The book “I hate you, don’t leave me” is a widely known bestseller about Borderline Personality Disorder written by Jerold Kreisman and Hal Straus. It is a book that is written for both mental health professionals and patients and provides an understanding of this difficult disorder that by far exceeds the clinical diagnostic criteria.
Mr. Kreisman kindly agreed to give Psych2go an interview about some questions regarding complicated details about BPD. Hopefully, you can find some answers that help you.
Psych2go(P2g): Dr. Kreisman, thank you so much for agreeing to do this interview with us. Your book “I hate you, don’t leave me”, that you wrote together with your colleague Hal Straus, is widely known among therapists and patients. Why did you choose to become an expert for Borderline Personality Disorder (BPD)?
Jerry (J): During my training, the diagnosis was just being understood and defined. Many of my colleagues recognized these patients to be troublesome and avoided them. I found many of them to be intriguing and brave.
P2g: BPD is the most scientifically researched personality disorder. Much is known and yet, a lot is still confusing. Is there a question that has not been answered yet by research?
J: We are still trying to figure the nature/nurture configuration. I believe the next decades will uncover more genetic and biological information.
(Note: For more information on this topic, read Dr. Kreismans article on Psychology Today: https://www.psychologytoday.com/blog/i-hate-you-dont-leave-me/201408/nature-and-nurture-and-bpd)
Long-term studies demonstrate that over time the vast majority of patients get better
P2g: Therapists struggle to tell the Borderline patient their actual diagnosis. When you tell a patient, what are the reactions? What is a constructive way of coping with the first time you get this diagnosis?
J: Many experts recommend telling patients immediately. I prefer to be more circumspect, depending on the patient. Some benefit from learning as much as they can about their issues. But for many, it becomes a label that is discouraging or a badge that is passively accepted as a rationality for irrational behavior, without motivation to change.
P2g: BPD patients might feel that they will never get better. Could you explain the lifetime prognosis and prognosis during psychotherapy?
J: Long-term studies demonstrate that over time the vast majority of patients get better, most to a point where they no longer exhibit symptoms that would satisfy a formal diagnosis of BPD.
P2g: Families of BPD patients often are chaotic and have many conflicts. What does a BPD patient really need from partners and relatives?
J: Understanding and Perseverance. Staying patient and supportive during times of conflict. I am currently engaged with a new book (to be published next year) that enlarges on the SET-UP paradigm I describe in the first two books.
P2g: What can patients do to take control over their destructive impulses?
J: Recognize triggers that lead to destructive impulsivity. Find alternatives, such as exercise, meditating, etc.
P2g: How can a BPD patient suffering from a long-term wish to commit suicide work through this chronic suicidality?
J: Suicidal ideation can serve as a kind of distraction from trying to get better. Instead of trying to work on problems, it is tempting to justify avoiding the work by a kind of, “Oh well, I guess I’ll just kill myself.” Psychotherapy and, sometimes, medication can help motivate. Over time, suicidal thoughts usually subside.
P2g: In which ways can you experience splitting and how can a patient understand that he or she is splitting? What can a patient do to be able to tolerate “shades of gray”, instead of only black and white?
J: Splitting is recognized when the individual can see the extreme contradictory reactions to the same person or situation. Merging the positives with the flaws is a task all adults struggle with when they have evolved past the “good guys-bad-guys” dichotomies of childhood stories. In BPD it may take longer to get there.
Many individuals with BPD are extremely sensitive and empathetic to others.
P2g: BPD patients are regularly among our most loving, caring and sympathetic patients. How can they use those traits as resources? How can they use their sensitivity for other persons’ emotions to make interactions easier?
J: Many individuals with BPD are extremely sensitive and empathetic to others. But this sensitivity can result in misinterpretation. It is important to develop the fortitude to “check out” emotional impressions by confirming or denying these impressions.
P2g: “Sometimes I act crazy” is a book looking at the day-to-day-struggles in the lives of BPD-patients and giving practical tips to cope with problems. Is there another book you can recommend?
J: Over the last 20 years, many books have been published by those with BPD or those living with someone with the diagnosis. I think finding what is helpful is a personal choice. I recommend that people look through several books and pick out those that resonate with them.
P2g: The topic of BPD is wide. However, is there anything you wish I had asked?
J: I appreciate your understanding of BPD that is reflected in your questions. Responding to more questions would require a separate book!