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Q I don’t know… I suspect my wife has symptoms of Borderline Personality Disorder (BPD). Is Gosling International effective in providing a solution for her, or is there someone else able to do a better job? Are the chances of recovery good?

A Borderline Personality Disorder (BPD) is a condition with severe long-term implications for relationships as a person with BPD needs a lot of understanding and tolerance of their behaviors. Yes, Karen Gosling is able to assist. Indeed she works already with several people suffering BPD.

In essence, the person may exhibit no real symptoms for long periods of time, however, under stress, he or she may experience intense feelings of deprivation and insecurity, and be prone to periods of rage. This seriously affects intimate and social relationships. An important element in therapy is non-judgement while the person ventilates their feelings and perceptions of life. This is necessary before self-awareness can be gained, by gently confronting the person to see things from another’s perspective.

Effective treatment of BPD will often include a combination of medication and cognitive behavioral therapy to assist the person stabilize their mood-disturbance and increase tolerance of anxiety. To this end, we are frequently in contact with doctors, psychologists, and psychiatrists for purposes of referral to ensure the person receives the best holistic care.

As cognitive-behavioral counselors, Gosling International’s counselors helps clients identify events (memory, thoughts, values, beliefs, expectations) in their lives that generate pain or negative emotion (stress) and produce excess adrenalin in the body. We assist clients to understand the physiological effect of excess adrenalin on their body and through increased awareness of their identity help clients to better manage their emotion state.

Effective outcomes for counseling depend upon a number of variables including a person’s willingness and readiness to receive counseling, their current emotional state, and receptivity to taking medication. Cognitive behavioral counseling is effective to help a client discover and correct the cause of inappropriate behavior and can serve as an appropriate avenue for referral point to other more specific areas of mental health care identified by an experienced counselor.

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Many times in our lives we experience emotional difficulties and are unsure of how to move forward. Karen Gosling, an expert CBT counselor, explores a common situation and offers insight as to how emotional well being can be achieved.

Note: The permission of clients has been obtained to present this real-life case study. The names of clients have been changed to protect their privacy.

Presenting Issue

John and Lisa agreed on counseling to help end their marriage amicably. Explaining that they no longer “got on”, frequently snapping at each other with rudeness and sarcasm, Lisa said that John no longer filled her emotional needs – to be loved, appreciated and cared for. John acknowledged he was working longer hours at the office to avoid going home and that he was feeling empty and in turmoil. Both said they felt “finished”.

Karen’s assessment

This couple had a combination of poor communication and unresolved past hurts. By improving communication and learning to talk safely about old hurts, there was a chance they could reconnect emotionally and restore intimacy.

Work done in counseling

When I asked, “Why did you both agree to attend counseling?” John admitted that he really didn’t want to leave Lisa, he loved her and hoped to restore their relationship. In amazement Lisa explained that she also didn’t want to separate. Coming from a broken home herself she knew the pain involved with having estranged parents, and was conscious of the emotional well being of their two young children. Lisa conceded that she was prepared to stay in the relationship even if John didn’t fulfill her needs.

I taught them a model of communication and each had the opportunity to level honestly with the other about feelings harbored concerning a certain issue, past or present. They had to listen to each other, acknowledging the feelings raised before continuing with the interaction. Due to the model feelings were communicated safely, without sarcasm or defensive responses.

Outcome

At their third counseling session John and Lisa, who were noticeably more relaxed and interacted with affection, said, “Karen, with your help we’re saving our marriage”. John explained he felt “lighter” and Lisa commented that close friends were remarking on how “connected” they seemed. Within three months of their first appointment John and Lisa survived the stress of having family from overseas to stay for three weeks and were thrilled by this achievement!

Karen’s advice for moving forward

Relationships fail for three main reasons: 1) Unresolved hurts, 2) Ineffective communication, and 3) Not giving and receiving love according to one’s needs. When couples experience communication difficulties both partners need the opportunity to tell their side of the story without interruption or judgement. They may need to have a session on their own in order to really “get things off their chest”. If unexpressed, past resentments remain anger triggers and can cause underlying tension leading to arguments “for no reason”. Couples need to learn how to give each other permission to raise past hurts, and discuss them using the communication rules. Open communication is the key to a loving and trusting relationship.

MORE CASE STUDIES

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Many times in our lives we experience emotional difficulties and are unsure of how to move forward. Karen Gosling, an expert CBT counselor, explores a common situation and offers insight as to how emotional well being can be achieved.

Note: The permission of clients has been obtained to present this real-life case study. The names of clients have been changed to protect their privacy.

ASK KAREN Sally came to counseling desperate for help with her seven year old son Max who had frequent rages. “It’s as though he is possessed”, she explained. At unpredictable times Max would lose control, become hysterical, and shout foul language at siblings, parents or even teachers. He also threatened to harm himself because he hated his life. Following each rage, Max would sob with remorse and seek comfort. Max realized his behavior was inappropriate but was unable to control himself. Sally felt his behavior was completely out of character.

KAREN’S ASSESSMENT Max was a very sensitive boy, meaning that he felt his feelings with intensity. When Max felt a negative emotion he felt it strongly, and if unable to resolve it or articulate it, the pain accumulated resulting in intermittent rage – his reaction to stress. Rage is also common in teenagers and is usually the result of the intense emotions and frustrations experienced during puberty.

WORK DONE IN COUNSELING I urged Sally not to respond emotionally to Max, but to detach herself from the outburst long enough to work out what emotional pain Max may be feeling and to acknowledge his painful feelings. For example, “Max, you must be really angry that I am asking you to help me when you want to watch TV”. If Sally gets it right, Max will probably agree and calm down, as he now feels understood instead of annoyed. I explained that Max will yell how unhappy he is with his life when he feels completely isolated. When misunderstood by everyone around him, it feels as if no one understands the pain he is experiencing.

OUTCOME Sally reported immediate changes in Max’s frequency of outbursts. She watched for any signs of agitation, then tried acknowledging Max’s feelings, and in most instances diffused the situation. Sally shared this strategy with her husband and the teacher and all reported an improvement in his behavior.

KAREN’S ADVICE FOR MOVING FORWARD Parents often feel exasperated or bewildered when their child suddenly starts exhibiting anger or rage. They question what, as parents, they’re doing wrong. Raging behavior is usually a result of the child feeling a negative emotion (stress) about some situation in his life which he is unable to analyze or articulate. The pain of the emotion is experienced with the outburst of behavior. Children describe that they are quite scared when they rage as they feel out of control and the anger seems bigger than them. Parents can assist by thinking about what their child may be feeling and validating that feeling to the child. As well as helping the child feel better, they’ll also learn an emotional language leading to improved communication.

MORE CASE STUDIES

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Many times in our lives we experience emotional difficulties and are unsure of how to move forward. Karen Gosling, an expert CBT counselor, explores a common situation and offers insight as to how emotional well being can be achieved.

Note: The permission of clients has been obtained to present this real-life case study. The names of clients have been changed to protect their privacy.

Presenting Issue

Barry, in senior management with a British company, came to counseling to explore his mood swings. He was 37 and had been married for nearly 6 years to a ‘warm and wonderful person’. There were no children yet, and the couple was wondering about the right time for having children. His wife also worked with the company and both had come to Singapore six months earlier from the UK.

Barry described himself as fairly conservative and not a risk taker, and said that sometimes he couldn’t believe he had accepted a job here in Singapore. He had never lived abroad and previously had never even visited Asia. In describing his problems, Barry said that sometimes he felt OK and reasonably good about himself, but that these good feelings gave way frequently to incredible depression and feelings of hopelessness and despair, that he often felt ‘not good enough’, and ‘not worthy’. He had experienced these feelings before, but he felt they were more intense and more frequent since coming to Singapore. He commented, “I’m not the person I thought I would turn out to be” and “I’m disappointed in myself”.

On questioning, Barry admitted that he had occasionally felt suicidal, but that he did not really believe that he would ever carry out a suicidal action. “Usually when I have the negative feelings I don’t have the energy to do anything about it, and when I feel more energetic, I reconsider, and think I will get on with life.”

Karen’s assessment

The counselor identified quickly that Barry was suffering from a low self-esteem, and that his critical view of himself has escalated since arriving in Singapore in a senior position and on a good salary (which he felt was too high for the actual work he was doing!). Barry was able to remember many incidents from earlier life and childhood that had helped create his low self esteem and was amazed that he had not identified it himself.

The counselor explained that identifying the problem is an important first step to doing something about it, and dealing with the destructive negative emotions.

Work done in counseling

The counsellor helped Barry to identify the judgmental and critical thoughts about himself that he was finding so disturbing, and taught him strategies to cope with them as they arose.

Barry was able to recognize that the thoughts were not constant, but seemed to be present at unpredictable times, in both work and social situations. In time, he was able to identify the negative feelings for what they were and control the devastating impact of them promptly.

Outcome

Barry became confident of his own abilities and recognized that he was indeed the most competent and suitable person for his job. He resumed his post-graduate studies and studied hard in his free time, successfully completing a masters degree within the same year of his first appointment. He continued to use the Self Esteem resource book suggested by the counsellor, as a reference tool whenever the old criticism arose. Most of all, he felt in control of himself, his thoughts and his well-being.

A few years later – Barry writes

Karen – Our work together was a critical intervention in a vicious cycle of poor self-esteem, negative feelings and depression and I am very grateful for your help (as is Louise). I have changed my role at work twice since we last spoke and feel very much more competent and in control, although I still have my rocky days (who dosen’t?).

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Q Two years ago my husband left me for another woman. After a month he begged to come home. I missed him. And he was a good father – so I took him back. He is now faithful, but I find it hard to be close to him physically. How can I trust him again?

A It must be very painful for you to still feel distant from your husband after so long. The beginning of rebuilding trust is to make the decision that you are going to trust. The decision comes before the feeling returns.

Usually a woman needs to feel safe and secure in a relationship, before she “opens up” sexually. When that trust is broken she will avoid feeling vulnerable. So she “clams up”, and her desire for sex lessens.

A man however, will usually seek sexual intimacy for reassurance that the relationship still exists. To him, a rejection in the bedroom might indicate that his partner doesn’t want him in her life.

This paradox is a cause of many relationship problems. The woman wants emotional intimacy before sexual intimacy, the man needs sexual intimacy to know it is worth revealing his emotional and tender characteristics.

It’s important to explain to your husband that you do want to have sex with him again, and that for you, this is connected to trust. Tell him that you understand how he’s feeling and that you know sex is an important component if the marriage is to stay on track.

Ask him to be gentle with you initially, with words and actions, in order for your trust and sexual desire to build. And you must try to relax enough for this to happen – don’t keep avoiding the opportunity.

If it helps you, ask him for words of reassurance. This “talking” during sex is not normal for a man – but he may well try, if he knows that it helps you. Tell your brain to recollect the positive things that have been a reality over the past few months – things he has done for you and his family, evidence that he loves you and is committed.

Over time your brain will become “desensitized” to the pain of his infidelity. And whilst the memory will never go, the pain will.

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