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Lost in the Mirror: An Inside Look at Borderline personality disorder (2nd ed.).
By Richard Moskovitz. Dallas, Texas: Taylor Publishing Company, 2001, 192 pages, $13.95.
Lost in the Mirror does an excellent job of taking the reader through the entire journey of borderline personality disorder, from the person’s childhood, which is usually filled with trauma, through the ups and downs of psychotherapy to how they can finally come to understand the origins of their pain. This book is divided into twenty-one short chapters and covers a diverse range of topics, including the issues of suicide, self-mutilation, and how a person with borderline personality disorder can control their impulses. At the beginning of the book Moskovitz includes a letter to the reader that explains that this book was specifically written for people with borderline personality disorder. Moskovitz then gives a description of what borderline personality disorder is, including the diagnostic criteria and an explanation of symptoms. Moskovitz writes about this disorder in such a way that this book would be appropriate and helpful for both psychotherapists and patients to read.
Moskovitz paints an accurate picture of people with borderline personality disorder while at the same time describing them in a very nonjudgmental and uncritical way. He further provides a description of the origins of borderline personality disorder such as biological factors and the very common factor of childhood sexual and physical abuse and victimization. In fact, Moskovitz states that four out of five patients with borderline personality disorder have a history of traumatic experiences. He further notes that while the groundwork for the development of borderline personality disorder may be laid during one’s childhood, it is common that the symptoms will not appear until adulthood. Moskovitz then explains how people with borderline personality disorder are uncertain of who they are and tend to have extreme emotional reactions and behaviors. He discusses how these factors affect the person with borderline personality disorder as well as those around her or him. Moskovitz describes how people with borderline personality disorder often use defense mechanisms such as splitting, black-and-white thinking, and dissociation in order to protect themselves from uncomfortable situations and feelings. He goes on to explain that such defense mechanisms, which are usually developed in childhood, later affect the person’s interpersonal relationships in adulthood.
Moskovitz discusses the sensitive topic of self-mutilation and does an admirable job of helping the reader to better understand these acts as well as the different meanings behind them such as punishment, a cry for help, and reenactment. He further explains that people with borderline personality disorder are at high risk for suicide and often make threats of suicide. He explains that it is important to take these threats seriously since this population is at great risk for suicide. Moskovitz explains that a borderline person might contemplate or commit suicide for a number of reasons including the feeling of power over others and the belief that they will gain the love and devotion in death that they did not receive during life. However, Moskovitz also notes that it is important to not encourage such threats if they are only being used as a means of manipulation of the therapist, a family member, or friend. Moskovitz explains that the only permanent solution to relieving the pain that causes such acts would be to change the borderline person’s behavior and emotions that underlie these acts.
Moskovitz goes into detail concerning what it is like for a person with borderline personality disorder during treatment, throughout the entire journey. He describes the importance of the client-psychotherapist relationship as well as the importance of treatment contracts. Moskovitz provides suggestions for ways in which people with borderline personality disorder can control their impulses such as by becoming aware of what makes them vulnerable, developing positive rituals, and learning to control their surroundings. He discusses the importance of determining a borderline patient’s source of anger and then teaching the person how to be more assertive as well as how to vocalize their feelings to others. He further goes into detail on how to work with people with borderline personality disorder to assist them in learning how to manage their emotional distance with others. He discusses the issue of hospitalization and gives a comprehensive explanation of why people with borderline personality disorder resist being admitted and then later resist being released. Moskovitz explains that most people with borderline personality disorder will spend some time in a hospital during their recovery. He notes that the main goals of hospitalization are to restore safety and to prevent impulsive behaviors in order to work through the underlying emotions.
Moskovitz explains the advantages of having borderline patients participate in group treatment in addition to individual psychotherapy. He explains that group psychotherapy provides an opportunity to learn how to manage relationships and communicate effectively. Moskovitz then gives a thorough explanation of medication treatment including all the possible medications that a person with borderline personality disorder may use as well as the strengths and weaknesses of each. Moskovitz then identifies the potential difficulties that may arise during psychotherapy with borderline patients. He notes that is important for psychotherapists to focus on the underlying emotions, not just specific behaviors. He explains that by a therapist just focusing on one particular behavior, the person with borderline personality disorder will most likely just shift from that impulsive behavior to another; not really addressing the underlying issues. Moskovitz then discusses several factors that are prevalent among people with borderline personality disorder. One emotion that is often present in this population is anger. Moskovitz discusses the origins of this emotion as well as productive and useful ways that a borderline person can learn to deal with their anger. Moskovitz then discusses the issue of intimacy. He notes why people with borderline personality disorder tend to have difficulty with their interpersonal relationships. He further discusses what a person can do to control their impulsive reactions to loved ones. He suggests that a person with borderline personality disorder do things such as monitor personal relationships, identify their feelings, and diversify their relationships.
This book would be appropriate for beginning to experienced psychotherapists, family and friends of people with borderline personality disorder, as well as people with borderline personality disorder themselves. Moskovitz goes into detail about how this population should be treated and makes numerous useful suggestions on how to work with this population. Additionally, Moskovitz does such a good job of not only describing what the symptoms of borderline personality disorder are but also the feelings and thoughts of the person with borderline personality disorder. Therefore, Lost in the Mirror would be a good source for family and friends of people with borderline personality disorder because it would help them to understand what their loved one is experiencing and feeling due to their disorder. Further, from reading this book family and friends could learn what they could do to help their loved one. Moskovitz includes a number of suggestions for family and friends of people with borderline personality disorder including maintaining boundaries and communicating their feelings. Additionally, this book would help them to understand that their loved one is not alone in their suffering due to this disorder.
Lost in the Mirror would further be an excellent choice for people with borderline personality disorder to read because it would, first of all, display to them that they are not alone in what they are experiencing and feeling. This would be evident to them through the many examples of patients’ stories that Moskovitz includes throughout the book. This book will further assist the person with borderline personality disorder to gain a better understanding of their disorder. Additionally, this book would inform the person with borderline personality disorder as to what psychotherapy will most likely be like for them, including what will bring them relief as well as what may possibly cause them distress. Additionally, this book would be appropriate for anyone who suspects a loved one might be suffering from borderline personality disorder or someone who is simply interested in learning more about this disorder and the people who suffer from it. Therefore, I would strongly recommend this book to psychotherapists, people with borderline personality disorder and family and friends of people with borderline personality disorder.
This book has numerous strengths without any apparent weaknesses. Lost in the Mirror does an excellent job of explaining what borderline personality disorder is as well as the steps that should be taken by psychotherapists and family members in order to assist a person with this disorder. Further, Moskovitz skillfully incorporates many examples of persons who were in therapy due to the fact that they were suffering from borderline personality disorder. I believe these examples are invaluable because they demonstrate to psychotherapists what kinds of methods and techniques are needed when dealing with this population. These real-life examples further reveal to people with borderline personality disorder that other people have experienced the same kind of feelings as them and that they are therefore not alone. Additionally, I believe that the wide range of case examples makes the behaviors and feelings of people with borderline personality disorder seem more real and understandable. Another strength of this book is that it is written specifically for people with borderline personality disorder which may make them feel like their problems and disorder are important. Finally, the biggest strength of this book is that Moskovitz included at the end of every chapter a running dialogue of the fictional case of “Sara.” Sara was a character that Moskovitz created based on the many patients with borderline personality disorder that he has worked with over the years. At the end of each chapter there would be a few pages of dialogue and story about Sara that are relevant to issues addressed in the chapter. Moskovitz takes this character through the beginning of psychotherapy through its successful completion and includes all the highs and lows along the way. I believe that this is an invaluable component because it demonstrates to the reader what people with borderline personality disorder experience and feel throughout their lives but especially during the stages of psychotherapy.
This book could be incorporated into psychotherapy in a number of different ways. First, the psychotherapist could assign the patient to read this book at the outset of treatment. The psychotherapist and patient could then take some time in the following sessions to discuss how the patient felt reading about her or his disorder and the experiences others have had with it. Another approach to incorporating Lost in the Mirror into psychotherapy would be for the psychotherapist to assign relevant chapters to the patient as they are relevant throughout the course of treatment. Then, psychotherapist and patient could explore and address the issues raised and their relevance to the patient. Regardless of the approach used, this book would be an excellent addition to ongoing psychotherapy as a bibliotherapy resource. The combination of real life stories of people with borderline personality disorder and discussions of which techniques are most beneficial in treatment are what makes this book appropriate for psychotherapists and patients alike. In conclusion, Moskovitz does an excellent job of taking this complex and often misunderstood disorder and explaining the feelings and daily struggles of individuals with borderline personality disorder.