Dr. Frank Yeomans on BPD Recovery

In this video, Dr. Frank Yeomans, specialist in Transference Focused Therapy, discusses recovery for those living with borderline personality disorder.

Recovery in Borderline Personality Disorder from Amanda Wang on Vimeo.


In terms of recovery as we see it… I would say to generalize, there are two different trajectories — and this gets back to how some people progress differently from others. In the best of cases, a person looks like they’ve just moved beyond having a borderline disorder. The way we would talk about it clinically — perhaps slightly theoretically — is they have just integrated their sense of self.

They have taken aspects of their psychological and emotional world that they used to project and experience as outside of themselves — very often angry or aggressive parts of themselves that were always perceived as the outside — reflect on them, see, “okay, that’s apart of me,” and our message to people is, “you know it’s better if something is in you to recognize it because then you can learn to master it.” If you don’t recognize it, instead of you being able to control it, it controls you.

So people integrate these fragmented and unacknowledged parts of themselves, they develop a much better capacity to modulate their emotions, when they’re really angry about something that happened, they can remind themselves in a way that’s partly an effort to begin and then becomes more spontaneous, “Yeah, I’m really pissed at so and so, being so late for dinner, kept me waiting, but then, last week they did this favor for me. So like, to bring the different parts of experience together so it’s woven into a context that includes negative and positive and therefore if not eliminates, significantly cuts — I’d say eliminates — the extreme reactions. One certainly has a right to emotional reactions, both negative and positive, but it just eliminates those extreme reactions — it just wipes out any other feelings about the person in the moment.

You have an integrated sense of self and an integrated sense of others and you learn to live with the complexities of yourself, of the world, and you learn to navigate life going through the rough spots without giving up, and going through the happy spots realizing there is no paradise, and therefore you’ve got this more mixed and complex, realistic view of things. And with that, often people can go on in their lives and be — the way I put it — as happy as a person has a right to be in the world, since I think it’s naive to think we can be totally happy. Every life has its difficulties and its limitations, its regrets and so on.

I would say that this lady I quoted is an example of that, because here she is, not only catching herself, but beginning to notice her projections — her reading into situations. Her imposing things on to others that really come from her. and as she observes that and is cognizant of that her integration in the world became much better. She was a woman who hardly had any friends because she was convinced that everyone didn’t like her because they might not return her phone call. Now when you get right down to it we’ve all had that experience but if we all concluded a phone call that is not returned means the person hates you, then none of us would ever have any friends because we’d just isolate. So she was able to integrate these momentary disappointments into a broader understanding of who the people in her life were, to not kind of eliminate or just be blind to the positive side of things, and therefore she could experience others with both more understanding, more compassion for herself and more compassion for them. And now she’s having friends, and she’s dating in a way that’s more satisfying than she was doing before, she’s making moves in her career that look very promising… so that’s one trajectory.

The other trajectory I was saying, to generalize on my outline, two possibilities, there are some people, who as I see it, never stop having that initial, very negative reaction you know, there’ll be a trigger event, there’ll be a quick spontaneous, oh they hate me, or this is hopeless, or I might as well just give up.  They catch themselves — it’s almost something you can measure in time, the degree, the length of time the person requires before they catch themselves.

And as treatment  progresses, they can catch themselves almost momentaneously. It just takes a very short time for the quick, familiar and old reaction — and the correction and adjustment. But, at least in my observation, this particular group of patients don’t, as the first group I’ve mentioned did, get beyond having that first, extreme and usually negative reaction. They can observe it more quickly, correct it well enough to move on more realistically and successfully with the situation, and I suspect, there’s something in their brain chemistry that is just prone to quick and extreme reactions. But the more evolved cortical parts of the brain have learned to see that when it happens, identify it as something they have to deal with, and then gain control and mastery over it.

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