Translated material
What to do with PRL? Tips for "border guards"
Borderline personality disorder (PRL, Borderline Personality Disorder) is a mental illness associated with the instability of interpersonal relationships and the image, emotional instability and impulsiveness. We have already talked about how people with PRL live , and today we will figure out what types of therapy are effective during a borderline disorder and what specialists advise “border guards” and their loved ones.
Anastasia Umanskaya , Gestalt psychotherapist: “With a borderline personality disorder, prolonged psychotherapy is the main method of treatment. And - the most effective. Therapy helps a person master the skills of coping with strong emotions and preserving long -term relationships. The most investigated the effectiveness of dialectical and behavioral psychotherapy. In addition to it, psychotherapy based on mentalization, psychotherapy, focused on transfer, psychodynamic therapy, are effective in it. The therapist draws up a treatment plan, taking into account the characteristics of the character, personality and living conditions of the patient, and includes individual therapy and classes in the group. ”
Therapy for prel
The services market offers many types of therapeutic treatment in which an ignorant patient can get confused. We have collected the main types of therapy with proven effectiveness .
Dialectic-behavioral psychotherapy (DBT)
The type of behavioral therapy, designed specifically for people with PRL by American psychologist Marches Linehan , the author of the book “Cognitive-behavioral therapy of the borderline personality disorder”. Within its framework, the patient is invited to realize that there are different points of view on a situation that is perceived by “unbearable” and “hopeless” so that he can ultimately choose a more adequate behavior. The main point in this therapy is the need to take patients as they are, while trying to teach them to change. In the DBT process, the therapist teaches the patient the necessary skills of emotional regulation, interpersonal efficiency, the skills of transferring stress, general mental involvement and self -control. The emphasis in the DBT is on recognizing the emotional reactions of a person, as a result of which the person suffering PRL feels support. The period of such therapy is usually from twenty -four to forty -eight weeks.
Dmitry Pushkarev, a psychotherapist , develops DBT in Russia: “Everyone, finding himself in a crisis, is looking for ways to cope with it. But they can be destructive: alcohol, aggression, suicide. Accordingly, the task of therapy is to teach the patient practical skills that will help to get out of the crisis. These are the techniques of awareness, control of emotions, the adoption of the situation or the search for a way out of it. DBT is a direction of therapy, which has gained very widespread in recent years. Initially, the methodology was developed for people with chronic suicidal behavior-for those who repeat attempts to kill themselves and cause damage even after treatment in the hospital (it is important to remember that boys and girls with a third or fourth suicide attempt to often get into Russian hospitals). Today, DBT is used in the treatment of severe patients, including serious mental disorders - with a borderline personality disorder or depression.
Russian experts founded the first community of dialectical behavioral therapy that spreads this practice. Here, psychotherapists can master DBT, and patients can go through group and personal trainings. ”
Therapy based on mentalization (MW)
It is aimed at stabilizing the sensation of himself and at the aid of the patient in managing emotions in a relationship. Mentalization is a process in which one person makes up the idea of behavior, thoughts, words and reactions of other people. This process allows you to explain the behavior of others and requires an analysis of the circumstances of the actions. People suffering from PRL most often incorrectly interpret the actions and actions of other people, investing in all their subjective meaning, which is why they do not accurately understand the state of others. In the process of therapy, the patient learns the exact perception of motives for other people's actions. The therapist explains that any situation can be perceived from different angles, teaches to ask clarifying questions about what could have thought, feel and make a person in the context of interaction with the suffering PRL. The task of therapy is to form the ability to reflect and teach the patient to other skills of interpersonal interaction.
Therapy focused on the transfer (TFP)
TFP is a psychodynamic psychotherapy with step -by -step instructions. It was developed specifically for the treatment of borderline pathology and is based on the idea that the patient is experiencing external reality through his split inner world-and therefore sees others in black and white (idealization or depreciation). Therapist’s task is to help the patient realize this distortion and learn to perceive both negative and positive features of people at the same time.
Phrases that each border guard must learn:
How do I feel now?
What do you mean?
What exactly do you want from me?
Is this reality or my fantasy?
I need time to answer you.
I am worthy of love and respect. But close people are worthy of respect.
It will pass soon, you have to wait a bit.
Cognitive-Bichevioral therapy
The type of psychotherapy, aimed at changing the image of thinking, as a result of changing mood and behavior, is one of the first to confirm their effectiveness . It is based on the idea that negative actions or feelings are the result of the current distorted observations and thoughts, and not unconscious problems from the past.
Together with the therapist, the patient is working to single out specific models of negative thoughts and behavioral reactions to complex and stressful situations. Treatment includes the development of more balanced and constructive ways to respond to stress. The therapist teaches the patient to constructive forms of behavior, adjusting dysfunctional thoughts and patterns of behavior. The result can be achieved in ten to twenty sessions.Scheme-therapy
Schemic (or schematic) therapy was developed by the American psychologist Jeffrey Yang on the basis of cognitive-behavioral therapy, psychoanalysis, the theory of object relations, the theory of affection and gestalt therapy. The “scheme” uses various therapeutic techniques: interpersonal communication skills, one -on -one dialogs, group discussions. The name of Yang therapy emphasizes the idea that the “border guard” acts according to the scheme formed in childhood. Such a scheme is formed under the influence of traumatic events or poor treatment in childhood and is activated in adulthood under the influence of similar circumstances, provoking a certain perception of the world and reaction to it. The purpose of the schematic therapy is to help the patient realize his schemes and the source of emotions that arise when activating these schemes, survive these emotions and find ways to respond differently to events, destroying old patterns of behavior.
A new direction for Russia was presented by Alexander Erychev, a researcher at the Bekhterev Research Institute of Research Institute. In Russia, this direction is just starting its way, so there are only a few certified specialists that you can contact.
Self -help
Anastasia Umanskaya , Gestalt psychotherapist: “A person suffering from a borderline personality disorder is extremely important to a sense of security. This means minimizing stress in personal life and at work, so that the responsibilities in business and houses are clearly defined, without ambiguities and generalizations. Stress will destabilize it.
It is important for a person with PRL to realize his own impulses and moods. Psychotherapy will help to distinguish real needs and painful impulses caused by imagination. A simple but effective way to realize yourself is to ask yourself a question several times a day: “How do I feel?”
It is important to slow down impulsive behavior. “Measure seven times, cutting one” is a motto for a person with PRL, who wants to improve the quality of his life.
It is necessary to master the technique of complacency. It can be meditation, breathing techniques, yoga classes, soothing music, aromatic bath. Respiratory techniques will help to pause in order to respond to the stimulus not immediately and less impulsive.
It is important to learn how to environmentally express both positive and negative emotions. If the first in our society is welcome, then with negative emotions is more difficult. But if you just suppress them, they are accumulating, and sooner or later an emotional explosion will follow. Therefore, one should learn to express them, but in a form acceptable to others.
It is useful to remind yourself that you are worthy of love and respect. As an exercise, recall your merits, achievements and reasons for pride more often. Set with realistic goals. Many small achievements will support you much better than one big and difficult achievement.
It is important not to give in to criticism within yourself and scold yourself as little as possible. Remind yourself that even the most difficult period is a temporary phenomenon and sooner or later will end.
A healthy lifestyle is always useful. Sports help to relieve excessive anxiety and anxiety. Physical exercises contribute to the production of endorphin, the “hormone of happiness”. And what seems to you completely terrible, perhaps after the run will not be so scared. But you need to know the measure in sports so as not to get the opposite effect of overload and stress.
It is important to adhere to a regular schedule. The instability of mood and self -doubt create internal chaos. And the schedule of food, sleep, sports exercises will make the world more stable and predictable. ”
With severe mental pain, it is necessary to distract, switch your attention to watching the film, communication, shopping - that is, do everything to change painful emotions with the help of events. Sometimes you need to give yourself a rest or arrange a small holidays.
If you have a serious crisis, thoughts about suicide appear, you can lower your hands and wash yourself with cold water, and then try to focus on what you see: describe objects and their shape to switch the focus. Then - perform breathing gymnastics: breathing in three scores in a breath and exhale five accounts. After a couple of minutes of such breathing, you need to try to approach the problem again and try to think in a constructive channel. Start analyze your behavior: understand what event provoked pain and destructive behavior, what emotions and thoughts arose. Try to imagine what consequences different options for your behavior will have in this situation.
It is worth learning to say to yourself:
Stop! Step back. Inhale-breath.
What happened is not a disaster: this is just a specific situation.
I will succeed! I can handle it! I'll stand it! I can!
I am not you. I have my own interests, needs, values.
This person is not only bad and not only good, he can be different, and I can be different.
I can accept it!
I accept myself.
I will take care of myself, I will do something pleasant for myself.
My life is worth living!
"Pill with borderline"
Regarding the drug treatment of PRL, there is no consensus. “Tablets from PRL” (like, for example, lithium from bipolar disorder or antidepressants for depression). But PRL rarely comes one thing. There is evidence that in 85 % of cases, patients also have other disorders. Most often, these are different types of anxious disorders, including post-traumatic (probably severe trauma and “launches” the development of PRL), panic attacks, dependencies, anorexia and bulimia, obsessive-compulsive disorder, and dissociative disorder.
Anxiety, depressiveness, irritability, attacks of aggression and suspicion, mood vibrations and short -term psychotic episodes can be treated with traditional medicines, so that part of unpleasant symptoms can be eliminated relatively quickly.
Patients of PRL often find themselves in a psychiatric hospital, usually after an attempt to suicide. There they are treated primarily drugs to help survive the most difficult period. The patient who is on drug treatment should strictly follow the doctor’s recommendations: do not prescribe or cancel the drugs on his own and do not change the dosage without advice with a doctor.
Blogger Ksenia Ivanenko : “The easiest method of obtaining psychiatric care is the appeal to the PND or outpatient departments with hospitals (when any needy can enroll in a consultation with the doctor, whom he chooses independently). You can contact a psychiatrist and private. For free hospitalization in most state psychiatric hospitals, you must first contact the PND, take a referral, come to the commission to the hospital, go through it, wait for the doctors to decide. You can go to the state hospital on a paid basis, but even in this case there may be lines and you have to wait until the right department appears. ” How to understand that you need the help of a psychiatrist and other methods will not cope with PRL?
Anna Ushkalova, psychiatrist: if you often feel uncontrolled anxiety, excitement, your emotional state is constantly deteriorating, the desire to cause damage to yourself, suicidal thoughts appear, you think or see something strange-be sure to contact a psychiatrist.
How effective are medications in the treatment of PRL?
A. U. They reduce the severity of emotional fluctuations, depression, manifestations of impulsivity, aggression and auto -aggression.
Is hospitalization necessary and in what cases?
A. U.: The need for hospitalization arises in suicidal intentions threatening the life and health of behavior. Hospitalization can also be shown in psychotic symptoms.
It must be remembered that in solving the specific problems of “border guards”, such as a violation of self -identification, emotional chaos, fear of loneliness, weak self -control, medicines will not help. Psychotherapy proved her effectiveness here.
What if a person close to you is a “border guard”?
Anastasia Umanskaya: “People with PRL are usually described as“ complex ”,“ manipulating ”,“ demanding ”and“ requiring too much attention ”. They are angry with their relatives and removed from them, do not know how to control destructive emotions and withstand difficulties. So the family of a person with PRL often feels emotional stress and even hostility.
In a romantic relationship, people with PRL are also inclined to create chaos, stress and conflicts. Often they are chronically unhappy with their partner. Such features are able to undermine relations with family members, friends, colleagues.
Despite all this, constructive relationships are possible. They are more likely with a stable partner who can withstand the emotional bursts of the “border guard” and react peacefully to them without tearing relationships. And it’s good if he has patience and ability to soften mood jumps.
1. If your partner suffers from a borderline disorder, it is important that you create a safe atmosphere at home with clumsy boundaries of what is permissible and what is not, and an understandable distance between you. The clarity, sequence and predictability of your behavior are very important to your loved one.
2. Remember about the cycles of depreciation-idealization: adoration can quickly be replaced by hatred, and vice versa, so do not perceive emotional bursts as a true attitude towards you.
3. Always treat seriously the threats of the suffering PRL to harm yourself or commit suicide. This is not a manipulation, he really can do that.
4. It is important not to devalue the feelings of a person with PR, even if relatives do not understand at all what is happening. The feelings that he experiences are real, and it is important for him to be recognized.
5. Do not forget and take care of yourself: enough time to sleep, eat, rest in time. Organize support for yourself and do not focus on a partner who can demand your whole time. Communicate with your friends who understand you, relax alone. Perhaps visit a psychotherapist. "
With adequate treatment, the prognosis for the “border guard” looks quite optimistic: there are chances to be completely cured (as doctors say, “to achieve long -term remission”) - there is.
Studies show that after six years of therapy in seventy percent of patients, the main symptoms disappeared. After two years of treatment, remission occurred in a third of patients, after four years - almost half. Only in six percent of patients, the disease returned again after remission.
Useful resources about PRL
In 2017, the PecyPcal Tsentp in Russia, the info -pacific, was fed up for a person, staging a pacquic, which was based on a drill from the secondary school and AVSTPALIA.
In the center of cognitive-biwhyvioral therapy, you can sign up for practical training in combating stress and control of emotions.
Первое в России сообщество диалектической поведенческой терапии (dialectical behavior therapy, DBT).Журнал «Психология сегодня»: Пограничное расстройство личности
Крупнейший англоязычный ресурс о ПРЛ
Раздел о ПРЛ на mind.org.uk
Книга о ПРЛ, написанная простым языком: И. Ю. Млодик « Карточный дом. Психотерапевтическая помощь клиентам с пограничным расстройством »В социальных сетях:
Пограничное расстройство личности. Ресурсный Центр
ВКонтакте / Facebook
Психотерапия пограничных расстройств личности
ВКонтакте I / Вконтакте II
Исследования и статьи о ПРЛ
Facebook I / Facebook II