Here is the second in a series of videos interviewing Dr. Frank Yeomans on progress with BPD through the lens of Transference Focused Therapy.
Usually the first signs of change are a decrease in acting out behaviors in the person’s life. In our experience since we invite people to set up this frame of treatment, that allows them or sort of facilitates their experience of intense affect in the sessions with us often, as they can experience they kind of emotions they would discharge acting out, the acting out diminishes because they’re able to experience and feel in contact in relation to somebody else emotions that were overwhelming. One of the first functions of therapy, by the way, is just containing emotions. Showing that things can be felt that the person might feel are intolerable or unacceptable — these emotions can be felt and experienced and observed together. So as that happens, most often there’s a decrease in acting out.
Then we try to help somebody use what we call their “observing ego” which I think is very similar in some of the meanings to Mentalization, the process of reflection. Because people with BPD tend to experience in a sort of raw, gut way and they don’t engage as much in the reflective process. So through our process of clarifying how they are feeling in the moment, bringing together that moment in time with other moments we’ve discussed and experienced together in therapy that might be very different, or contradictory or not fitting together — that’s how we’re dealing with the fragmented parts of the person — we ask the person to reflect with us, how can it be so different from one moment to another?
And it’s a reflection that they usually don’t do on their own because when they are in the moment, they’re usually in the moment — not thinking, “oh, well yesterday I felt very different now let me compare the two, let me reflect on it.”
So that’s how we try to bring the integration process into play. So as therapy evolves, two things happen. First of all, people begin to ACCEPT affects — emotions in themselves — that would have been totally intolerable to them before and that they would discharge by acting out. Because don’t forget, acting out doesn’t mean misbehaving, acting out means putting into action an emotion or feeling you can’t bear, so you get rid of it.
Now some feelings do seem intolerable. But if you help somebody experience them, reflect on them, and then integrate them into their whole being, then you begin to see somebody replace acting out with reflection.
I wanted to read you a quote from a patient who recently terminated, because I think it shows this process. She said,”In the past, if anyone said anything,” and she meant to me or about her, “it would set of this swirl of low self esteem. Now, I’m not saying I’m the top, but I’m not an idiot. I’m okay. It sounds so cheesy” she said with a little embarrassment, “believing people can like me. But it wasn’t just about self esteem. It was how I imagined others toward me. To think all these years I’ve been imagining what’s in people’s minds and I’ve been wrong. But I’m smart and I was convinced I was right. At the beginning of therapy I’d want to leave therapy because i thought you were taking me away from the truth.” The truth being that everyone hated her. “I thought everything was negative. I thought all the attacks on me were right.” And then this is the part I like best. She paused on what she just said, and she said, “Now this way of thinking better be real. Because now I realize there’s no absolute truth.” So that’s the end of her comment.
Now what I liked about it in just simple English it’s talking about that process of getting beyond that projection of negativity. Getting beyond that reading into situations that’s coming from inside that the person though was coming from outside. And it also shows that now she can reflect on things and right at the end when she said, “This better be real because there’s no absolute truth,” it showed she learned the reflective process. She learned I think what every human being should do and frankly not everybody does whether not they have a psychiatric problem, but everybody should do… they should have an experience and then take a moment to think, “Okay, how accurate is my perception of this experience?” So she’s got to the point where reflection has become like a normal reflex for her — that’s where we would like to see people.