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All Behaviour Is Meaningful: Q&A with Dan Warrender

Dan Warrender is a lecturer in mental health nursing at Robert Gordon University in Aberdeen, Scotland. Dan also continues to practice in the NHS as a mentalization based therapist. His teaching, PhD research and clinical interests are around people diagnosed with ‘borderline personality disorder’. He is currently an executive group member of the Scottish Personality Disorder Network.

This is the first ever guest post on the blog written by a mental health professional. I hope you enjoy it. Thank you to Dan for sharing your thoughts, experience and ideas!

Photo of Dan smiling. Dan is wearing a black shirt and has short hair.
Photo of Dan smiling!

What do you like most about working with people with BPD? They are people with stories, and often these are stories which have not been heard or understood before. I enjoy working with people and encouraging mentalizing and reflection, so that people can learn about themselves and improve their relationships with others. I also learn something from every person I work with. Exploring people’s minds and lives inevitably leads to reflecting on your own.

What tips would you give to health and social care professionals working with someone who has BPD? Try and educate yourself, particularly around the limitations of diagnostic criteria, and the impact of failed attachments, neglect or trauma on symptoms which are often classified as ‘BPD’. People are always much more than the diagnostic label they are given, and need to be understood in the context of their life experiences. Learning and understanding the principles of trauma informed care is also essential, given that a high proportion of people diagnosed with ‘BPD’ have experienced trauma.

In addition, some form of clinical supervision or reflective space is necessary, as work can be challenging and anxiety provoking, particularly around risk of harm. A literature review I recently completed found that the things that people value in their care are simple; having access to care, being focused on the person rather than the diagnosis, seeing beyond behaviour and exploring underlying distress, being involved in decisions and being offered hope. There is no reason we can’t achieve this.

Text reads: 'I learn something from every person I work with.' - Dan. Background is a wet leaf.

What advice would you give to someone newly diagnosed with BPD? Remember that you are more than a diagnosis. A diagnosis is a social construction, which may be useful if it provides access to effective treatment, but ultimately it may not explain the reasons you are experiencing the difficulties you are. I’m always careful when I challenge diagnosis, as people’s distress is always real, but it just does not fit neatly into a checklist. Diagnosis is more of a ‘what’s wrong’ than a ‘what happened’, and the best way of understanding your difficulties may be through a formulation, a kind of life story rather than a label.

The reason I always use inverted commas around ‘BPD’ is to highlight the considerable critique of the diagnosis, as it is critiqued as invalid, ignorant of people’s life experience and inherently stigmatising.

What do you think is the biggest misconception about BPD amongst professionals? That the distress experienced by people diagnosed with ‘BPD’ is “just behaviour”. Hearing this is unquestionably my biggest frustration. All behaviour is about something, driven by mental states such as thoughts and feelings, and therefore is full of meaning. To say anything is “just behaviour” is a failure in empathy and mentalizing.

Text reads 'all behaviour is about something and therefore is full of meaning.' - Dan. Image background is green leaves.

What advice would you give for the loved ones of someone with BPD? That often the difficulties in interpersonal relationships are down to misunderstandings, and the key is to try to understand the misunderstanding. Sometimes people don’t make sense to us, and we need to reflect and mentalize, considering what another person may be thinking and feeling, while being mindful of how we may be impacting on them. There are so many things unsaid in relationships, and I would encourage honest but sensitive conversations about what everyone is going through. The things we don’t say, others may never know.

How do you feel when you hear stereotypes about people with BPD, such as the myth that people with this condition are attention-seeking or manipulative? It frustrates me that not only do some professionals misunderstand and dismiss the distress of people diagnosed with ‘BPD’, but that they actually make their own jobs more difficult.

We often wonder why some people in care do not make progress, but this can be because the professionals lack hope, and outcomes become a self-fulfilling prophecy.

Because some people hold these attitudes, they don’t put effort and commitment into working with people, and as a result people don’t improve.

What would you say to someone with BPD who is feeling hopeless and like things will never get better? It may be very hard, and it may take time, but you can get better. I’m always careful not to invalidate the very real feeling of hopelessness, and try and hang onto hope for people if they can’t at that moment.

Evidence tells us that generally people improve over time, however I’m aware every minute can feel like an eternity if you are struggling inside your own skin. There is no linear path to recovery, and it’s a process that’s unique to every individual. People do get better, and so can you.

Text reads: 'It may be very hard and it may take time but you can get better - Dan. Background is green leaves.

Thank you again to Dan for this thought-provoking post. I especially liked reading Dan's point that all behaviour is driven by mental states. I think everyone who knows someone with mental health problem could benefit from remembering this idea as it can help create compassion and understanding, rather than frustration or confusion. Wishing Dan all the best with his PhD research!

Check out these links below to find out more about Dan's work, his research and to read his blog >


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