I work with people diagnosed with Borderline Personality Disorder (BPD) within a team in which we apply Dialectical-Behavioral Therapy (DBT), which is one of the treatments with the greatest empirical support for this pathology. .
These people generally come to the office quite sad and hopeless because previous treatments have failed. Part of that discomfort arises from the fact that the people around them often maintain that they are manipulative. It hurts them because they experience it as something inaccurate, because they feel that it does not speak about them.
In workshops and interviews with family and friends, the assertion of manipulation is frequently heard. For people who live near the person affected with BPD this can be very common, since certain elements of their daily life experience with these people can lead them to this conclusion if they confuse the effect that these people’s behaviors have on them. with their intention. Effect and intentionality of a behavior are not synonymous and the methods of functional analysis of behavior give a good account of this. But we will move in this direction a little later. What is surprising, perhaps, is that some mental health professionals also support the manipulation hypothesis with respect to borderline patients.
The working hypotheses that professionals hold regarding a patient have a strong influence on the person who suffers. This is the voice of an expert and what he has to say will be taken seriously. If it is the same professional who supports the manipulation hypothesis, these people are trapped in the double experience of receiving an interpretation of their own behavior whose intention was different – no one knows more about the intention of a behavior than their own agent. A weighty interpretation that ends up confusing them even more about who they are and their own identity – a delicate topic for people who suffer from BPD.
Manipulation vs Operant Behavior
The myth that people who make suicidal attempts and threats or self-harming behavior are manipulative is false. It is a very common mistake that increases the stigma of these people and constitutes an obstacle for family and friends, and also for therapists, who could be of support; It distances them from empathetic, assertive and warm responses. Maintaining this myth takes away the desire to help, to put it in simple terms.
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You might think it’s counterintuitive to maintain that suicidal threats are not manipulative. However, to begin with, it is very important that we understand the differences between the emotions associated with suicidal behavior, the suicide attempt, and the factors that reinforce said behavior. If you don’t have much knowledge about operant conditioning, you can think of reinforcement as a consequence of a behavior that causes that behavior to increase in the future – or be repeated – because it is in some way pleasant or relieving; Reducing emotional pain, affection, attention, offering something the person wants or stopping something unpleasant for the person can be reinforcements after suicidal behavior.
Marsha Linehan, creator of DBT, says that “the problems of people with BPD are twofold. On the one hand, they usually have deficits in interpersonal skills, emotional regulation, and tolerance for discomfort. On the other hand, environmental factors block coping skills and interfere with the self-regulation skills that the person has: in general this blockage occurs through giving reinforcements to patterns of problematic behavior and punishments to healthy and improving behaviors (Linehan , 1997).
The suicidal and parasuicidal behaviors of people with BPD usually fulfill functions of emotional regulation and environmental regulation. Many of these behaviors are reinforced by emotional relief (negative reinforcement) and by obtaining attention and warmth from important people in the person’s environment (positive reinforcement). Given these conditions, it is expected that they will be reiterated in the future, until better ways to obtain the desired results are known.
The fundamental thing to highlight is that operant learning processes take place outside of consciousness. People respond to reinforcements and aversives without being aware of it (Martin & Pear, 2008). While manipulation is a deliberate attempt to obtain a specific result, behaviors guided by reinforcing consequences are, in principle, non-deliberate and unconscious. Here is the big difference. Only a functional analysis of suicidal behavior will allow us to identify its function, what its triggers are and the consequences that maintain it.
Effect and Intent are not equivalent
To make sure we are referring to the same thing, let’s consider the definition of the word manipulate, which, according to the RAE, consists of “intervening with skillful and, at times, cunning means, in politics, in the market, in information, etc., with distortion of truth or justice, and at the service of particular interests.” Now let’s compare it with DBT’s definition of borderline problems, which maintains that these people commonly do not have good interpersonal skills. Something doesn’t add up here. Unfortunately, “the operant nature of suicidal and parasuicidal threats is often the most salient aspect for therapists working with borderline people. In this way, these behaviors are seen as manipulative. The basis for this statement is usually the therapist’s feeling of being manipulated (…). However, it is a logical error to assume that if a behavior has a certain effect, the agent of that behavior performed it to achieve that effect. Labeling suicidal behavior as “manipulative” in the absence of an adequate functional analysis of the intention of that behavior can have deleterious effects (Linehan, 1993).”
Basically, feeling manipulated (effect) does not mean being manipulated in the sense that it is the other’s intention to manipulate (intention).
Still, you might be wondering: why do I feel manipulated? There is a fairly simple explanation but it is usually useful: “When people worry about what happens to others, they do not want others to suffer, but at the same time they cannot prevent suffering from occurring; Thus, victims are likely to be blamed for their own suffering.” (Linehan, 1993). That is, when we cannot prevent someone we care about from suffering – because it is not in our power to do so – this causes suffering in us and to stop our suffering we tend to blame our loved one, generally without being aware of the function they have. blaming the other. We also often respond to inappropriate requests for help by offering what we were not willing to offer when the request was in the appropriate tone. Fear often makes us give in the worst circumstances what we denied before, that is, we end up reinforcing suicidal behavior instead of behaviors linked to life. The result is the feeling of being manipulated, without necessarily being that way in reality.
A possible path
The key to overcoming this is to cultivate mindfulness of our emotions and learn to separate facts from interpretations.
For family and friends of people with BPD: Remember to provide attention, care and affection when these are requested effectively and behaviors linked to life appear.
For therapists: It increases the capacity for compassion to assume that all patients want to get better and are doing the best they can. Don’t forget how difficult it is to live with the amount of suffering that comes with having BPD. Be curious about your own emotional reactions, they provide useful information, but do not attribute them directly to the patients’ intentions. They need less interpretation, more validation and better skills.
References
- Linehan, M. (1993). Cognitive-behavioral treatment of borderline personality disorder. New York: NY: Guilford Press.
- Linehan, M. (1997). Borderline personality disorder. The Journal of the California Alliance for the Mentally Ill, 8(1).
- Martin, G., & Pear, J. (2008). Behavior modification. Madrid: Pearson.
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