SWEET INSTITUTE – Continuing Education for Mental Health Professionals

Those with Borderline Personality Disorder: What They Need

Mardoche Sidor, MD and Karen Dubin, PhD, LCSW

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“I no longer know what to do. I have tried everything, but she takes one step forward and one step backward. I am just tired and drained.” Elsa articulated these words to Rodis, a consultant who had just started to work with her.

“You are feeling tired and drained. You’ve tried everything, and you no longer know what to do. I am wondering how else this all has been affecting you. Now, you are here perhaps wondering what to do next, and I am here to facilitate this process, so we can then find a way to facilitate the path for your patient and client. Now, tell me, how exactly have you been working with her?” responded Rodis.

“Well, we have tried all sorts of skills. Sometimes she applies them, and other times, she doesn’t. Sometimes she does her assignment, and other times, she doesn’t. I have been telling her over and over what to do, how to do it, and even when to do it. She has really been up and down,” explained Elsa. “Well, there seems to be a lot to talk about here. And as I explained the first time we met, most of my interventions will be in the form of asking questions. As I ask you questions, you will likely be thinking through the answer, realizing some obvious and simple things that you might have overlooked before. Other times, my questions will help you realize some gaps that require filling, and we’ll then take steps to do just that. How does that sound?” responded Rodis, to which Elsa agreed.

Very few “conditions” enjoy the fame equated with Borderline Personality Disorder. Equally, very few “conditions” have been subjected to as much stigma in the field of mental health as Borderline Personality Disorder. Borderline Personality Disorder has often been used as an epithet, “She’s so borderline.” Our way to rationalize when someone is not getting better “Oh, she’s just a borderline,” and a wastebasket diagnosis whenever we misunderstand what is really going on with the patients and clients we serve. More importantly, those properly diagnosed with Borderline Personality Disorder can be challenging. And this is not only due to the nature of the condition but also the fact that we barely understand those living with this condition. This lack of understanding means we are unlikely to really facilitate their recovery. Furthermore, even for those of us who strive to understand this patient population, facilitating their recovery is no small thing. And the question is why? We will answer this question and outline ways for us to facilitate improvement. First, I would like to lay a foundation for the ways we can understand those diagnosed with Borderline Personality Disorder.

There are several theories and explanatory models for Borderline Personality Disorder. There is much literature on all of them, though I am not going to mention them here. In this article and subsequent ones, I strive to help facilitate an understanding of those with Borderline Personality through the framework of the SWEET 7 Fundamental and Universal Needs, which I will introduce in the rest of this article.

The SWEET Fundamental and Universal Needs theory postulates that we all have needs, all of which are neither fundamental nor universal. And some of our needs are both fundamental and universal. In other words, these are specific needs that we all must have fulfilled—specific needs that are undeniable, that each one of us have and hence are universal.

Regardless of who we think we are, who we are told we are, and how we feel about ourselves, we all have these needs. Regardless of where we were born, our ethnicity, the language we grew up speaking, we have these specific needs. These specific needs are the same regardless of our gender, our sexual orientation, our socioeconomic status, and our cultural beliefs. Whether we believe in spirituality or religion, in science or hard work, in humanity or in ourselves, we share these specific needs. Hence, this explains the fundamental and universal characteristics of these needs, which we call the SWEEET 7 Fundamental and Universal Needs.

Here are the SWEET 7 Fundamental and Universal Needs:

  1. Sense of Safety

  2. Sense of Freedom/Self Identity and Variety

  3. Love and Connection

  4. Self-worth

  5. Meaning and Purpose

  6. Growth

  7. Contribution

And here you have it; I have presented the SWEET 7 Fundamental and Universal Needs. And in this article series, I will describe how to understand those with Borderline Personality Disorder through the lens of these needs. Following this, I will demonstrate how to best facilitate the fulfillment of each and every patient living with Borderline Personality Disorder.

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