The person who is traumatized needs to be met with the fact that everything inside him or her is there for a reason, and that everything also needs to be seen and understood. It is not enough to try to urge the person to "get along." 

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This is an important message from psychologist Arne Blindheim in the magazine Sykepleien about how people with emotionally unstable personality disorder, also called borderline personality disorder, can best get help.  

The background for his post is that nurse Kathrine Benedicte Larsen recently spoke out in favor of pushing such patients out of the "victim role", while psychologist Blindheim criticizes this approach for lacking depth. In this post we will reproduce some of what the psychologist writes in his post.

 

Long-term relationship trauma

In short, his message is that traumatized people need help to relate to their whole being. This applies to both the need for closeness and care, but also the need to keep appropriate and healthy distance from others.

Arne Blindheim writes: 

It is quite well known ... that the vast majority of people who receive the diagnosis (i.e. borderline personality disorder) have been exposed to extensive traumatic experiences growing up, in the form of sexual abuse, violence and neglect.

The usual dynamic that develops with such experiences is that one gets an inner fragmented world, where a part of oneself tries to pretend like nothing when one is unable to take the painful reality into oneself, and tries to focus on daily tasks.

This side of the person can easily become quite flattened with little contact with emotions and body, as this easily triggers contact with the pain that one has inside. However, one fails to get the hurt inside out. This is needed, and can in some cases come out as a part of itself that is small and helpless, and carries pain.

Showing up as small and helpless can, for example, take the form of the person suddenly appearing as if he / she is a small child. Some people speak with a childish voice, some people experience that they are four years old every now and then, and in general the behavior can seem very special. This phenomenon is often referred to as "regression", and occurs not infrequently among patients with borderline personality disorder.

 

One person - three parts

It is important to point out that regression of this type is not a spectacle. An important theory in psychology is that the traumatized person has an ongoing conflict in the psyche, where one alternates between three different "modes", or parts of the personality - which virtually fight to be the one who gets to express themselves: 

 

  1. The vulnerable part: That is, the part of you that feels the painful experiences, that is as small and vulnerable as a child, and that wants comfort, help and understanding.

  2. The daily life part: This part pretends in a way that everything is fine, downplays and makes the terrible events unreal, in order to be able to manage the daily life and not have to take on all the difficult things. In order to be able to do this, it must also push away a lot of emotions, especially negative emotions, and can therefore experience being quite emotionally flattened, and also being afraid of emotions.

  3. The controlling part: That is, the part of you who try to stay in control and who is in strong conflict with the vulnerable part. In a way, this part hates and harasses the part of you who feels difficult emotions.

This may sound a little strange, but it has its reasons. To be functioning across these structurally dissociated layers becomes a way of surviving when circumstances are very precarious.

It thus begins as a survival mechanism through childhood. In adulthood this strategy is no longer needed, and what was previously a "solution", now becomes the problem itself.

 

The painful and difficult are neglected

An important point in Arne Blindheim's post is that many who work closely with people with borderline personality disorder are preoccupied with avoiding to encourage the vulnerable part of these patients. 

Actually, he suggests that his preoccupation is a main message in Larsen's article mentioned at the beginning of this post (i.e., in an attempt to push the indivual out of the so called "victim role"). 

Blindheim points out that this will be a very inadequate way of trying to help the patient. He demonstrates this by referring to two other traps that are easy to fall into. He writes:

Another trap is to ally with the daily life part of the person, something I have the impression of easily becoming an option for the staff, and which I also perceive that parts of mental health care encourage. In practice, this means that one focuses on the here and now, often trying to medicate away the restlessness and emotions in the person, or encourage them to ignore the hurt.

In this way, the person and staff may do the same as the early caregivers: one neglects the hurt, and along with it the injured child.

He adds that a third trap is that one allies oneself with the controlling part of the person - that is, the part of the person who "hates" the vulnerable part of the personality, and who does not want to admit the difficult feelings at all.

This implies that one rejects the person's need for help, and rather gives signals that express that one must "get along". One expresses negative statements toward the person, including that he/she "manipulates", is only "craving for attention", and the like.

The result is again a rejection of the vulnerable and hurtful in the person.

 

To help "the whole person"

Arne Blindheim concludes that traumatized people need help to relate to their whole being, which is achieved by therapists and staff helping one to understand that everything inside the person is there for a reason and that everything also needs to be seen and understood.

- In this way, the person can be helped to function as a whole, where there is both room for time to take care of daily life, as well as time for vulnerability and the pain that has occurred, and with a balance between closeness and distance to other human beings.

- This is extensive work both for the person themselves and those around, and requires that you get the time and resources needed. If one is to manage this, one is dependent on the people around you understanding this dynamic, as well as accepting and respecting the whole person with natural needs and reactions based on what one has experienced, he adds.

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Written by

ove heradstveit

Ove Heradstveit

Psychologist, specialist in clinical community psychology. PhD.
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