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SET Communication

“SET”—Support, Empathy, Truth—is a three-part system of communication (see Figure 5-1). During confrontations of destructive behavior, important decision-making sessions, or other crises, interactions with the borderline should invoke all three elements. UP stands for Understanding and Perseverance—the goals that all parties try to achieve.

The S stage of this system, Support, invokes a personal, “I” statement of concern. “I am sincerely worried about how you are feeling” is an example of a Support statement. The emphasis is on the speaker’s own feelings and is essentially a personal pledge to try to be of help.

With the Empathy segment, one attempts to acknowledge the borderline’s chaotic feelings with a “You” statement: “How awful you must be feeling.” It is important not to confuse empathy with sympathy (“I feel so sorry for you . . .”), which may elicit rage over perceived condescension. Also, Empathy should be expressed in a neutral way with minimal personal reference to the speaker’s own feelings. The emphasis here is on the borderline’s painful experience, not the speaker’s. A statement like “I know just how bad you are feeling” invites a mocking rejoinder that, indeed, you do not know, and only aggravates conflict.

FIGURE 5-1

The T statement, representing Truth or reality, emphasizes that the borderline is ultimately accountable for his life and that others’ attempts to help cannot preempt this primary responsibility. While Support and Empathy are subjective statements confirming how the principals feel, Truth statements acknowledge that a problem exists and address the practical, objective issue of what can be done to solve it. “Well, what are you going to do about it?” is one essential Truth response. Other characteristic Truth expressions refer to actions that the speaker feels compelled to take in response to the borderline’s behaviors, which should be expressed in a matter-of-fact, neutral fashion (“Here’s what happened . . . These are the consequences . . . This is what I can do . . . What are you going to do?”). But they should be stated in a way that avoids blaming and sadistic punishing (“This is a fine mess you’ve gotten us into!” “You made your bed; now lie in it!”). The Truth part of the SET system is the most important and the most difficult for the borderline to accept since so much of his world excludes or rejects realistic consequences.

Communication with the borderline should attempt to include all three messages. However, even if all three parts are stated, the borderline may not integrate all of them. Predictable responses result when one of these levels is either not clearly stated or is not “heard.”

For example, when the Support stage of this system is bypassed (see Figure 5-2), the borderline characteristically accuses the other of not caring or not wanting to be involved with him. The borderline then tends to tune out further exchanges on the basis that the other person does not care, or may even wish him harm. The borderline’s accusation that “You don’t care!” usually suggests that the Support statement is not being integrated.

FIGURE 5-2

The inability to communicate the Empathy part of the message (see Figure 5-3) leads to feelings that the other person does not understand what the borderline is going through. (“You don’t know how I feel!”) Here, the borderline will justify his rejection of the communication by saying he is misunderstood. Since the other person cannot appreciate the pain, his responses can be devalued. When either the Support or the Empathy overtures are not accepted by the borderline, further communications are not heard.

FIGURE 5-3

When the Truth element is not clearly expressed (see Figure 5-4), a more dangerous situation emerges. The borderline interprets others’ acquiescence in ways he finds most comfortable for his needs, usually as confirmation that others really can be responsible for him, or that his own perceptions are universally shared and supported. The borderline