I Hate You, Don't Leave Me

Inside the mind of a borderline.

The Adult Borderline at Home

Ozzie & Harriet ... and Lisa

Lisa never really left home. She did go away to college … colleges, actually, three altogether, but never stayed longer than a few months. A roommate was mean; professors were boring; administration was unresponsive; etc. The longest she lived away from her parents was for eight months with Rod, her on-again, off-again boyfriend. Sometimes she returned home with bruises, complaining he beat her. But she would get angry when others questioned his caring for her. Finally he terminated the relationship and moved away.

Now, 30-year-old Lisa was home. Ozzie was allergic to her cat, and both parents hated her smoking. She was fired or left jobs after a short sojourn. She angrily resisted suggestions for work or return to school. Her uncle gave her some work at his business, but she was unreliable, and refused most assignments. She alienated her siblings and other family. She responded with rage, pushing her mother and threatening to hurt herself, when confronted. Lisa refused to see a doctor or therapist, and had had no medical care for six years. Ozzie felt they were enabling her dependency and wanted her to leave. Harriet was afraid she couldn’t survive by herself. Both were right.

How can parents deal with the adult Borderline at home? Although recent studies confirm that most symptoms of BPD (Borderline Personality Disorder) improve over time, deficiencies in socialization and occupational success often persist. Ozzie understood that the longer Lisa’s life remained stagnant, the harder it would be to live a satisfying life. Lisa at thirty was insufferable. Lisa at 50 would be helpless. Harriet feared provoking a crisis. If abandoned, Lisa could hurt herself or be exploited by others, as she was with Rod. But such vulnerability existed even now without intervention.

Ozzie and Harriet developed a plan. They agreed to assume a more businesslike, matter-of-fact approach to Lisa. Utilizing SET-UP techniques (for a detailed description see our books, I Hate You, Don’t Leave Me, and Sometimes I Act Crazy), they quietly informed Lisa that she had to find her own place in four months, establishing an exact date for her move. They no longer demanded or suggested options, trying to treat Lisa in a more adult way, emphasizing adult consequences. They attempted to frame conversations about her options less as directed exhortations, and more as ideas coming from her. They offered to help her look for places to live, explore employment or even disability opportunities if she wished, but accepted with equanimity when Lisa would decline. They also offered to supplement her income for six months while she adjusted. Then they hunkered down for the “crises,” which would be inevitable, since previous promises and threats had been ignored without follow-through.

The first crisis would emerge at the time of the pronouncement to move and/or at the time of the move. Parents should make gentle, occasional reminders of the date. A few weeks before the move, “help” the borderline to pack, either in suitcases or garbage bags. At some point there will be resistance. Previously, after an argument, Lisa had punched her mother, threw an ashtray at her father, and impulsively swallowed a handful of aspirin. Despite Lisa’s objections, her parents called an ambulance to take her to the hospital. But after waiting several hours in the ER, and receiving a cursory assessment by the doctor and a hospital social worker, Lisa insisted on leaving. Since her evaluation showed no toxic signs of drugs, and with her denial of destructive intent, the doctor explained he could not hold her in the hospital and released Lisa to her parents, who took her home. But this time when Lisa acted out and went to the ER, her parents refused to take her home. They might have filled out an affidavit describing the violence and their fear it would recur; or, they could leave responsibility for Lisa’s disposition up to the hospital. In such a way, this event can be a “safe crisis,” by insuring Lisa will be safe while holding firm to the agreement. This stance also forces the hospital system to more actively assist in confronting Lisa’s problems and dealing with realistic placement options.

Another, though more painful option, in dealing with a crisis is to invoke police. After suggesting or arranging transfer to an apartment, hotel, or friend’s residence, her packed bags can be placed outside on the stipulated date. If, in this most extreme situation, Lisa still refuses to leave or, after a short time, returns to the house demanding to enter, threats or a physical confrontation will inevitably erupt. Lisa’s trespassing can be addressed by police. The involvement of the hospital social workers or the police assist parents in helping the child confront real world consequences and assist with options.

Obviously, these are the most extreme examples. But in the more usual situations, several principles apply:

1. Cease demanding. Frame limits in a calm, matter-of-fact way. But don’t set limits you can’t enforce. Most important, both parents have to be agreeable to the plan.

2. Expect a “crisis” when limits are challenged, which they will be. Past demands/threats were not consistently applied, so don’t expect them to be respected this time.

3. Utilize community resources, despite discouragement. Social services have waiting lists. Police hate the paperwork with family disputes. Hospitals try to move patients out, and won’t always provide the family services unless you insist. So, insist!

4. Continue unconditional loving support. The changes necessary for the borderline to adapt to a lifestyle independent of parents are monumental. Such a transformation will always require caring reinforcement. The rewards are in knowing that Lisa will be able to survive in the world when Ozzie and Harriet can no longer protect her…and for Ozzie and Harriet to return to nurturing themselves.

Jerold Kreisman, M.D., is a psychiatrist and best-selling author of numerous books.

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