Tuesday, April 14, 2009

Building a life instead of rehashing the past?

I recently read an interesting blog post on the treatment of borderline personality disorder at mentalhelp.net. Many people with BPD have had childhood trauma, and this is where therapy usually begins. The patient and clinician delve into whatever traumas they may have faced, what happened, how they felt, etc. Sound similar to eating disorders, eh?

In a new book titled
Treatment of Borderline Personality Disorder –A Guide to Evidence-Based Practice by Joel Paris, a researcher and professor at McGill University, he offers a different viewpoint. In studying various forms of theories and controlled trials of psychotherapy of BPD, Paris concludes that the most effective BPD treatments all have one commonality. He says:

They focus on the present, and on the current issues a person is dealing with. According to Joel Paris, people with BPD don’t get better by uncovering memories and rehashing the past, but by using the past as a context for understanding the present. This includes validating and acknowledging a person’s life history, and then putting it behind them. What sets successful therapies for BPD apart is that, in one way or another, they teach people how to tolerate painful feelings and to how experience difficult emotions without acting upon them in self-destructive ways.

He goes on to say that how a person with BPD needs to give a commitment to making a life for themselves. The goal is to work on building a life worth living, while putting the past into perspective and learning skills to tolerate intense emotions. Building a life for oneself is by no means an easy task. It includes developing goals for the future, finding work, and building relationships...The trick is to diversify one’s interests, and to try to retrieve satisfaction and pleasure from a range of different activities, relationships, and emotional investments.

Much of what Paris proposes has similar connotations with DBT therapy, but I still think it needs to be heard more. So often in eating disorder treatment, it seems the clinicians want to focus too much on the past and not enough on the present. While I certainly think delving into the past is one integral part of therapy, it doesn't need to be rehashed but more than once or twice unless it is causing a complete detriment to the present. All the past does is offer context and understanding for the who we are and how we came to be. Once we learn that, it really is time to let go, move on, and live in the present. After all, the past cannot be changed, but you do hold the power to change your own future.

Note--*I'm currently working on one past issue which has plagued me for awhile, but I'm hoping after that to not revisit the past. More can be learned at post Revealing secrets


Lola Snow said...

The worst part of therapy for me was any time anyone came close to a bit of my past. It is difficult though, to look at a situation in the present, refer back to past but without dragging the whole damn thing out into the open again. It's too tricky to compartmentalise the way we feel about our own history. Personally I'm hanging about waiting for a brain transplant!!!

Lola x

Carrie Arnold said...


Thank you for this post. It makes a lot of sense. I really like what you said about using the past to put the present in context, and then moving on.

Like Thom Rutledge said: Learn from the past and then get the hell out of there!

Kristina said...

Definitely an interesting topic!
From my own experience, YES, it's important to understand the past, but moving beyond it and really focusing on the present and the future has been HUGE for me.

PS. Word verification is "doggess" - is that like a dog goddess?

Tiptoe said...

Lola, yes, I too want that brain transplant! Kidding aside, not dragging the past full out is difficult but not totally undoable.

Carrie, I thought what this researcher said explained it so well. Yes, I love Thom's quote!

Kristina, I think it really is beneficial for so many of us. It can be a hard task but in the end provides us with a better ability to LIVE.

"Doggess" I like that term, and boy know quite a few of them!