The healthy adult
It may seem odd to have a ‘ healthy adult ’ mode when dealing with BPD, but it is exactly this mode that the patient needs to cultivate and eventually maintain. Due to absence of a normal, healthy childhood, as well as uncontrollable events during this period, the healthy adult mode is seldom strongly present during the initial stages of the therapy.
The patient's deficit of healthy development in areas such as bonding with others, autonomy, self - expression, self - value and the lack of experience in dealing with realistic limitations, requires the therapist to serve as a representative of the ‘ healthy side ’ particularly in the beginning of the therapy.
However, it is the healthy adult who initially ensures that the patient seeks out and remains in therapy. At later stages of therapy this mode helps the patient to achieve healthy goals. These therapeutic goals such as relationships with others, looking for educational or work opportunities, and other such activities that the patient will enjoy and be capable of completing, are necessary for successful completion of the therapeutic process. While in this mode the patient not only dares to show her feelings, but also shows she is capable of controlling their expression, a necessary skill for the BPD patient to accomplish.
As previously stated, in the beginning of the therapy, it is the therapist who serves as a representative of the so - called healthy side. By the end of the therapy, the healthy adult is so evolved that she can take this role over from the therapist and the therapy can be concluded in a healthy, appropriate manner.
Treatment Methods for the Healthy Adult
The therapeutic relationship changes slowly but surely from that of a parent – child relationship to that of a relationship between two adults. The patient becomes more and more autonomous and is able to find solutions to her problems without the help of the therapist. From the very beginning of therapy the therapist searches for contact with the healthy adult, even if these moments are few and far between. In particular when dealing with aggressive and impulsive behaviour, the therapist seeks contact with the healthy adult directly and tries to end this behaviour in order to continue with therapy.
Example of talking with the healthy adult
Nora is threatening to stop therapy because her boyfriend broke up with her and now life has no meaning.
t : Nora, I understand that you're having a very difficult time right now but I want to talk to your healthy adult side. What I want to say is that you shouldn't stop therapy now because you will end up having more problems. I understand that right now you feel like it's going nowhere, but you also felt this way when we began therapy but you stuck it out. Right now everything may seem hopeless, but your healthy adult knows that this will pass and I can help you with it.
The patient is capable of expressing and sharing her feelings with others. This is easily observed during therapy sessions as her feelings are expressed without any deterrents. The stories she shares with the therapist show her ability to deal with emotions and feelings in her relationships with others.When she is faced with strong emotions, she is capable of researching which one of her old schemas is at work.She can offer alternative healthy schemas to counter these old schemas on her own.
The healthy adult is capable of studying the underlying thoughts of threatening negative feelings or impulsive behaviour and disputing them. She can think about herself and the world as a whole in a nuanced manner and is competent in having a Socratic dialogue (see Chapter 6 ) in her head without having to write everything down in a cognitive diary.
The patient participates in different sorts of activities appropriate to a normal adult lifestyle such as maintaining friendships and building a relationship.She either works or studies or has some other meaningful way to fill her days. The healthy adult makes the final decisions as to those individuals from her past she wishes to maintain contact with and those she chooses not to.
During the first half of the therapy the therapist may sometimes think he is talking to the healthy adult while in reality he is being faced by the protector. Especially when dealing with patients whose protector has a strong tendency to rationalize and trivialize, the therapist can be led to believe that the pathology he is dealing with is not too serious. In this phase the therapist has to ask himself whether this healthy behaviour is in accordance with the severity of the pathology at the start of therapy. He has to at least check the emotions of the patient to get more clarity on this issue (see earlier discussion on obstacles when dealing with the protector).