So I think it's a historical term. And what happened was that there was a group of patients on psychiatric units that at some times appeared psychotic. I mean, they seemed what people would call crazy hearing voices, very agitated, dysregulated acting bizarrely, and at other times just look like the worried well, like anxious people who seemed worried about certain things. And they weren't quite psychotic all the time, like the schizophrenic patient. But they also weren't quite as worried as through the so called worried while the anxious people, they seem to straddle that borderline between these two conditions.
And it was hard to tell when they were going to be in one camp or another because they seem to switch back and forth. And so because they didn't fit neatly into this category, the term borderline came up.
The research is very positive on borderline personality disorder, it's considered a good prognosis, diagnosis that the natural course of borderline personality disorder when it's not complicated by things like trauma and substance abuse and things like that, is that the vast majority of people will get better, that means that they won't meet the criteria.
On the other hand, they may have difficulty in relationships and finding jobs, but their ability to regulate their emotions might improve over time. That's That, to me was never good enough. That we wanted an ability to have much richer, much more fulfilling lives. And Dr. Linehan's idea of dialectical behavior therapy with developing a life worth living, authentically having a life worth living, was really the task.
And this is where we started to drill down on some of her treatment in terms of DBT.
And really realized how core mindfulness was to developing this life with, we're working with much younger kids, I mean, hers were all adult patients, we're working with much younger kids, and we're seeing much more optimistic outcomes.
At this point, no other psychiatric disorder is going to give you 80% remission and six years, nothing else. So that in and of itself is already a better outcome. So it's not so much just abandonment, and I think that most of us would fear abandonment from the people that we love and care for and serve, there's nothing wrong with abandon fear of abandonment, per se, it's not so much the fear of abandonment is the extreme reactions to fearing that abandonment.
Now, the problem with people with borderline personality disorder is that they at times, can fear abandonment, even when it's not there. And then they act as if the abandonment were real. So for instance, let's say a person doesn't return a phone call or shows up home late, then this idea that pops into the person's mind that, Oh, my God, they don't like me, they don't care about me, they must be seeing somebody else, they're going to leave me. And it could have been that they were stuck in traffic or that their phone had died, or whatever it is, and then acting as if it is a true thing. And then asserts that not only the fear of abandonment, but it's fear of either real or imagined abandonment. And then it's those frantic efforts.
And that often becomes relationship, destroying, because then they start incessantly texting or calling or begging, and those sorts of things. And it's very confusing to the other person, because they say, I had no intention of banding here. I don't even know what you're talking about. And you're behaving in these ways. And that can be very off putting, so it's that cleaning nature, that becomes problematic, and relationship destroying. Yeah, I mean, I think then what tends to happen is, is that in the context of feeling pretty good. It's almost like a mood dependent relationship in the context of feeling good, then I really care about you and I feel cared for by you.
And you're the best person you're central to my existence into my well being. But then when I'm feeling a little bit upset, or dysregulated, and I'm not liking you all that much, all of a sudden, that essence is just taken away and then I you know, can rapidly turn on the person who I cared about so much is because that feeling has suddenly gone and that connectedness is gone and To the person on the receiving end of the relationship who may not be as emotionally intense.
It's very, very confusing because all of a sudden, you know what, yesterday, we were the best of friends, the best of lovers, the best of parent, children, whatever it was, and all of a sudden, this awful, terrible person that you hate, and you want to get rid of, and all of these sorts of things. And then the person might say some pretty mean and horrible things in those contexts, and that becomes hurtful to the person doesn't know what's going on. And eventually, that very behavior leads the person to say, I can't do this anymore, I want to leave, which then triggers the fear of abandonment. So there's, so these things are all tied in, together.
And this idea of really paying attention to wait a second, the same person that you're hating is the same person that you loved yesterday that you know that these are just qualities in all of us. And sometimes we get it wrong, sometimes we get it right but to hold someone in a much steadier point of view than seeing them in these extremes of like, tremendousness, wonderfulness and terribleness.
So, for people with borderline personality disorder, one of the theories is that developmentally as they as they grow up, there's something about their environment that doesn't reflect back to them, what their experience is, and, and when that happens, very difficult to know what your own values are, what your emotions are. And so you're always looking to the outside to try to say, who you are and how to be. And so many of these young people, certainly what we see is that they take on the train to do your the emotions, do your or whatever it is. Now, a lot of people say, well, that's just normal adolescence, because our lessons are constantly changing their values.
But that is developmentally normal for typically developing adolescence. But for people with borderline personality disorder, is this desperate need to find an identity? And it is just it's very unsettling for them because they just don't know where exactly to land. And if you say, Who are you tell me about yourself? Where are your endearing traits?
What are your enduring wishes and all of that? It's it, it causes them to flounder and to be very unsettled. Because they can't really answer that question. And then this sort of need to fit in, comes in. So where's it at one time settled, typically developing our lesson for a person with borderline personality disorder, to very unsettling experience, I think that as with anything, we're talking about, disorder, that has a range of severity, that's not really necessarily reflected in the DSM, in terms of like severe borderline personality disorder, or mild, it'll be the same as anything else, diabetes, mild, moderate, severe, asthma, all of these sorts of things.
So I think that somebody who has very severe borderline personality disorder, what we see is constantly changing values, constantly changing employment, you know, getting pissed off at the boss easily and then saying, you know, I'm done.
Changing relationships, and, and changing belief systems, and all of that sort of thing. But I think a lot of people with with more stable borderline personality disorder can are very employable and can stay at a job, it's just when that becomes much more severe.
These impulsive behaviors, as described, are typically in the context of impulsive behaviors that are potentially dangerous to the person who does it. And so, so, you know, adolescents might be impulsive in the sense that they, you know, might sneak out at night or have a beer when they shouldn't be having and, and those sorts of things and maybe those things are just developmentally more normal. in people with borderline personality disorder, there's an extreme of impulsivity. so dangerous driving, dangerous sexual encounters, dangerous drug use.
So there's an extremeness to to these impulsive behaviors. And often these impulsive behaviors are not out of developmental curiosity, oh, I wonder what it would be like to have sex or or use this drive or whatever it is. But it's often an attempt to regulate how they're feeling in the moment. So when you're feeling abandoned, sometimes having you know, sex with a stranger might be nothing to do with having the sex but wanting to be close to someone. But in order to do that, it might be having sex or not that they're necessarily interested in how they, you know, alcohol or or the drug, but that they like how it changes their own emotional experience.
So often, the function of the behavior is very empowering. To look at, and it's also just how extreme those behaviors can, can get. It's often as with any impulsive behavior is not so much that they're not thinking about consequences most of most of our lives we live pretty mindlessly. In any case, we often decide that something's impulsive when it works out badly.
Rather, and, you know, we're often asked the question, what's the difference between impulsivity and spontaneity, often we make that distinction based on outcome. You know, because somebody who's spontaneous was, you know, go and do this. It has this quality that it happens much more quickly. And a lot of the thinking about the consequences come in the aftermath of whatever's happened. But in that moment of desperation, the need to change how they feel, makes it whatever the behavior is feel like the right thing to do.
One of the tragic statistics is that it really is a very lethal condition, and that in historical populations, one of the data points that we had was that in people who required hospitalization, about 10% of people with borderline personality would kill themselves. And so, so when a person with borderline personality disorder says that they're suicidal, it is imperative that the mental health professional or the family member, take them absolutely seriously.
And a close cousin to suicidal behavior is self injurious behavior. And I know that when I was trained as a doctor, a lot of people would come in with self injury. And they'd often be left to be the last people in the emergency room to be treated, because it was considered to be manipulative, attention seeking, quote, unquote, a cry for help.
And it turns out that research shows that that's rarely the case. And I remember a case once of a parent who said that their child had been cutting because they were looking for attention.
And I said to the kid, how long have you been cutting for? And she said, for about two years. And I said to the parent, where did you find out and they said, We found out last month, I said, that's the most terrible attention seeking behavior I've ever seen that it took two years to find out.
And because it rarely has that function, most often the function is to remove intense psychological pain.
And if you can put yourself in the position of somebody who would prefer to self injure through cutting or one of these other behaviors, than to deal with intense psychological pain, it begins to give you an idea of how much psychological pain they must be in that this feels better than that. Because I can't imagine cutting myself or if I do, I cringe at the idea.
But to be in that much pain, that that's what you would do was mean, how awful really is a reflection of how awful it is for people with borderline personality disorder.
I think a lot of people who come in have been incorrectly diagnosed with something called bipolar disorder.
And what we know about bipolar disorder is that it's a condition where people have mood states that are enduring for periods of time, maybe a week or two weeks or even or even longer.
What's distinct about people with borderline personality disorder is that their mood states tend to be much briefer, sometimes minutes, sometimes hours, rarely longer than a day.
And they tend to be reactive in nature. So they tend to be precipitated by something that's happening either interpersonally between me and the end, somebody else, some experience that activates my emotional system, or something interpersonal, which is a way I think about myself, that triggers an emotional response.
And that emotional response tends to be very quick, and tends to be very intense.
And, and then when they have that intense emotional response, they tend to take longer to get back down to their baseline. But because they take longer to get down to their baseline, what can happen is, is that if something else happens, there it goes again, there goes that emotional intensity. And all too often it can lead to other saying, you know, what the heck, you know, the other person didn't call you or so what you got to be it was just a small test or whatever it is.
And it just leads people to feel first of all misunderstood. But then Others don't understand why they've had these huge reactions.
People used to think about it as sort of boredom and emptiness that was like a tedium with his life. But when we looked at it from a research perspective, there's this quality of aloneness. So that even though they're surrounded by people, they consider friends and that friends consider them to be friends. It's the sense that their experience is so different, that they're not really understood.
Imagine being a person who gets dropped into a village in a foreign land, they don't speak your language, they don't need your food, they don't understand your experiences. They will, how can you be alone? But you're alone, because you're not understood, culturally, contextually, philosophically, emotionally, and all of these sorts of things.
And so so it's that kind of an experience, because your emotional experience is so intense, because your activity is so much. How do you explain that to someone, and it's a misunderstanding, a lack of connectedness along along those ways. I think it's not only uncontrollable anger, I think it's generally uncontrollable emotions. Typically, that kind of anger is what we would now call a secondary emotion and a secondary emotion is an emotional response to an emotion.
Often, what we find is that these kids are really sad.
Maybe they're feeling guilty and shame, but those emotions are intolerable. And so what they tend to do is lash out instead. Sometimes they are angry not to say that anger doesn't exist, but it's much more complicated than just anger. And again, anger is certainly what gets people's attention, because there's yelling or screaming or fighting, and when somebody is feeling shame, that typically doesn't get to the conditions, you know, rooms, but anger does, because teachers, co workers, parents complain about, you know, this, this, this rage and, and often it seems to be precipitated by the smallest of things.
But if you think about someone with a peanut allergy, a single peanut can precipitate a massive reaction to the person with a peanut allergy. Whereas to someone who doesn't have it, they'll eat a peanut and nothing happens to them. So that's that kind of experience. Sadly, many people with borderline personality disorder have also experienced tremendous traumas in their life, either as a consequence of borderline personality disorder, in the sense that perhaps, out of desperation to be with someone they've gotten with the wrong people, and then experienced a trauma physical, emotional, sexual traumas. Or, or they experience these traumas, because they're very sensitive, and then they use behaviors consistent with borderline personality disorder in order to try to regulate those emotions.
Sometimes it's a chicken and egg problem, but that you often see, and certainly in our research, with people with severe borderline personality disorder, that somewhere between 30 and 50%, have had definable traumas.
And in the context of that, we see some trauma symptoms like dissociation, a disconnection of their experience, from their own reality, and they can it can feel as if the world isn't real, or that they can, they might not feel real. And the paranoia often has this quality of sort of attribution of people's intentionality, you know, kind of, Oh, I can tell that you don't like me or something along those lines.
And like with many of the symptoms, these things tend to be transient. And often during moments of high emotionality, but then when it begins to settle, it seems to dissipate. So it's not an enduring paranoia as in schizophrenia, or paranoid personality disorders.
It's not in it's not in the DSM, yet one of the things that one of the criteria one of the symptoms that I see and many people who have difficult to treat borderline personality disorder is intense, self loathing and self hatred, and, and a belief that no one could possibly love them. I remember having a group once with kids really liked each other, all of them believed they could not be outside.
Well, how can this very interesting paradox exist? That you all say that you're unlovable and you love everybody else in this room? So what's happening here in this It's it's, it's so entrenched that it doesn't, they can't even label it as a thought or as an experience.
It's not, I think that I am unlovable I am it I am, I am a hateful person in the same sense that they would say I am a woman. So it is it is fused with their identity. And it's much more difficult to treat than a lot of the externally obvious behaviors like self injury, or drinking or something like that. It's sort of undoing years and years of self assessment and self reflection and self labeling, to try to get them to not believe that anymore. Again, judgment, as with abandonment, as with intense relationships, are all part of can be part of a normal life. And so that, so it's not so much that we don't judge ourselves that we might not judge other people.
Again, it has to do with the extremeness, with which this happens, so that there's a self description that makes them intolerable to themselves. I'm a terrible person, other people are going to hate me in those sorts of things. And what's interesting is that with borderline personality disorder are often wonderful pet owners, they don't feel judged by their pets.
They don't feel judged by very young children, they often can be quite compassionate. But the minute a person is someone that has opinions and thoughts, and those start to be reflected in conversation, they can begin to feel judged by them, even when there is no intention to to judge on a completely different matters sort of interesting, there was some research that was being done in, in veterans with, with trauma in anxiety disorders. And they were using a program that had an avatar attached to it. So there was this avatar face on the computer screen. And people thought this could be ridiculous, because not a real person.
But it turned out that it was not only as effective, and perhaps even more than a psychotherapist. And when they were asked why he No, it's a computer program. Why is it more effective, they said, because we knew it was a computer program, we knew we're not being judged.
And so this idea of in terms of theory of mind of imagining what another person is thinking of you, which can sometimes be a projection of your own thoughts onto somebody else, or, alternatively, something that you've heard, for such a long time by a parent, by a co worker, by kids at school who bully, that you are awful, and ugly, and terrible, and out of control.
And all of these things become self constructs that then, you know, perpetuate and endure.
Historically, you know, we talked about the genesis of borderline personality disorder that people were either, you know, appeared psychotic, or they appear neurotic.
And so what would happen is that they were very, very confusing to psychotherapists. And back in the day, medications didn't seem to be doing anything. Not that there seem to be doing anything today, per se. But the the treatment of the day was psychoanalysis. And we are pretty clear that traditional psychoanalysis did not work. And so therapies to end what because they didn't work.
They often became patients that therapists did not want to treat, because otherwise they'd have this group of patients who just weren't getting better, or they would seem to be getting better, but then fall apart and all of that so, so there weren't effective treatments. in contemporary times, there are lots of new treatments.
There is dialectical behavioral therapy, cognitive behavioral therapy, mentalizing based therapy, transference focused psychotherapy, schema therapy, cognitive analytic therapy, protocols called steps. So all these new therapies, and they're being studied. The one I like most certainly is dialectical behavior therapy, because I think it's got the most research and most evidence base, but even dialectical behavioral therapy. Churchill said about democracy, it's the worst form of government but for all the rest. It's the same with DBT is the worst form of therapy except for all the rest so that it really does help but there's a group of people who don't seem to benefit from from it.
And then certainly the question of, you know, do you switch therapies are not and a lot of that is being researched in the same way that maybe one medication works for one person and another one doesn't, or one antibiotic works for one person and another one doesn't. So are there characteristics of people for whom one form of therapy is going to work and not other other people.
And so I think that if I had a child who had borderline personality disorder, I would certainly want them to start in dialectical behavior therapy, just because the evidence for a lot of the behaviors that we've been talking about is the most robust. But having said that, there are, for instance, another form of therapy that I really like tremendously is called MBT mentalizing based therapy. And that has also a robust research base to it. Not so much. in adolescence, I typically work mostly with adolescents.
And I think that the research is best for DBT, and adolescence. But, you know, it doesn't address all of the problems of borderline personality disorder. And I think that we can learn a lot from some of these other treatments. Another question that some have asked is, well, if MBT works, and DBT works, and you just put them together into a new form of treatment, and there's no evidence that putting to evidence based treatments together will create an evidence based treatment.
Although it's possible that it might. So that's a very important question. I think that one of the things that we find out is that the average tenure of DBT therapists is about three years.
And it seems to be a function of two different things.
One is burnout. And that is that working with self destructive self injurious suicidal people with emotion regulation, problems, who are potentially going to idealize and devalue, over time can take its toll, especially if you're working alone in the community, with with very little support. So, so one thing is burnout. And you know, you want to have a system of care, that's going to support the therapist, as well.
The other thing is that, unless you're in an environment that is going to continue to reinforce learning and continue to teach, it's easy to start to forget some of the techniques that you've learned or think about how to apply them in context.
So I think that having an ongoing practices is critical to being able to maintain good DBT treatment, as well as having a group of people who are going to be able to help you out. I think that it's very, very difficult to treat something without awareness. I mean, imagine that you go to your physician, and you say, there's something wrong with me. And they said, What is it that's wrong with you? Is it white, and I just don't feel very well. Without a more accurate description. You know, who knows who knows what the treatment is that you're going to be, they might be giving you something that's going to help, hopefully, they might be giving you something that's going to do nothing, but they might be giving you something that's going to make the situation worse.
So in order for you to drill down on what it is, you'd say, Well, you know, I think it's in my stomach.
Okay, well, now we've isolated the organ, and what is it that you feel I feel like a burning sensation is okay, well, now we're thinking, well, maybe it's an ulcer or something like that, we can do some tests for it, you can you begin to drill down by being more descriptive of what it is that's going down, or what's going on, at any given point.
And without that awareness, it's very difficult to for the person to notice, you know, what was happening to them, but to be able to describe, well, for the physician to then or for the trader to be able to say, Well, this is what we're going to do. So if somebody, somebody with with borderline personality disorder comes in, and they don't know, what their own emotional experiences, what their urges are, how they got to do, the behaviors that they did, all that's going to happen is that people might put them on medications that they don't need, or provide treatments that don't necessarily help. And so this idea of mindfulness is twofold one for the patient, to be able to really drill down on what is actually happening to me, right now.
Now, it's almost antithetical to thinking about borderline personality disorder, because people with borderline personality disorder can have so much dysregulation, but as we talked about earlier, these are episodic moments.
And so this idea of being able to catch them as they arise these dysregulations, this upsetness much earlier on is going to be very important. And then for the clinician, who practices mindfulness to see Their patient in love to see them as a human being who is suffering with compassion, and then to be able to sit there and treat without judgment, it's just a wonderful thing.
It's a wonderful experience for the clinician, and it's a wonderful experience for, for the patient. And then you can also get them to do things that they don't want to do necessarily, because you're doing it out of out of compassion.
And it's much easier to get someone to do something that they might not want to do when you know that they care about you. And that, you know, fundamentally, they're doing it out of your best interest. You know, you don't necessarily need a therapist or surgeon, you don't need a bad therapist, you know, and a person who can really work with deep understanding of this of this condition, of course, is going to be helpful. But not everybody has the luxury of being able to have a therapist and, and so people who might not have extreme borderline personality disorder, but who recognize some of the traits of emotion dysregulation of some upsetness in relationships, but not anything that would trigger psychiatric hospital or need for therapeutic intervention.
Once you can start paying attention to what is happening to you the habitual nature of your mind, how the mind goes into autopilot, mindless repetition of behaviors, say, Oh, well, then I'm doing that thing again, then you've got the choice of turning left or turning right.
But if you've always turned right, you might think that's the only option I have, or go straight or go up or go down one of these things, because now you're doing it with awareness, you still might make that same choice. The difference is that you're doing it with awareness. Now you know that you're doing it.
For many people who have been traumatized, this idea of taking yourself out of yourself can feel a lot like dissociation, that what I disconnect all the time is it's not so much that it's observing yourself in action, as if you were your own observer, sometimes with people with trauma, this this. The problem is that by observing that, in quiet states, it allows for very intrusive memories and flashbacks and very difficult experiences. So you have to modify how the mindfulness is, is practiced, because it's it, it can be tremendously useful for many of us. And for people with borderline personality disorder, not to be able to have the capacity for self reflection and self awareness, to be your own observer.
But for some people who've had terribly intrusive memories, and very painful ones, that action can, can be, can scare them from mindfulness. And so the idea in that context, is simply to observe something else to see the quality of paying attention.
When you're drinking a cup of tea, you can just be sipping on it while you're talking to me, or you can just drink a cup of tea. Well, what if you were to think about it this way?
Let's just say that you had a terrible toothache. And and what I said to you is, well, what are you going to do about it?
So you said, Well, you know what, I was prescribed a very powerful painkiller, some time ago, wanted me to take that, sorry, I have to experience the toothache anymore. Is it okay to take this, or you can say, you know what, I know that if I go and run or do something else go into your movie there, I'll be able to distract from it, I don't have to pay attention to that, what then happens is, is that in the long run, all that's happening in that process of this toothache is that the tooth is getting more and more rotten, the hole is getting better. And eventually, you know, you're going to have this jaw that's infected. And you know, it could get really, really bad.
And so avoiding dealing with it through some distraction, taking medication, some other short term way means that you aren't going to get that tooth out. And so by not distracting by paying attention to that tooth, you say, wow, there's something happening with my tooth, I can pay attention to it, and say, you know, well, now I need to do and go and do something active like go and get it, get it removed, for instance. But you're not going to do that if what you're doing is constantly avoiding paying attention to it. And or, let us imagine this, you walk into your bedroom, and you hear this noise. You know what it is, but it scares the living daylights out of you.
And so you sit there frozen or you run out of your room, that what the better thing to do would be if your room is dark, is to turn on the light What happens when you turn on the night? Well, then maybe there is something terrifying in there. And then running away or doing something is is justified. But you might remember, oh, we bought a pet puppy the other day, and it was just wrestling around on the carpet and, and it's okay, nothing to be frightened about.
And so by turning on the light, you're shining awareness on what is. And so mindfulness has this quality of shining the light, on an experience, something that is causing emotional upsetness, that is causing suffering, and that by doing so, it gives you more information about what you can then do after this.
For people with borderline personality disorder, the problem is, is that they either avoid experiencing that, and avoidance is putting the lid on the boiling pot of water, it gets worse, or they do behaviors that make their situation worse, and then continue to suffer.
So for example, if they self injure, and then they feel guilty about that, and shame about that. And then they're suffering even more. So both of those situations, either expressing some behavior or repressing some experience leads to more suffering.
What we know, in research studies is that, that it appears to be about 60%, genetic and 40% environmental, and why would this be?
What is it that you're inheriting from a parent. And so what you might be inheriting is the genes for emotional sensitivity, the genes for impulsivity, the genes for a certain way of thinking, and that when paired with certain environmental stressors, including trauma and other things, then activate the full disorder. So sometimes you can actually see it coming down in generations, where it's, you know, grandmother, to mother to child, sometimes along the male line, but they're not always, certainly Linda had didn't focus so much in terms of the evolution of dialectical behavior therapy into what percentage was genetic, and what percentage of it was environmental in the sense that both influence, and it is the transactional nature of the environment and the genes that lead to the disorder.
But in more, with more empirical evidence or more empirical research, it shows us about 60%. In terms of impairmanent, one way to sort of think about it is imagine a cube of ice, and you are sitting in a very cold room that is below freezing, and that cube of ice to stays the way that it is.
And then you walk outside, you change the environment. And you move that cube of ice over his hot surface, and very rapidly changes not only to water, but it changes to steam, and other things like that. And, but where has all that gone, it's gone. It's changed in its nature, but all those molecules and atoms remain and persist. And this is happening all the time, in all of nature, that things are constantly changing. Atoms are spinning, and electrons are spinning, and molecules are forming and reforming.
And so that when we think about a thought, the same thing is happening with thought, why do they feel so permanent. And Einstein had had a thought about this. And he said, you know, your hand, in the hand of a pretty girl for an hour feels like a minute, but your hand on his hot stove for a minute feels like an hour. And so that when a thought is paired with a very painful emotion, it can feel like an eternity.
And so often with people with borderline personality disorder, they seem to be unable to tell a story linearly. Because they're not seeing it through the lens of time, they're seeing it through the lens of emotions.
And so what might have seemed like 10 minutes to you, to somebody who's emotionally intense might seem a lot longer, and, but everything will change, it will change and it's knowing that that can be very helpful.
Now, if you've got borderline personality disorder, it can be tricky, because what they'll say back to us, well, then, you know, I felt happy yesterday for five minutes.
But I know that that's going to change because you're telling me about change. And so that's also true.
And it's the idea of then just being to be present, because this moment, neither has the beginning nor an end is just This moment, so just be in that moment. And it does get tricky. The other the other idea that is very important is that emotions, if you look at them at a neurobiological level lasts for 10 to 20 seconds. And you can see this in an infant. It's very, very quick, you can see them get angry, then you distract them, and then they're happy. And then you steal their ball and they get angry again, and it's you know, you can see how quick it works in the brain.
So why do they stick for so long, the sticks are so long, because they're they're tied to strong emotions. And it's uncoupling that with it will allow the emotion, the thought and the emotion to pass on. I'm often asked the question about why I like to work with people with borderline personality disorder, when so many people get burned out in this field.
And I find that for me that they're the most the most inspirational people that I have ever met. And the reason is that most of us, don't examine why we live. But thinking about why you want to kill yourself forces you to examine, why why live and it can be in speaking to someone with borderline personality disorder. And in your face, real time Reality Check about the things that you hold important and have value. And so I consider myself blessed to certainly in working with other people with borderline personality disorder, because they challenge me to bring out the very best of myself in relationship to them. And so what I think about is this, no other group of people can get me to think in this way than people with borderline personality disorder. And why is that? Why is that the case? I mean, why am I so inspired by them, and it's this overcoming of adversity, time and time and time again, and so on. So, I think these are these incredible people who don't even see it in themselves.
And if they can get to see how wonderful they are, that they are not second class citizens, that they've labeled themselves that way, maybe because of things that have happened in their past, but that there's greatness within them as there's greatness within all of us, that there is essential to the universe as any one of us is.
Because without them and without us, the universe is not the same universe, the universe cannot be the same universe without either either one of us. And so once they can see their own essential goodness, which is within all of them, then what we see his magnificent change and magnificent contribution to society. And this idea of bringing mindful awareness to this essential goodness, and really turning on its head, the messages that society and a lot of their early upbringing may have given them and see someone flourish is beyond exceptional not only for the therapists but for them as well.
