Table Of ContentOvercoming Borderline
Personality Disorder
Overcoming Borderline Personality
Disorder
A Family Guide for Healing and Change
VALERIE PORR, M.A.
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Library of Congress Cataloging-in-Publication Data
Porr, Valerie.
Overcoming borderline personality disorder : a family guide for healing and
change / Valerie Porr.
p. cm.
Includes bibliographical references and index.
ISBN 978-0-19-537958-7 (hardcover)
1. Borderline personality disorder—Popular works. I. Title.
RC569.5.B67P67 2010
616.85′852—dc22
2010009506
1 3 5 7 9 8 6 4 2
Typeset by Glyph International, Bangalore, India
Printed in the United States of America on acid-free paper
This book is dedicated to
a very special
TARA
who taught me to understand suffering and
compassion and motivated me to find a way to
help people onto the path out of suffering
Contents
ONE Loving Someone with Borderline Personality Disorder: The Family
Experience
TWO The Science of Borderline Personality Disorder
THREE The Principles of Behavior Change
FOUR Understanding Dialectical Behavior Therapy
FIVE Understanding and Applying Validation
SIX Mindfulness
SEVEN Grieving and Radical Acceptance
EIGHT Dialectical Behavior Therapy Skills for Behavior Change:
Interpersonal Relationships, Emotion Regulation, and Distress
Tolerance
NINE Mentalization: Understanding Misunderstandings
TEN Putting It All Together: Integrating Skills for Acceptance and
Change
Afterword: For Clinicians
Resources
Bibliography
Index
Foreword
IF YOU ARE READING THIS BOOK, CHANCES ARE THAT YOU, LIKE Valerie, come to this
moment and these pages not by choice. You come desperate, having already
traveled a long and arduous road as you sought answers, explanation, and the
possibility of real help for your loved one with borderline personality disorder
(BPD). You seek an understanding that is only possible among those who have
stood in your shoes, who need no words to truly get the horrors you have faced,
the fear as you consider the future, the profound sadness and grief, and the
yearnings of your heart. You come hoping against hope that perhaps you will
find the way out of the hell you and your loved one have endured.
However you got here, whatever your own path has been, you have arrived
well. You can take comfort in knowing that your guide, Valerie Porr, has devoted
decades of her life scaling the mountain tops far and wide, also searching for
answers and explanations about BPD, and for a way out, for those she loves and
for those she may never meet. She has applied her brilliant and creative mind,
her seemingly endless and bountiful energy, and a determined passion to the
pursuit of gathering, piecing together, distilling, and disseminating all that is
known scientifically about BPD. This book, a compilation of all she has learned
and now teaches to those in her family classes, is a labor of love if there ever
was one. Valerie has read scientific journals copiously, often making connections
unseen by researchers themselves until hearing her astute observations. She and
her members attend scientific conferences throughout the world on an annual
basis (American Psychiatric Association, American Psychological Association,
Association of Behavioral and Cognitive Therapy, International Society for the
Study of Personality Disorders, to name a few). She engages deeply in these
meetings, fearlessly asking hard questions, and reminding the scientific
community that our research “subjects” are her and her members’ sons,
daughters, wives, and husbands. You can expect to find Valerie seated near the
front, with camera in hand, taking digital images of the presenter’s slides so she
can immediately incorporate what she has learned into her next class or
workshop. There is no time to wait. People are dying and lives are being
destroyed by the disorder of BPD.
I originally met Valerie shortly after she formed TARA, her nonprofit
organization that seeks to assist and support loved ones of those afflicted with
BPD. She had applied to attend a 10-day Intensive Training in Dialectical
Behavior Therapy (DBT), a scientifically proven treatment for BPD developed
by Marsha M. Linehan, Ph.D. at the University of Washington. Her application
sparked a number of interesting and important conversations for our training
organization about the role of families in “treating” individuals with BPD. DBT,
like those it seeks to treat, is difficult to learn, even for well-trained mental
health professionals. DBT is a comprehensive treatment built on multiple
theories, containing numerous principles, strategies, procedures, and skills.
Linehan’s primary treatment manual (Linehan, M.M., Cognitive and Behavioral
Treatment of Borderline Personality Disorder, New York: Guilford Press, 1993)
is thick, tedious, and technical. How could family members with no training in
mental health treatments be expected to learn DBT, let alone use it well?
Furthermore, was it even ethical for them to do so? Over time, I discovered how
naïve and wrong I was. I learned that in fact the most ethical and effective
approach to treatment is, when possible, to actively engage families who seek to
help in the treatment. Indeed, few others will go the distance as will family
members of those with BPD.
The contents of this book have their roots in that DBT intensive. Valerie’s
team returned to the second part of the DBT Intensive Training having
established TARA’s first DBT psychoeducational program for family members.
Through her tireless actions and her commitment to rigorous scientific research
and evidence-based therapies, she has the ear of the scientific community and
has helped those who treat BPD to understand the rightful place of family
members in treatment. As she has told me and other treatment professionals on
many occasions, while we therapists can go home at night and observe our limits
with respect to responding to our clients’ crises, family members of individuals
with BPD are never off duty. My time with a particular patient is limited to an
hour or two a week, whereas a family member’s contact may fill the remaining
hours, to care for and coach in more effective ways of responding.
You arrive on this scene at a very exciting time, as many advancements
have been made in the understanding and treatment of BPD over the past two
decades. BPD is no longer the life sentence it once was. Those who receive an
evidence-based therapy can expect very positive outcomes, including full
remission from the disorder. There are now several manualized and empirically
supported psychosocial therapies for BPD, including DBT and mentalization, the
two therapies described within these chapters. Valerie’s emphasis on DBT is
rightly placed, as it is the treatment most rigorously researched to date.
Currently, there are over ten published randomized controlled trials conducted by
