Are clients with Borderline Personality Disorder too needy? Follow up thoughts from attending the NEA BPD conference.

This past week I attended a conference hosted by the National Education Alliance for Borderline Personality Disorder. Dr. Alan Fruzetti presented on Dialectical Behavior Therapy and Dr. Anothony Bateman presented on Mentalization Based Treatment (an alternative treatment for BPD). Then they both did a “role play” of a session (with the same client and same presenting concerns)- each demonstrating the theory and application of the treatment they represented. It was a wonderful opportunity to see two very skilled clinicians at work.

During the role play, the acting client identified a great deal of difficulty when her boyfriend suggested that he did not want to “cuddle” with her- as he wanted to “take things slowly.” She expressed a great deal of distress about this situation- including thoughts of suicide.

At the end of the role play, Dr. Fruzetti asked the audience if they believed that the client was “too needy.” Several people raised their hands. He then suggested that he did not believe the client to be “too needy.”

I really appreciated that he did this- mainly because of the stigma in the field around borderline personality disorder and neediness. Having, wanting, needing, or desiring things in the first place has somehow been interpreted as pathological and problematic- and gets punished. (“It should not be as it is. You should not be as upset as you are.”) It also seems to defy self-acceptance. Clients often have some deal of difficulty sorting out confusion regarding self-experience (ie, not feeling real, confusions about experience and feelings, acting or behaving in ways that are inconsistent with intentions). It seems that pathologizing the wanting only makes things more confusing- and creates more problems- and I regret that it is so common in the mental health field to do so.

Being clear about what is wanted is a sign of improvement. Knowing adaptive and effective ways of getting it involves skill. Attacking oneself for wanting or desiring something in the first place is not an effective way of solving a problem. In addition, attacking oneself for wanting or needing things in the first place reinforces this idea that reality should not be as it is. Accepting how things are also involves acceptance of oneself- even though wanting something very badly can be painful.