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People with borderline personality disorder often have difficulty creating a structured, adult container for their life. Instead of developing and sticking to a daily schedule for predictable reoccurring events—like going to bed at a reasonable time given when they must get up in the morning—they tend to prioritize whatever feels good in the moment.
For example, my client Sara told me in her session that she needed to get to sleep early because she has an important meeting the next day. But next session I found out that she never got to the meeting because she felt so lonely she went to a bar looking for love. She settled for a night filled with drugs and sex. She woke up late and decided to skip work because she had already missed the meeting. The promise of love was more important to her than the possibility of losing her job.
The Borderline Lack of Structure and Their Focus on Love Can Derail Therapy
James F. Masterson (1926-2010), the well-known expert in borderline personality disorder and the author of many books on this topic, used to say that the worst thing that could happen in the therapy of someone with BPD was if they fell in love. All therapy progress would stop because all they will want to think about is their new romance and they have not yet developed enough self-discipline to stay focused on anything less pleasant (1976).
Note: I am using the terms borderline, BPD, and borderline adaptations as shorthand for people who qualify for a full diagnosis of borderline personality disorder.
Borderline Clients Need Less Spontaneity and More Structure
While some of my other therapy clients need to become more comfortable with spontaneity, the opposite is true for many of my borderline clients. They often secretly live like a young teenager. They procrastinate, have trouble staying motivated to finish things, and live a very disorganized and impulsive life designed to keep painful feelings at bay.
Lack of External Structure Mirrors Lack of Internal Structure
Their lack of external structure often reflects their need for greater internal structure. And their lack of internal structure makes it harder for them to create a stable external structure suitable for a healthy adult.
What do I mean by this? Most adults create a set of basic rules about things that they do every day—like choosing a regular bedtime and what to eat for breakfast so that they do not have to waste time and energy making the same decisions every day.
But my clients with BPD often feel overwhelmed by the whole idea of organizing their life and sticking to a regular schedule. Painful feelings start to surface when people with BPD self-activate. To stop the pain, they stop moving forward and go back to however they coped before when the emotions felt intolerable. As a result, my borderline clients often develop sleep or eating disorders, various types of addictions, and use sex to get companionship.
Masterson called this pattern “The Borderline Triad.” It consists of one step forward, then negative feelings start to surface, followed by a step back into using an old, maladaptive defense that makes them feel temporarily better but undoes their progress (1976).
Living a More Structured Life Is Calming for People with BPD
Before clients with borderline adaptations can deal with the root of their problems, they need more tools to work with their feelings productively and a daily structure in place that is sturdy enough not to be derailed by every mini crisis. Often, DBT (dialectical behavior therapy) is a good place to start learning the necessary tools (McKay et al., 2019).
Once they have these tools, a deeper, insight-oriented psychotherapy aimed at healing BPD has a better chance of success, such as the object relations approach outlined in James F Masterson’s books.
By adding external structure, they build more internal structure through repeating the same patterns daily. Repetition itself tends to be calming rather than exciting. Eventually, neural networks form in the brain and repeatedly fire together. When that happens, what previously required a lot of thought and willpower now happens automatically. The repetitions create the neural networks and, once in place, the mental and emotional energy they save can be used for other projects (Edelman, 1987).
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How to Help Yourself
If you recognize yourself in the above description, here are some steps you can take to improve your life by creating structure.
Step 1: Make a List. Make a list of three things that would add healthy structure to your life.
Step 2: Choose a Focus. Choose only one to start to work on immediately.
Step 3: Be Realistic. Choose something you can see yourself actually doing.
Step 4: Motivation. Before you begin, write down how doing this will improve your life. Reread this whenever your motivation flags.
Step 5: Start Now. Start doing the new behavior immediately as best you can.
Step 6: Keep Beginning Again. Some failure or backsliding is inevitable. Just start again and pat yourself on the back for doing so.
When you have successfully implemented your first improvement from your list, pick another one. Notice how good your new successes make you feel about yourself.
What If You Have No Idea What to Choose?
Here are some life areas that adults handle every day. I am listing some basic ones below to get you started.
Sleep: Choose a regular daily time to go to sleep and wake up. Plan on about eight hours of sleep. Most people need up to an hour and a half to wind down for sleep. This translates to turning off the television and getting off the cellphone or computer or anything else stimulating. Reading and listening to soothing music is usually a good way to unwind and prepare to sleep.
If you find your thoughts disturbing, download a meditation app like “Insight Timer” to your cellphone, put on your earbuds, and go to sleep listening to a soothing guided meditation for sleep.
Eating: Learn something about good nutrition and plan simple, healthy meals that you can make at home. If you eat out a lot, decide what changes you would like to make in what you order.
If you have an eating disorder, part of building a new relationship with food may involve getting appropriate help with your disordered eating.
Exercise: If you are not already exercising, make a reasonable and realistic plan to do so. Be realistic and choose something you like that you can stick with. You can start with as little as 10 minutes a day.
Health Care: Make those doctor and dentist appointments that you have been putting off. A surprising number of my clients with BPD never see a doctor or a dentist unless they are having a painful emergency.
Finances: Make a budget, live within your means, and start saving for retirement. Do not take on expenses you cannot afford.
Summary
If you are struggling with borderline issues and have trouble meeting the normal demands of adult life, you are likely to benefit by adding predictability and more external structure to your daily life. A chaotic life makes people feel more chaotic emotionally. As you work to implement changes and start to feel more stable, your self-esteem is likely to get restructured in a positive way as well.
To find a therapist, please visit the Psychology Today Therapy Directory.
