This article is published in the book:

"Psych 101 -
What you didn't learn in nursing school."

by Kathi Stringer
Paperback: 320 pages
ISBN-13: 978-0615193137

Being 'Flat' with BPD Clients

Written by Kathi Stringer

Reader Feedback HERE


What about therapists who are emotionally "flat" with you? Is this helpful or not helpful? I had one person tell me to be "flat" to prevent being pulled in emotionally by someone with borderline personality disorder.

Signed: Inpatient Intern


Who comes up with this stuff? Being `flat' conveys a lack of nurse-to-patient relationship, lack of a therapeutic alliance, lack of positive regard, lack of validation, lack of being empathically engaged. Beliefs like that will help keep the revolving door spinning around. To hear such things must be unnerving for you (must be crazy-making for you). I would think for a person to mirror me with a `flat' effect (in a locked setting) would cause anxiousness which would tend to escalate stress levels that may lead to disorganized thinking that may finally culminate into impulsive acts. Backfired again.

Additionally, to generalize `be flat with someone with borderline personality disorder' is like saying `someone who is black' or `some Jew' and etc. Not all Jews, Blacks, Whites and etc are the same. How one person in my race behaves does not speak for me. Of course some may argue that we are talking about a `behavior group' and not race, which won't fly because with borderline personality disorder there are 156 possible combinations. For a staff to suggest be `flat' with all borderlines is like saying the countertransference remnants lingering from the last borderline personality disorder population is transferred to the new patient with borderline personality disorder. How unfair because staff is not skillfully trained. When I hear statements like that, it gets translated in my head to – "because I'm not qualified to handle it differently." Not only that, but with borderline personality disorder, staff is getting a `mixed bag' since most times Axis II traits are often a cluster of other PD's.

I have thought for a long time that it would help if a facilitator were hired for the sole purpose of in-service training to help bring in new fresh ideas, stimulate staff, create and inspire challenges within the team. I mean all successful ballplayers have coaches to keep them motivated, why not the same with an effective treatment team? I would conjecture that the extra cost would decrease the repeated hospitalizations. But of course, if I was in the business of getting sick people in my hospital, I guess I might play coy (refuse a facilitator) to keep getting repeat business and job security.