Mary, John is very sensitive and you should try not to get him angry because he explodes. You're his wife. You should try to be supportive of him and not put him down. I thought you were different." Mary worked hard to contain her own anger about this intrusive call. She didn't want to explain herself to John's mother, so she decided to wait until he got home to talk to him.

When John came home a few hours later, he seemed like his old self again. He brought her flowers and told her that he was sorry that he lost his temper. He told her that he didn't mean all the things that he said, and he wanted to make up with her. Mary was confused, but she was glad that John was "himself" again and she thought that his overreaction earlier that evening might have been due to his being under a lot of stress at work. 

She decided to leave well enough alone and not bring up anything about John's boss or his work or the phone call from his mother that evening. That night, John and Mary made passionate love and, once again, Mary felt that no one had ever loved her as much as John.

Over the next few weeks, everything seemed back to normal again--until John had an argument with his mother. Once again, John was pacing back and forth and he was very angry and upset. There were numerous calls back and forth between John and his mother where they were yelling at each other, crying, and hanging up the phone. 

As Mary watched things unfold, she told John, "Try not to let your mother affect you so much. Why don't you just let things simmer down before you call your mother again." John responded by losing his temper with Mary, "What are you talking about!?! My mother is the best mother a son could have. She's not bothering me! You're the one who's bothering me. You're never on my side. You're the worst wife a man could have! Why don't you leave me alone!?! I don't know why I ever married you!" Then, John stormed out of the apartment.

As these scenes became more frequent, Mary began to realize that John had serious emotional problems, and that his family was very dysfunctional. She became very vigilant when she got home to try to "read" John' s mood because she never knew when he was going to be his charming, loving self or when he would be angry and demeaning of her. 

She also began avoiding certain topics that she knew would make John angry to avoid dealing with his temper. But as careful as she tried to be, she was still subject to John's impulsive and destructive rage which often came for no apparent reason. She also often felt misunderstood by him, and when she tried to explain herself, John dismissed whatever she said when he was in an angry or anxious mood.

Over time, Mary began to realize that John stopped being as attentive to her needs. When she tried, very tactfully, to bring this up with John, he lashed out at her because he felt criticized, "Oh, like I don't have enough going on at work and dealing with my family! Now, you're going to make demands of me too! You're too demanding! I can't deal with it, Mary! You have to stop!" Mary began to explain that she often felt lonely and she couldn't understand what happened to their relationship. Hearing that, John's anger escalated and he began breaking things around the apartment.

Mary became so frightened that she started to run out, but John caught her by the arm and began begging her not to leave. He dissolved into tears and promised her that he would change, "You have to help me, Mary. I need your help. Don't leave me." At that point, Mary had already seen enough of this behavior to know that John was unable to keep his promises to change. She told him that she thought they both needed to get help and if he didn't get help, she would leave.

Since John had a very strong fear of being abandoned, he complied with her wishes. He asked his family doctor for a referral, and his doctor referred him to a DBT therapist who specializes in working with people who have borderline personality traits. Mary also began her own individual psychotherapy to deal with her issues in their relationship.

It took a long time and it wasn't easy, but John learned how to cope with his overwhelming feelings of anger and fear of abandonment. There were many times when John wanted to leave therapy because he felt the therapist didn't understand him. Then, there were times when he thought his therapist was the best therapist in the world. Mary also learned to take care of herself in their relationship. Over time, their relationship began to improve. The family dynamics in John's family never changed, but John and Mary learned not to get so caught up in them.

The above scenario represents a somewhat optimistic outcome of living with a spouse who has borderline personality disorder. Not every relationship turns out that well. For instance, people with borderline personality disorder often refuse to get help. It's hard for them to see that they have a problem, and they often blame everyone else. In other cases, they might go back and froth between blaming others and blaming themselves.

If you're the spouse who is on the receiving end of this behavior, it can be very hard, if not impossible, to deal with on an ongoing basis. One of the most challenging aspects of this type of relationship is that you often can't see when your spouse is going to shift from being loving and thinking that you're wonderful to being angry and blaming and accusing you of being the worst spouse ever.

When you go through these sudden ups and downs with your spouse, you might feel like you're on an emotional roller coaster. You might also feel that you hardly recognize this person, who is supposed to be your spouse, when he or she makes these sudden emotional shifts.

While there is a place for compassion and understanding, you should never allow someone to emotionally abuse you or your children. Remember that the person with borderline personality disorder traits is responsible for his or her behavior. If there is abuse, especially physical abuse, you need to make a safety plan for yourself and your children to be able to leave the household quickly, if needed, and go somewhere where you feel safe.

Getting Help in Therapy
Even if your spouse refuses to get help, you probably need help yourself to deal with a spouse who has borderline personality traits. 

Only you can decide how much is too much and if you want to stay or leave, but by seeing a licensed mental health professional, you can sort this out and learn what your role is in participating in this relationship.

About Me

I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist

To set up a consultation, call me at (917) 742-2624 during business hours or email me.

Understanding and Coping with Borderline Personality Disorder

Borderline personality disorder (BPD) is a mental health diagnosis with a wide spectrum.

There are people who have borderline personality traits who are considered high functioning (i.e., they are able to hold a job and might even be very successful in their careers; they have intense emotional upsets, including intense anger, but they are able to recover from them relatively quickly; and their relationships are usually chaotic, but they're not extremely chaotic).

Understanding and Coping with Borderline Personality Disorder

However, someone who has intense borderline personality traits often will not be high functioning (i.e., they might have problems maintaining a job; they usually have very intense emotional upsets and it takes them longer to recover; their anger can turn to rage very quickly; they might even become violent; and they tend to have extremely chaotic relationships).

If someone who is usually high functioning is under an inordinate amount of stress that leads to a feelings of emotional fragility, their symptoms can worsen very quickly.

In order to understand borderline personality disorder, it's important to understand BPD traits. Although each person is unique, the following traits are usually associated with BPD:

Relationships and Fear of Abandonment:
People with BPD tend to have intense and chaotic relationships with a lot of conflict. These conflictual relationships often include ongoing cycles of breakups and reconciliations with the same people. People with BPD also often go from idealizing a loved one to completely devaluing him or her and this change can be very sudden.

Borderline Personality Disorder and Fear of Abandonment

Underlying these emotional dynamics is a strong fear of being abandoned by loved ones. Understanding this fear, which might not be apparent when the person with BPD is angry or rageful, is one of the keys to understanding his or her behavior. Often this fear originates from an early history of emotional abandonment, neglect or abuse making the person with BPD vulnerable to real or imagined threats of abandonment as an adult.

Loved ones are often shocked and bewildered at the ability of a person with BPD to do a "180" with sudden mood shifts. This might involve a sudden change from this person being loving and kind to being angry and rejecting, often with little provocation.

People with BPD will often alternate between wanting to be "rescued" emotionally, where they might be very clingy with their loved ones, to severing ties with their loved ones due to a real or imagined slights.

Emotions:
People with BPD often experience strong emotional instability, especially when under stress. BPD is associated with intense feelings of anger, rage, sadness, and feelings of emptiness, which can be extremely overwhelming.

People With Borderline Personality Disorder Are Often on an Emotional Roller Coaster

They are often on an emotional "roller coaster" with frequent "ups and downs" for no obvious reason. There are often frequent and sudden mood shifts which might frighten the person with BPD as well as their loved ones.

Sense of Self:
People with BPD often do not have a stable sense of self. They might experience themselves as being happy one moment and then sad the next moment for no apparent reason.

Behavior:
Borderline personality disorder is usually associated with impulsive behavior. People with BPD might engage in impulsive shopping sprees, sexual behavior, alcohol or drug abuse, gambling, cutting themselves, bingeing and purging food, violence or they might make impulsive suicide attempts.

People With Borderline Personality Disorder Often Engage in Substance Abuse

Aside from being impulsive and engaging in risky behavior, people with BPD frequently engage in "cutting off" or severing relationships precipitously. They also have a low tolerance for frustration which can lead to angry outbursts or violent behavior.

Thinking:
For people with BPD, their thinking is usually as chaotic as their emotions which, of course, go hand in hand. They might become highly suspicious or paranoid. They might also dissociate (i.e., "space out" or get numb) as a defense against intolerable feelings. Often, their thinking and perceptions can be distorted. Also, they tend to think in "all or nothing" terms.

What Causes Borderline Personality Disorder?
Research has shown that there seems to be both genetic and environmental components to the development of borderline personalty disorder. With regard to genetics, it's often the case that a person with BPD has at least one parent who also has BPD. In terms of the environment, there is often emotional neglect or abuse in early childhood.

What to Do if You or a Loved One Has Borderline Personality Disorder:  Get Help
If you or a loved one has BPD, it's important to get help. Since BPD is often confused with bipolar disorder and ADHD, it's important to start with an evaluation by a psychiatrist who is a good diagnostician. If a person who has BPD is drinking or abusing drugs, the substance abuse problem needs to be addressed and stabilized in an appropriate dual diagnosis program.

For people with BPD, Dialectical Behavioral Treatment (DBT) is often the best form of psychotherapy either in a group setting or in individual treatment. Although I am not trained in DBT, I have heard from many colleagues and clients that DBT is often very effective. In NYC, you can contact the American Institute for Cognitive Therapy (http://www.cognitivetherapynyc.com/) for a referral to a DBT therapist.

For loved ones who are struggling to deal with spouses or other family members who have BPD, it's important to understand that BPD is a mental health disorder and to try to have some compassion for the person with BPD. However, it's also very important that you take care of yourself at the same time. And if there is the potential for violence, first and foremost, you must have an escape route to ensure your safety as well as the safety of your children.

Being in a relationship with someone who has BPD can be very challenging. It can often lead to feelings of anger or despair. Only you can decide if you want to remain in the relationship or not, and you might need the help of a licensed mental health professional to decide what's best for you. In a future post, I'll write specifically about people who are in relationships with loved ones who have BPD.

About Me

I am a licensed NYC psychotherapist, hypnotherapist EMDR and Somatic Experiencing therapist.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (917) 742-2624 or email me.