BPD, DID and emotional pain
Hello fellow ACT journeymates,
I have a client who meets criteria for Borderline PD and Histrionic PD. She believes that she has DID. Whenever the issue of emotional pain comes up in therapy, she states that she cannot handle it. She says she dissociates and or goes psychotic, and this indeed has happened in session. Once in confronting the recent death of her mother with whom she had strong conflict, she "dissociated" and other "personalities" emerged, one which is verbally aggressive, and she ended up being hospitalized overnight. She calls it being psychotic, which in a way it is. So what am I asking? Hmmm. I find myself fearful of writing a question in fear of seeming insensitive. From what I understand of ACT, I don't want to reinforce the idea that she can't handle emotional pain, yet when approached her reaction is very strong. Honestly, I would prefer to do DBT with her, but there are not any DBT resources available in my clinic and we have built a strong therapeutic relationship. Any ideas of how to better help this client? I do believe it is what she tells herself about the pain that causes most of the suffering (e.g. I will lose control. I will go psychotic. I can't handle it).
Thanks!
JCC
Your instincts might just be right
And they're a good working hypothesis to start from. You could explore this in the moment with her, as this "pain" or "dissociation" is there, from her perspective. Where does she feel that emotional pain in her body? Does her chest tighten up, or feel heavy, e.g.? How does her breathing change when she is aware of this intensity of experience? Can she notice her rules as thoughts? What DOES it mean to tolerate an emotion - what would that look like? Can she start to pay attention to the urge to escape in the way that one might watch a hole in a tree for a baby bird to poke its head out for the first time?
Another ACT approach altogether would be to check in with her about how her efforts to struggle and avoid this intense experience (again, what is it composed of, in the moment?) are getting in the way of her life. What does this interfere with for her? She may not be able to meet you there quite yet, so this one might be for later.