Carer 101

People with BPD, when distressed, may often try to off-load some of their overwhelming emotions onto others, particularly people who they feel closest to. This emotional offloading may cause further distress for the person with BPD, as they fear their emotions may be too much and it will push others away. If we respond to someone in distress by blaming, problem solving, or becoming distressed ourselves, their feelings of not being heard or understood can become even more overwhelming.

If the person is accusing or blaming you, admit to what is true, or acknowledge that they are speaking the truth as they see it at that moment. Arguing and justifying your position will only compound the issue.

Whilst you do not need to agree with or feel that their behaviour is appropriate, it is essential to acknowledge that the distress they are feeling in very real for them. Actively listen to what they are saying, often the meaning behind the words. Focus on their feelings instead of reacting to their accusations/words. Be receptive rather than reactive. 

Some ways to tell if you are hearing and understanding correctly is to ask “I am not sure if I understood you properly and I need some help here.” “Do you mean………?” or “I notice that………… Is that how it feels for you?” 

Adopting an approach of caring curiosity with a genuine interest in supporting the person will help support them in their struggle.

You may need time to consider what has been said before responding. Shifting the focus is sometimes helpful (e.g., moving outside, or asking if the person would like a cup of tea). IMPORTANT: The focus needs to stay on the other person and their needs, not on the doing or fixing.

When both of you are upset, it is exceedingly difficult to be calm and things are often said that may be best left unsaid. It is often unhelpful to continue the conversation at this time. Explain that you need some time to consider what has been said and that you will hang up the phone / leave the room / go for a walk / drive around the block and call them or be back in 5-10 minutes. Encourage the person with BPD to use some strategies to soothe themselves whilst you are gone. Make sure that you are back or phone within the time frame you state, otherwise you risk inadvertently reinforcing the person’s concept of abandonment and untrustworthiness.

You are also likely to be feeling quite distressed and uncertain about what may happen in your absence. (You may be afraid that the person may self-harm as a way to manage their distress.) It may be helpful for you to have a support person you can contact to help you to debrief, and to support you; maybe to provide a place for you to stay if it becomes necessary.

It is extremely helpful to have your own therapist/counsellor to support you as you work through some of the challenges and assist you to develop helpful strategies and new skills to support the person with BPD.

For you: Learn strategies to calm yourself in times of stress. Deep breathing, count backwards, visualisation…whatever works best. This will assist you to continue to engage, in a more supportive way, with the person as you promised.

For the person living with BPD: The safety and/or crisis plan is a living document and needs to be reviewed when things are calm, preferably with the person themselves, a mental health professional/s, the person’s main (and extended) support network. This should include discussion about helpful (and unhelpful) ways for carers to react to certain situations. The plan needs to be dynamic in nature, clearly describing how the plan can be implemented and what is expected of all family members.

Speak with others in the person’s support network about common situations that cause the person distress. This will help them to understand what is happening for the person with BPD, and how they can respond in supportive ways.

If you have previously agreed to some boundaries, be consistent and kind when enforcing them. Remember that during a crisis is not a good time to make a new boundary. Remember, too, that boundaries refer to your own behaviours, what you can/cannot do or tolerate. Healthy boundaries are essential for healthy relationships. Be mindful not to use boundaries as a punishment, as this increases the difficulty of distinguishing between healthy and unhealthy boundaries.  

Similar to the pre-flight video we see before take-off, we need to care for ourselves to be able to care for others. Making sure we get enough sleep, exercise, nutrition, and time to engage in activities we enjoy, helps us to remain as calm and as focused as possible during times of stress. This improves our ability to manage difficult situations and decreases feelings of resentment and burnout.

Sometimes, no matter how hard we try, we may get emotionally involved in the crisis and respond in an unhelpful way. If this happens, acknowledge to yourself that you’re doing the best you can at this particular time. As challenging as it may seem there is always the possibility, when things are calm again to open a discussion acknowledging that it appears something you said or did was distressing for the other person and explore together what would have been more helpful at the time.