Support, Empathy, Truth – SET for Borderline Personality

When borderline personality disorder makes communication difficult, following the SET method may help. SET stands for support, empathy and truth. It was developed by Jerold J. Kreisman, MD and Hal Straus, the authors of I Hate You, Don’t Leave Me and Sometimes I Act Crazy.

Why SET Works

The symptoms of borderline personality disorder (BPD) can result in the BP asking for conflicting things or being unable to recognize that the another person cares for them, especially during times of stress. A person with BP may be unable to experience conflicting feelings at the same time, and tends to see things in black and white with very little shades of gray. As a result, the BP experiences her current feelings as a persistent state of being.

SET allows friends and loved ones of people with BP to honestly and address the person’s demands, assertions, or feelings, while still maintaining appropriate boundaries. It is important to do these steps in order, as each step builds upon the other.

Support

Support refers to an initial statement which indicates the loved one supports the person with borderline personality. It is a statement that begins with “I” and demonstrates concern and a desire to help. It can be anything that establishes a foundation for the relationship or interaction: “I want to try to help you feel better,” “I care about you,” or “I am worried about how you are feeling.”

The support statement is meant to reassure the BP that the relationship is a safe one, and that her needs matter even during this difficult moment.

Empathy

Empathy refers to communicating that the loved one understands what the BP is feeling, and focuses on “you.” It is not a conveyance of pity or sympathy, but instead a true awareness and validation of the feelings of the BP: “I see you are angry, and I understand how you can get mad at me,” “How frustrating this must be for you.”

It is important not to tell the BP how she is feeling, but instead put her demonstrated feelings into words. The goal is to convey a clear understanding of the uncomfortable feelings she is having and that they are OK to have, thus validating her feelings. Without such a statement of empathy, the BP may feel that her feelings are not understood. It is important to use feeling words, as in the examples above.

Truth

Truth refers to a realistic and honest assessment of the situation and the BP’s role in solving the problem. It is an objective statement that focuses on the “it” — not on the subjective experience of the BP or Non-BP. Often the BP may seem to be asking, or demanding, something impossible, not taking an active role or responsibility in resolving the issue, or even presenting you with a “no-win” situation. The truth statement is meant to clearly and honestly respond to the difficult demand or behavior of the BP, while placing responsibility appropriately: “This is what I can do…,” “This is what will happen…,” “Remember when this happened before and how you felt so bad about it later.”

It is important to use the support and empathy statements first, so that the BP is more likely to “hear” what you are saying, otherwise the truth statement may be experienced as little more than another, and expected, rejection creating even more defensiveness or anger.

Validation and Support Are Not Agreement

When first learning about SET, it can seem that you are being asked to agree with the BP.  But that is not the case, instead is a specific method of responding to very real feelings that the BP is experiencing at the moment and is likely inhibiting his/her ability to engage with you honestly.  It also helps to remember that validating feelings does not mean that you agree with the feelings, only that you recognize that the BP is feeling them.  Finally, the supportive communication described in the SET model does not mean that you are letting the BP off the hook or control you, instead you are focusing on engaging in honest communication and doing your best to ensure that you are being heard, not just defensively reacting to what is being said.