Interview with Neil Bockian Ph.D.

New Hope for People with Borderline Personality Disorder

Are you treating patients with the borderline personality disorder?

Yes, I currently have a small private practice. Currently, I am doing a lot of writing and teaching, so I see clients 1 or at most 2 evenings per week. I have seen a few clients who called because they read the "New Hope" book, which was very enjoyable, since they knew a lot about the disorder and about my approach. I've also done some telephone consultations with people from around the country.

What initially attracted you to the field of psychology?

There are many things that attracted me. People are fascinating! I had great classes in psychology in high school and college. My professors at Wesleyan University were very inspiring. Like many young people, I wanted to "help people." Now, I know that just about anybody with any job is in the business of helping people. An accountant helps people with their taxes, a factory worker helps people to enjoy new products, and a telephone operator helps people to find phone numbers. More accurately, what was most meaningful to me was helping people who have emotional pain, and helping them to feel better.

What attracted you into studying the borderline personality disorder?

I went to the University of Miami to study with Dr. Theodore Millon. Millon's ideas about personality were incredible and fascinating to me. I had the privilege of studying with him and being on his research team. I became a specialist in personality disorders.

What gave you the inspiration to write New Hope?

Prima Publishing was looking for an author for their series. New Hope for People with Bipolar Disorder had just been written, and they were looking for someone to write a book on borderline personality disorder. My name came up, since I had written "The Personality Disorders Treatment Planner." I immediately saw great value in the "New Hope" project. Many people have assumed that BPD is hopeless, but I knew that there were many good treatments out there, and many people who have dramatically improved their lives. So I wanted to get the word out, as widely as possible.

What were the main points you wanted to express in your book? 

Of course, the main point is that there is hope for people with bpd-that they can get better. I then wanted to outline how. You need to:

1) understand what it is, 
2) get a good evaluation, perhaps involving psychological tests, 
3) get good psychotherapy, 
4) include interventions with the body. These should include nutrition, exercise, and body awareness (e.g. yoga or dance/movement therapy). Medications can be very helpful. "Alternative" therapies, such as homeopathy and Vedic medicine can also be very helpful, and can have far fewer side effects than medications. 
5) Take care of yourself with stress management techniques, such as relaxation training or meditation. 
6) Get the family involved, when appropriate. Families can be key allies in treatment. In addition, many family members are baffled and hurt by the symptoms of the disorder, and they need support, guidance, and information. 
7) Keep up with the latest information. New research is helping to unravel the mysteries of BPD. Your newsletter is a great source of late-breaking information. The seriously curious can also go to NIMH's website, and see what studies have been funded.

I think there are 2 components that are, at this time, unique to the "New Hope" book relative to other popular books on BPD. Valerie (Porr, my co-author) and I put a lot of energy into explaining the biology of this disorder. Few people know that this disorder is caused about 50% by biology (such as genetics) and 50% by environmental causes (such as interactions with other people). If you misunderstand the biology, or assume that biology has nothing to do with it, you will misunderstand this disorder-and the person who has it. The other area that has not been explored in other books is "alternative" treatments. There is little in the scientific literature about bpd and these treatments, so I did interviews with experts in the areas of homeopathy, Traditional Chinese Medicine, and Vedic medicine. I summarized the literature on herbs, nutritional supplements, and other treatments. Sometimes, I had to look at areas that were not bpd itself, but related conditions (such as depression, anxiety, and attention deficit disorder) to find relevant material. 

Do you think we will see any major changes in treatment in the next 10 yrs?

Yes! Research into both psychological and biological interventions are continuing. I believe that there will be improvements in medications, and in psychotherapy. In "New Hope" I discuss the many new ideas and research projects that are on the horizon. I am also hopeful that early intervention will help to prevent BPD.

I am hopeful-though I can't say I'm confident-that there will be research on alternative methods, such as homeopathy and Traditional Chinese Medicine as treatments for BPD. There's not much money for research for those modalities, and I don't think BPD is on their radar screen, but it should be.

What drew you to work with patients who have the BPD diagnosis?

Shortly after completing my internship, while working at a hospital in New York, I worked with a client who had borderline personality disorder. He was a tough character on the outside-he was verbally and physically abusive to nursing staff, and wreaked all kinds of havoc on our treatment team. I devised a plan whereby all of us-everyone involved with his care-would treat him consistently, based on a behavioral treatment contract. We discouraged his abusive behavior, and provided a stable environment. The turnaround was incredible! The abusive behavior completely stopped, and his natural charm emerged. He became one of the more popular patients on the unit, even with nursing staff. Before he left, he bought pizza for the nursing staff to thank them for their excellent care. I was hooked. When I think of this client (I have written about him under the pseudonym, "Doug Freeman,") I have bittersweet memories. He died a few years after our intervention, of a lung infection. His closest friend contacted me. How did she get my name? Doug kept my card in his wallet, to the day he died. 

I think that with this population there can sometimes be enormous changes, since they generally deeply desire a strong connection with people.

Many mental health care professionals refuse to work with patients with the BPD as they are unsuccessful in their treatment and say that people with this disorder are "difficult and frustrating to work with." What do you tell them?

The short answer is that I tell them to learn about the many great treatments that there are, and provide appropriate referrals if working with people with BPD makes them uncomfortable. The problem is not being uncomfortable. We all have niches. People who do work with adults usually don't do work with children, and vice versa-they're different specialties. The problem is the assumption that treating BPD is hopeless, that nobody likes working with individuals with the disorder, and therefore there is no point in making a referral. Of course, that is not true; many therapists enjoy working with people with BPD. The easiest place to find such therapists is in Dialectical Behavior Therapy (DBT) programs, though, unfortunately, many communities do not have DBT programs. Simultaneously, I encourage therapists to get more training in treating people with BPD if they are interested, since once you are sufficiently trained and/or in the appropriate setting, working with people with BPD is challenging and rewarding. I also encourage therapists to make routine use of initial testing, e.g. with the Millon Clinical Multiaxial Inventory (MCMI). This can alert clinicians to the likelihood that they are working with someone with BPD, so that they either treat or appropriately refer the client appropriately. 

That answer works here in Chicago, where we have two DBT programs and other resources. In other cities and towns, referral is not so easy. If you need a referral, a great resource is my co-author Valerie Porr's organization, TARA-APD. You can call 1-800-4-TARA-APD. 

How long have you been treating patients with BPD?

About 15 years.

Do you plan on writing any more books in the future and if so what kind?

I am currently working on a book called "Personality Guided Therapy for Depression." It is targeted at clinicians and academics.
I also have developed an interest in poetry by people with mental health conditions such as personality disorders, depression, anxiety, and PTSD. Although I have no immediate plans to do so, I could imagine putting together a poetry anthology that would be used to help others understand the feelings of people with mental health conditions better. I think that poetry is a great way to get at an important question: what does it feel like to have borderline personality disorder (or other conditions)? Once people understand, it leads to empathy, and empathy leads to more positive connections among people.

2/03