Being 'Flat' with BPD Clients

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Hi Kathi, I wrote to you awhile back thanking you for your insights to BPD and how it has helped me understand what is wrong with me. I follow your words very closely and feel that you are very wise in the matters of the treatment of this disorder. I want to support your feelings regarding the "Flat" method of treatment. I have been in hospital twice and have spent quite a few hours in talk therapy, unfortunately BPD has, as you know, a side effect that seems to prevent therapists from making contact with their patient. It seems to me that the biggest walls are up when working with therapists that;

a. Can not sympathize with me, or

b. are flat in their approach

These 2 issues are as bad as each other, anyone with this approach will never get through to a sufferer of BPD


UUUUUUUUUgh!! Kathi...what an ignorant individual!!! You are soo right...to provide a healthy, safe environment, is to "be" with the patient. Yes, one must know their own issues for transference/counter transference issues, but to deny the process and not experience with the patient, much would be missed and the patient would not really work, because most people have trauma issues--thus being paralleled by the non-receptive therapist! Sigh.


I'd like to add to this that when doctors are "flat" with me, I tend to assume they don't care about me and/or aren't taking me seriously, which tends to make me escalate my behavior and frequently get hysterical to try to make them listen to me. If they're being "flat" to avoid being pulled in emotionally, then this is surely exactly the behavior they are trying to avoid? I can't think of any worse behavior with people who worry about being abandoned or disliked.


Once, when I needed help the most, I was unlucky enough to get two therapists in a row who practiced "non-directive therapy." That is, they were as emotionally "flat" as possible, with as little interaction, as little humanity, as few comments as they could manage. I agree that this posture is harmful to the patient. I left both situations with lowered self-esteem than I entered. I also got the notion that therapists really couldn't (or wouldn't) help me. These therapists seemed not to be interested in me and seemed rejecting. I still needed help, but I went to the medical library instead and was a long time healing.

If a therapist cannot prevent being pulled into the bpd, then he should just not treat these patients until he can learn how to avoid that. He might, with care, tact, and compassion recommend another therapist to the patient. Also, do it early enough that the patient doesn't end the sessions on his own by just not showing up next time.