![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 41 to 65 of 129. Go back in thread:
Posted by alexandra_k on January 5, 2006, at 16:48:18
In reply to please ignore my previous post » James K, posted by James K on January 5, 2006, at 15:31:10
((((((James K))))))
Posted by alexandra_k on January 5, 2006, at 16:48:58
In reply to Re: To Gabbi and alexandra, posted by Larry Hoover on January 4, 2006, at 22:31:57
Posted by alexandra_k on January 5, 2006, at 16:49:23
In reply to Re: (((((Larry)))))) (nm), posted by alexandra_k on January 5, 2006, at 16:48:58
Posted by alexandra_k on January 5, 2006, at 16:49:42
In reply to Re: (((((Deneb)))))) (nm), posted by alexandra_k on January 5, 2006, at 16:49:23
Posted by alexandra_k on January 5, 2006, at 16:50:09
In reply to Re: (((((Gabbi)))))) (nm), posted by alexandra_k on January 5, 2006, at 16:49:42
Posted by Emily Elizabeth on January 5, 2006, at 17:12:28
In reply to please ignore my previous post » James K, posted by James K on January 5, 2006, at 15:31:10
But I do think you made some good points and it came from a good place--you wanted Deneb to help herself so that she doesn't have to experience the pain that you (and your loved ones) have. Take care and please keep contributing...but get some sleep too.
Best,
EE> I should have been asleep. I don't feel I was appropriate in that post and I apologize.
>
> sorry,
>
> James K
Posted by Racer on January 5, 2006, at 17:22:40
In reply to Re: blocked for 6 weeks » Larry Hoover, posted by Dr. Bob on January 5, 2006, at 16:11:05
> > You manipulate them (in other words, you lie to them). You ... overdose on non-prescribed medication as a game.
>
> I'm sorry you don't feel well, but please don't jump to conclusions about others or post anything that could lead them to feel accused or put down. Even using their own words.This isn't to protest in any way, only to show you the perspective I had on that post: it looked like a Tough Love sort of thing, where Larry was showing Deneb another perspective on her own words, rather than using them to accuse her. Does that make sense? My brain hurts, and I'm not sure I am communicating well right now.
I read Larry's post as saying something kinda like "Deneb, when you say you're manipulating your pdoc, that's pretty much saying you're being dishonest with them -- lying to them."
Nope. Brain just don't want to start them communication centers today... Hope that made some sort of sense...
Posted by alexandra_k on January 5, 2006, at 18:42:06
In reply to I read it differently » Dr. Bob, posted by Racer on January 5, 2006, at 17:22:40
Hey. I do understand what you mean (at least I think I do..)
But I think problems with the 'tough love' approach have come up before (Chemist springs to mind...)
I think...
The trouble comes because...
A lot of the academic writing is not civil.
Academic papers write about people with BPD displaying...
Manipulative intent
Attention seeking behaviour
etc etc
And the trouble with those...
Is that they ARE judgements.
They attribute malevolent motivation / intent to the person.
They say that the person has that conscious intention and that it is that conscious intention that leads to their behaviour.But intent must be assessed... And not assumed...
And the trouble with assessing intent...
Is that oftentimes the person comes to see their own intentions in the way that others do.
They internalise their judgements.
They judge themself.
And ultimately... That is unhelpful.
Ultimately... That tends to lead to INCREASED distress and no reduction in the unhelpful behaviours.Deneb only started talking about 'manipulative intent' AFTER reading about BPD online...
I noticed that...
And while I appreciate that Larry was simply adopting Deneb's chosen words (and was not intending to judge her) the point is that Deneb was being uncivil to herself because she has started to internalise the uncivil judgements that exist in the psychological / psychiatric literature.
Those judgements...
Hurt me a great deal.
How can one internalise those and like oneself?
How can one internalise those and have any self respect?I struggled with those judgements... I struggled with my self image... I struggled with how I should view myself (in a way that was both true and helpful to me) for a number of years... And the thing that helped me the most with that... Was Linehan.
Those judgements come from counter-transference (in a clinical context).
When a clinician says 'that is a manipulative thing to do'...
That is the point where the little bell is rung in peer supervision to indicate that the clinician is viewing the client in a way that is doubly unhelpful.
Firstly, it is unhelpful because the client will only internalise that...
Secondly, it is unhelpful because the clinician is likely to feel very frustrated indeed if they view the clients behaviour in that way... And that typically results in... Lashing out at the client...Linehan counters this unhelpful dialectic by maintaining that people with BPD aren't more manipulative than people without BPD. In fact... If anything people with BPD need to learn to get BETTER at learning to manipulate other people. They need to learn behaviour that they can display that is more likely to facilitate helpful responses / helping behaviours from others.
Sorry... But this issue is a personal bug bear of mine...
I also think that one can post a 'tough love' kind of post that is within civility guidelines...I think...
I am getting fairly good at doing that?
(Just as one example...)
?
Linehan says that instead of saying 'that is a manipulative thing to do' what one really should say is 'I feel manipulated when you do that'. What that does... Is it distinguishes between the behaviour, and the clincians emotional response to that behaviour. It brings it to the clinicians attention that the manipulative bit is their own emotional response rather than anything intrinsic to the persons behaviour.
And that... Allows them to explore their own emotional response and come to see that other interpretations are possible...
Sometimes other interpretations can be tricky...
That is when one needs to walk away.
And hopefully...
SOmeone else is able to hit apon a non-judgemental one...
Posted by Gabbix2 on January 5, 2006, at 19:40:02
In reply to Re: Too afraid to get help » Gabbix2, posted by alexandra_k on January 5, 2006, at 16:47:31
>
> > I did not say he was being judgemental.
>
> I know you didn't say that or imply that at all. I guess I just wanted to clarify that to make sure Larry knew that we weren't accusing him of being judgemental (or thinking that he was being judgemental).
>
>I'm sorry, I thought afterwards that you were probably making a general comment.
> Hmm. Sometimes... Yeah, I hear you. But also... Sometimes there is a lesson in that too that if someone feels a little angry or frustrated then that is not the end of the world. They can feel a little angry or frustrated in response to your behaviour while AT THE VERY SAME TIME caring about you really very much.
>I honestly don't think one is better than the other. I know of some people who say they had their wake up call when someone basically said finally said "Look I've done what I can you're on your own"
I just know for me that was the worst thing anyone could have done.
> I think I hear what you are saying. Disgust... I guess thats my fear... That other people will express or be unable to conceal their disgust in response to me.
>Yeah.. definitely.
> I still want to come back to the flotation device analogy...
> Sure it helps to know there are people on the sidelines cheering you on...
> It helps one not be overcome with despair...
> But long term...
> It is a 'maintenence' strategy...
> It needs to be fairly constant
> If there is a break...
> Things can fall apart
> And...
> Why?
> Why why why
> When one can learn the skills to swim?
> And when there is a flotation device right there to help one while one takes the steps one needs to take in order to learn the skills?
>
> Maybe...
>True.. but maybe the last time grabbing the life preserver ended up dragging them further out..
Or maybe they could grab it but they've never had this much attention paid to them before.
That sounds so terrible, there is so much judgement surrounding "needing attention" even though we all do.
It's kind of like some girls only know how to get attention by being precociously sexual, and end up getting hurt, and repeating the behaviour.
In that case.. sometimes the person needs affirmation of other good qualities not to be shut out, or punished.It's not necessarily consciously manipulative.
(That I know you know.. I'm speaking in general terms)That's why I have real trouble with the hard line approach when there are so many things we are unaware of, even when at the outset it looks cut and dried.
However I think realizing that you can't do it anymore, for yourself, is quite different than taking the hardline approach, I'm not equating the two at all.I think were in agreement here, just expressing different sides of the whole issue.
>
Posted by Gabbix2 on January 5, 2006, at 19:42:19
In reply to Re: I read it differently » Racer, posted by alexandra_k on January 5, 2006, at 18:42:06
Amen to that!
I went through virtually the same experience.
And it still is a real sore spot with me.
Posted by JenStar on January 5, 2006, at 19:55:23
In reply to I read it differently » Dr. Bob, posted by Racer on January 5, 2006, at 17:22:40
I agree, and I don't think Larry deserves a block for this. Deneb has called herself manipulative in multiple posts over many months, and I think Larry was trying to point out how she needs to keep that in mind as she decides how to proceed. I really wish Dr. Bob would reconsider this block.
JenStar
Posted by alexandra_k on January 5, 2006, at 19:58:18
In reply to Re: I read it differently » Racer, posted by JenStar on January 5, 2006, at 19:55:23
> Deneb has called herself manipulative in multiple posts over many months...
Lets suppose I call myself a useless sack of sh*t in multiple posts over many months...
Does that mean that someone else gets a break for calling me a 'useless sack of sh*t'?
People typically aren't warned / blocked for being uncivil to themself...
Though... I think you will get PBC'd / blocked if you call yourself a swearword unasterisked ;-)
Posted by JenStar on January 5, 2006, at 20:09:04
In reply to Re: I read it differently » JenStar, posted by alexandra_k on January 5, 2006, at 19:58:18
Well, it's an interesting question!
But I believe there's a difference between a descriptor like "manipulative" and one like "sack of ****." It's a slippery slope issue to assume that ALL self-descriptions are incorrect if they are not positive ones.
"Manipulative" is a word that can be used clinically to describe certain behaviors, while "sack of ****" is a phrase that would mostly be used to denigrade or demean, without giving a clear idea of any behaviors.
From the way Deneb describes her behavior to us, I have to agree that she is correct in the way she labels some of her behaviors, assuming that she is being truthful.
I think Larry was only using her own examples to help point out a cycle of behavior that he saw.
That's my opinion!
thanks,
JenStar
Posted by Phillipa on January 5, 2006, at 20:21:39
In reply to Re: I read it differently » alexandra_k, posted by JenStar on January 5, 2006, at 20:09:04
I think Lar was just tired of the same thing over and over. Just my opinion. Fondly, Phillipa
Posted by zeugma on January 5, 2006, at 20:59:15
In reply to Re: I read it differently » Racer, posted by alexandra_k on January 5, 2006, at 18:42:06
But I think problems with the 'tough love' approach have come up before (Chemist springs to mind...)>>
chemist used the tough love approach??
no, don't answer.
yes, now i remember what you're alluding to, and it is still a sore spot with me. i did not agree with the terms of the block. in fact it grieved me greatly.
(that block really saddened me.)i can't think through the analogies with the present situation. except.
-z
Posted by alexandra_k on January 5, 2006, at 21:01:55
In reply to Re: I read it differently » alexandra_k, posted by JenStar on January 5, 2006, at 20:09:04
> Well, it's an interesting question!
:-)
Thanks for posting :-)
> I believe there's a difference between a descriptor like "manipulative" and one like "sack of ****."yes. you will find the first description in the clinical literature wheras you will not find the second... ;-)
> It's a slippery slope issue to assume that ALL self-descriptions are incorrect if they are not positive ones.
I never said or meant to imply that all negative self (or other) descrtiptions are incorrect. I think... That is where the point comes in that some truths... Can be uncivil.
I'm less worried about 'objective' truth regarding ascriptions of intention (which is an interesting topic though something of a can of worms) than I am interested in the utility or pragmatic value of negative descriptions of intention, however...
> "Manipulative" is a word that can be used clinically to describe certain behaviors, while "sack of ****" is a phrase that would mostly be used to denigrade or demean, without giving a clear idea of any behaviors.
What behaviours are described as manipulative?
Do these behaviours OBJECTIVELY have something in common...
Or is all that these behaviours have in common the point that other people typically respond to those behaviours BY FEELING MANIPULATED?You might worry about my considering 'manipulated' to be a feeling...
Lets suppose you say 'someone is doing that in order to manipulate another person'
How are you likely to feel in response to that description of their behaviour?
Indignant
Frustrated
Annoyed
Etc.
If someone tells you 'that person is a little manipulative' then do you respond by being warmly disposed to that person or by being cautious of them?Description...
May seem like a anal semantic technical point...
But when YOU are the person being described...
When it is YOUR BEHAVIOUR that is being described...The difference between negative and positive descriptions surely seems to be more than a mere technical point.
And...
When you consider whether you are likely to feel well disposed or ill disposed to someone in virtue of the descriptions you adopt then the descriptions you adopt has consequences for your emotional responses and your behaviours that are further reaching than a mere technical point.
> From the way Deneb describes her behavior to us, I have to agree that she is correct in the way she labels some of her behaviors, assuming that she is being truthful.
So either she is manipulative or she is a liar?
Truth only comes into it if you assume that people have direct and infallible access to their own intentions. Current consensus in psychodynamic theorising and cognitive psychology (and even behaviourist psychology so much as one is allowed to talk about intentions) is that mental states (including intentions) may be different from the way the person reports them to be.
That is true for you
True for me
True for DenebThat does not make us into liars...
Interpreting ones own intentions (and the intentions of others) is a matter of INTERPRETATION and multiple interpretations are possible. And the principle of charity (which I choose to adopt as much as I possibly can) dictates that one should always assume good intent (or at least the absence of malevolent intent) insofar as possible.
Why?
Because the consequences of that... The world is seen through a positive rather than negative lens and the world seems like a fairly nice place rather than a fairly horrid place... And the consequence of that is I am likely to feel happier and well disposed to others whereas if I am too ready to adopt negative interpretations I am more likely to feel sad and bitter and resentful and ill disposed to others.
Posted by sleepygirl on January 5, 2006, at 21:03:45
In reply to Re: I read it differently » Racer, posted by alexandra_k on January 5, 2006, at 18:42:06
the term "manipulative" does indeed sound insulting, yet it is in sooooo much literature
How else can we say it? - the connotation is too negative and doesn't quite fit, but the whole BPD thing tends to have a negative connotation
Maybe we just keep changing the words as they get too many associations to them, but isn't every diagnosis an assumption - this one particularly problematic because it assumes intent?
Posted by alexandra_k on January 5, 2006, at 21:25:19
In reply to Re: I read it differently » alexandra_k, posted by sleepygirl on January 5, 2006, at 21:03:45
> the term "manipulative" does indeed sound insulting, yet it is in sooooo much literature
yes. and that is why... i feel fairly insulted when i read that literature. at least... i do now. before... i read it... and felt sad... and would cut myself to try and feel better because i thought i must be a really horrible manipulative attention seeking person and must be punished :-(
and...
so that description wasn't so helpful.
it was counter-productive as a matter of fact.
it increased my distress and increased the very behaviours that were problematic.> How else can we say it?
how else can we say what?
we can describe this is a cycle we see (just describe don't judge or try and get at motivation or intent). we can say that it seems unhelpful to us (we can list consequences or likely consequences)
sometimes the best strategy is just to focus on those things...
> the whole BPD thing tends to have a negative connotation
thats where i'd say read linehan.
and don't bother with the rest.
or perhaps thats a little unfair...
if you read stuff that sounds judgemental
(and / or that leaves you feeling bad about yourself)
then STOP
because...
mostly...
that is the writers own sh*t
their own issue
and there is a lot of that out there...and the people who are supposed to help...
sometimes they can be the people who harm the most...and thats really very sad :-(
but as consumers part of us taking the power back is for us to
NOT INTERNALISE THEIR B*LLSHIT
not see ourself in that way...
and not see others in that way either...> Maybe we just keep changing the words as they get too many associations to them,
that tends to happen in practice yes.
but that is where linehan talks about some of this stuff. i think it applies to her stuff on judgement... and i think it also applies to the civility rules on these boards...
it might seem to be a mere verbal point...
a matter of 'what we should call it'
a matter of 'what words we should use'
but for anyone who really understands...
who understands something of the theory...
the rationale behind the theory...to grasp it is more than just getting ones head around what words to use...
to grasp it is to grasp a whole way of thinking...
a world view.
interpretation
the freedom we have with interpretation (to appreciate that multiple interpretations are possible)
and to be charitable.
> but isn't every diagnosis an assumption - this one particularly problematic because it assumes intent?
this dx is typically considered to be most problematic... typically because it is considered that clients with BPD tend to elicit the most intensive counter-transference responses / reactions from others...
linehan considers that the behaviours that are exhibited are rendered understandable in light of what the person has inherited in conjunction with their experiences in the world... the person is typically in a lot of pain... but to negatively judge the person for their behaviours (that are the result of pain) amounts to... blaming the victim.
and that seems to be so...though that doesn't mean that people shouldn't own their own responses...
(just like if someone is uncivil to us that doesn't mean we can be uncivil back)
DSM is supposed to be fairly much purely descriptive...
but...
it is not.
(which is to say that some of the desctiptions assume negative motivation / intention)
that is why...
i posted a post to muffled a little while ago over on psychology with linehans dx criteria (which may be viewed as a non-judgemental alternative to dsm though it captures all the main points)
i think...
she is a master on positive / neutral interpretations...
she has helped me immensely...
but i have much to learn...
Posted by sleepygirl on January 5, 2006, at 21:37:40
In reply to Re: I read it differently » sleepygirl, posted by alexandra_k on January 5, 2006, at 21:25:19
Multiple interpretations are almost always possible, but some individuals are indeed less than charitable, and would rather put a stamp on it and call it "done", because the countertransference can be so difficult to deal with, because we're all flawed maybe and needy and because of all the pain.
That is "there" and not "here" I mean, and so it propagates what is felt as an inherent badness possibly in the first place.
Posted by alexandra_k on January 5, 2006, at 21:59:11
In reply to Re: I read it differently » alexandra_k, posted by sleepygirl on January 5, 2006, at 21:37:40
> Multiple interpretations are almost always possible,
*always* possible methinks ;-)
and... there may be no further fact of the matter...
OR
internalising an interpretation could make it so (which is even worse because then it would mean that those who offer negative interpretation might be more likely to produce harm than help)> but some individuals are indeed less than charitable,
though *why* are they uncharitable?
a charitable interpretation of *why* might be...
that they don't appreciate the likely consequences of their interpretation (for their own thoughts / feelings / patterns of behaving)...> and would rather put a stamp on it and call it "done", because the countertransference can be so difficult to deal with, because we're all flawed maybe and needy and because of all the pain.
yeah... one should probably be charitable to therapists too ;-)
i think... it is because they don't appreciate the likely consequences of their interpretation.
sometimes... people are in the grip of a theory too, and they believe they have hit upon *the truth* or *the fact of the matter* regarding another persons intention...therapists are people too and they aren't perfect neither. and yeah, there is a lot of pain in the world. and yeah, i have already tried to describe (charitably i hope) *why* people might be feeling frustrated in response...
> That is "there" and not "here" I mean, and so it propagates what is felt as an inherent badness possibly in the first place.
yeah...
and people get worse :-(
and clinicians wonder why?????
that is why (IMO) some therapists can be terrific because they are able to grasp something of this...
and that is why (IMO) i have had some fairly terrible DBT therapists because they thought it was a purely verbal move and they didn't seem to appreciate the reasons *why* one should be charitable...
Posted by wildcard on January 5, 2006, at 22:43:34
In reply to Re: To Gabbi and alexandra, posted by Larry Hoover on January 4, 2006, at 22:31:57
>>I'm sorry.
>>i am not at all well
I hope you hang in there. Sometimes to take care of yourself you have to let go of trying to take care of others. I'm sorry this whole thing happened. I'll miss you.
Posted by Berberis on January 6, 2006, at 7:09:14
In reply to Re: To Gabbi and alexandra, posted by Larry Hoover on January 4, 2006, at 22:31:57
(((((Larry)))))
I value your participation on these boards. You've responded often to my posts (under a different name) and I can't begin to tell you how much I appreciated your *very helpful* replies.
Please, please, please come back at the end of your block.
Posted by NikkiT2 on January 6, 2006, at 14:12:46
In reply to Re: I read it differently » JenStar, posted by alexandra_k on January 5, 2006, at 21:01:55
one of the biggest learning curves I've had inb my new job, is realising that actually, yes, therapists DO think their clients are often being manipulative.. they often actually dislike their clients.
Just because Linehan wrote something in a book, doesn't make it 100% correct.
As someone with BPD. As someone who does alot of voluntary work with people with BPD. As someone who works in a paid manner with people with BPD..
We *do* manipulate. We are masters of manipulation.
Take an example of mine..
I was doing very very badly.. But I couldn't get the help I needed. The waiting lists were long, and it felt to me like I wasn't "ill" enough, or that no one believed I was ill enough, for the help I so desperately wanted and needed.
So, I got a knife and cut myself, on my hands and forearms. because I *knew* that they would be seen, and I thought that if I could show them I could cut myself, they would think I could do more, and thus give me treatment.Thats manipulative behaviour.
Every day at work I am told "if you don't make x happen, I will do y"..
So so often "friends" say "if you don't do x, I will do y, then you will feel bad".
What Linehan stresses is that therapists mustn't give in to the manipulation.. That if they do, it reinforces that the behaviour will get the end results desired. Positive reinforcement and all that.
Like I say, just my point of view to throw into the mix
Nikki
Posted by NikkiT2 on January 6, 2006, at 14:18:57
In reply to Re: To Gabbi and alexandra » Larry Hoover, posted by Berberis on January 6, 2006, at 7:09:14
I know you never believe me, but you remind me SO much of me when I was in the first half of my twenties.
but.. wiuth regard to your "mini overdoses" (as I always called mine).
I always took just enough to make me sick, a little ill, or sleep.
It took ALOT of hard work to get to this point in my recovery. ALOT of hard work.
And now? Now I have a stomach that is screwed up and I feel neauseas about 80% of the time. If I get hungry I start retching. If I get full I start retching.
My colon in screwed. I have almost constant gut pain. I switch from constipation to diarhea and back again. I have constant lower back pain from it.
My liver function is getting pretty ropey. I get aches from that and really can't risk drinking alcohol too much.
My kidneys are also pretty unhappy. I have what feels like a constant kidney infection.All of that has been caused by my "mini overdoses". So while you think you're doing little damage, you're not. When you get to 30 and think your life is finally sorting itself out, please don't face these physical battles that I am.
Please. Please listen to us. Theres alot of us here who have been there, done that.
Nikki
Posted by alexandra_k on January 6, 2006, at 16:31:21
In reply to Just my POV, posted by NikkiT2 on January 6, 2006, at 14:12:46
Hey there. Thanks for joining in :-)
> one of the biggest learning curves I've had inb my new job, is realising that actually, yes, therapists DO think their clients are often being manipulative.. they often actually dislike their clients.
Yeah. And if they think that... Then... How much are they helping as opposed to hurting? I mean... Nobodies perfect... And my understanding is that talking through some of those feelings and trying to understand things from a non-judgemental pov (where it is possible to like the client) is one of the important functions of peer support. Liking the client... Has been found to be correlated with helping the client...
I know that what you say is true. And that is why (IMO) therapists can be more likely to harm than to help... And that is why... I couldn't work with the majority of people I saw. Becauase... They didn't like me. They judged me. And they DIDN'T EVEN TRY to be charitable to me.
> Just because Linehan wrote something in a book, doesn't make it 100% correct.You mean just because Linehan wrote something in a book about how clinicians *should* view it doesn't mean that they think they should do it that way or that they are able to do it that way all the time?
I would say...
That is the difference between giving 'verbal assent' to her theory and censoring what you have to say in front of others...
And really understanding *why* it is important to do this. Because if you don't like the client they are surely going to notice. If you judge the clients intentions negatively then they are surely going to notice... And I think... That really isn't going to help them. Or you either. I mean... Burnout and all...
> As someone with BPD. As someone who does alot of voluntary work with people with BPD. As someone who works in a paid manner with people with BPD..
> We *do* manipulate. We are masters of manipulation.Linehan talks about how consumers come to internalise that way of seeing themselves because they are told it *that many* times.
What is hard with the 'manipulation' example is that everybody manipulated (no judgement) to a certain extent. Thats why she tries to reclaim the word by talking about how everybody does this and by talking about how people with BPD need to learn to get BETTER at manipulating others / their environments.
It is the judgement that is crucial...
But generally speaking... To call someone manipulative is to make a negative judgement about their intentions (malevolent intent).
So...
> Take an example of mine..
> I was doing very very badly.. But I couldn't get the help I needed. The waiting lists were long, and it felt to me like I wasn't "ill" enough, or that no one believed I was ill enough, for the help I so desperately wanted and needed.
> So, I got a knife and cut myself, on my hands and forearms. because I *knew* that they would be seen, and I thought that if I could show them I could cut myself, they would think I could do more, and thus give me treatment.
> Thats manipulative behaviour.That is one way of looking at it...
Another way of looking at it is that you did what you thought you needed to do to get better. I did similarly... I don't view it as manipulation (or if I do I don't judge myself negatively for it) because the fact is that is what i needed to do in order to get a little help in this f*cking crazy making mental health system.There may well have been more appropriate ways to go about that (ways that did not have to result in harming myself)... But the fact is that I needed a little help in order to learn more appropriate ways of getting a little help...
Ah... One of the paradoxes of BPD...
> What Linehan stresses is that therapists mustn't give in to the manipulation..
I bet she does not say it like that...
Maybe a verbal difference...
But I think it expresses a different 'world view' if you like of people with BPD...> That if they do, it reinforces that the behaviour will get the end results desired.
She also talks about how there need to be alternatives...
The client needs to know the alternatives...
The client needs to be cheerleaded and coaxed and cajoled and manipulated (if you like) along to have a go at those alternatives...And...
When you fail to reinforce a behaviour that has been reinforced before... Typically behaviour escalates before extinguishing. When you are talking SI or suicidal behaviours failing to reinforce... Can amount to playing chicken... Can be fairly risky...
What you need is alternative behaviours to reinforce...
So the focus is on that rather than on 'punishing' of behaviours that are unhelpful.
> Like I say, just my point of view to throw into the mix
:-)
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