I Love this Week's Readings!

Terrie Moffitt’s Adolescence-Limited and Life-Course-Persistent Antisocial Behavior and Marsha Linehan’s Borderline Personality Disorder have been two of the most lucid, illuminating, inspiring readings of the semester. They are both brilliant figure-ground compositions. Both say a lot (the figure); yet the negative space of the unsaid (the ground) tells just as rich a story. I’m not even talking about “subtext,” here. It’s more like a pulsating “simultext."

Carl Rogers’ unconditional positive regard is the simultext of Marsha Linehan’s article on BPD. My blog a few weeks back scoffed at unconditional positive regard: if psychologists need to operationalize compassion for their clients, I thought, they might be in the wrong profession. After reading Linehan, I embrace unconditional positive regard as both necessary and sufficient. A tell-tale sign of BPD: “The emotional state of both the patients and the therapists seemed to deteriorate when these individuals entered psychotherapy.” Linehan elucidates many mechanisms for maintaining or re-engaging a therapists’ unconditional positive regard for these clients who are so challenging. The first is forthright golden-rule empathy. People with BPD suffer “intense misery;” at another point Linehan likens both their pain and--critically--their basic human innocence, to that of burn victims and cancer patients. This points to another simultext of the article: psychologists have had real contempt for people with BPD. Secondly, the acceptance aspect of Dialectical Behavioral Therapy that is both prerequisite for and mechanism of change is fundamentally Rogerian. Also very Rogerian is Linehan’s emphasis on process over structure. Rogers and Linehan may both agree with the principal of the school for kids with LD I used to teach at: If the process is right, the outcome will be what it needs to be. Of course the “right” processes is often a matter of great debate, but simply (re)locating the emphasis on the process seems much more “right” than not.

[By the way, Borderline Personality is the most misleading term ever. It sounds like these patients are “on the fence” about having a clinical diagnosis or not. In fact what defines Borderline Personality disorder is that individuals don’t hover over a boundary, they continually breach various boundaries. 1. Of life and death (36% of people who meet all 8 DSM criteria for borderline personality disorder are suicidal). 2. Of expected outcomes (by definition, BPD are resistant to treatment). Of client-therapist boundaries (see above discussion of client-therapist emotional states.)]

The simultext of Moffit is the critical importance of etiologies as a framing device or lens. Etiology is like a framing device because of its cropping function; it decides what should be considered as well as what is irrelevant. It’s like a lens because our understanding of one etiological model so easily influences how we evaluate others, making it easy to conflate or invalidate new information that may bear on our model. I entered grad school determined to come out an interventionist. I want to discover the tools for swooping in and changing behavior. More and more, though, I’ve come to realize how critical it is for intervention-oriented psychologists to really refine their understandings of etiologies. A fully realized etiology, like Terrie Moffit’s, does a whole lot of the interventionist’s work. By providing so much evidence about the mechanisms of life-course-persistent antisocial behavior (the kind society really needs to worry about), we interventionists can direct our behavior.