9.01| Supporting a Child in Therapy for Borderline Personality Disorder

[lbjnltx]

Recovery from Borderline Personality Disorder is challenging. Individuals having committed family support heal significantly faster and at higher rates than those isolated or on their own.

Being a caretaker of a person with Borderline Personality Disorder is complex and demanding, even self sacrificing, andit requires strength, love, realistic expectations, protecting your family, and preserving your own emotional health.

For the family, very little is intuitive, it takes specialized skills to support a loved one. According to Dr. John Gunderson, MD, it is important to allow them to fail in a loving way - to learn about reality. Defining and constructively enforcing limitations is important, too. Too often, people assume that the person with BPD should know and respect their limits as any other adult would. This is not a realistic assumption for people with this disorder. You set limits by stating them in advance and in clear, simple language.

This five part guide for supporting a loved one is based on recommendations from McLean's Hospital, a national center of excellence for Borderline Personality Disorder treatment affiliated with Harvard University.

Five-part Guide <click here>

[qcarolr]

I know that these work for my family, when I am grounded enough to have access to the skills. Taking care of my own needs - this is first step in all of this. This is from my notes. If you watch this a I missed something, please post a reply correction.

Family Guidelines:

Understand we struggle with our own reactions: goal to decrease blame on family to reduce reactivity, learning acceptance

We need stucture: education, support groups, etc

Learn princples of validation

5 guidelines:

• Go slowly: it took years to get here, be patient with the process for improvement



• Small steps: attainable goals, staying focused



• Emotionally engaged: not neutral or dull, modulate tone, avoid blaming and judgement, describe vs. evaluation, have family routines, avoid assuming the worst



• Manage anger and response to pwBPD's anger: acknowledge as legitimate any kernal of truth in their experience, resist taking to persoanlly - anger is "addressed to occupant"



• Addressing problems: collaborate with others in pwBPD's life, ask how you can help pwBPD, stay consisten - keep following rules and routines, state limits of tolerance - keep it simple and non-coercive, do not tolerate abuse - walk away saying you can discuss later, find professionals that encourge family to be involved.

The NEA_BPD "Family Connections" program offers so much of what he is talking about here. As gd7 become more independent, I would really like to train to provide this in our area. I have a dream!

qcr  

[lbjnltx]

Here is my journal on my daughters (BPD d13) residential treatment at Falcon Ridge Ranch

Falcon Ridge Ranch Month 1<click here>

[qcarolr]

I watched a couple of the utube videos last night from a recent conference of NEA-BPD. It gave hope to me for my DD26, and had a lot of emphasis on how important family support and advocacy is for our kids. It also gave me encouragement that much of the work I have done with the resources here at bpdfamily.com are on the right track with the research that the Overview video presented. He also discusses the 6 treatment options that show good success for our kids.



www.youtube.com/watch?v=C8o2h2Ic8dc

The one thing that was discussed that differs from what I have read here at bpdfamily.com is the value of our kids knowing their dx of BPD. This has opened a doorway for me to connect with the mental health providers that work on a very limited basis with DD. DD is the one that limits this connection - and they are not assertive in any way with her about her dx or treatment options and the benefits they can provide for her to reach her goals of getting a job and moving into her own place.

DD did sign a release for limited contact for me with the NP that does her meds supervision. (nurse practioner) The non-profit mental health center does not have a pdoc that sees clients directly - only for supervision of the NP's - in the adult program. [My gd7 does see a pdoc for her anxiety meds - the child program is seperate area]. I have left a message for her NP to call me and discuss ways we can collaborate for DD's support.

I see that my role needs to shift from 'case manager' with DD to one of advocate with professionals in her life - and to find ways for DD to accept the professionals she needs in her life. Since she has this motivation to get her own place, which means getting a job, I believe she may be more open to working within the mental health system to accomplish these goals. I am more hopeful anyway.

Come back and share what you think of this video (it is on another thread as well) and how it impacts your connections with your pwBPD.

qcr  

ps. the change in DD ie. moving out which pushes her getting a job has been pushed by my enforcing the limits on pot smoking in our house and no overnight guests. There are violations, and she is asked to leave (which she does every weekend anyway). The pressure of these boundaries is being applied very consistently by me - avoided at times my dh. I withdraw from contact with DD - meduim chill temporarily - when these violations occur and dh is not supportive. This seems to be working for now. When she is compliant then I am available to her as this advocate.

[jellibeans]

You and I must have been doing the same ting this weekend... .    I watched this video and I did think it gave me hope and a great deal of understanding. There are so many videos on BPD by the NEA BPD... .    all so helpful... .   

[Reality]

A very informative presentation, clearly articulated.  It confirms much of my thinking.  Very interesting point about the need to treat the BPD before the depression. 

Reality

[qcarolr]

Reality - at least diagnosis the BPD before waiting for the depression to lift! The other statistic that seemed important to me personally was that depression had a higher rate of recurring pattern with BPD dx.

I am coming to believe that BPD may be part of me, and that I have worked really hard to overcome many of the consequences. And was very lucky to find supportive people along the way in my life - spiritual intervention   Maybe why my depression never has really left me despite meds and therapy. Maybe why my pattern of bipolar never really fit the model.  I always have to be conscientous about self-care and managing my emotional distress -- and so easy to blame others for my distress.

So plan to talk with my T about this tomorrow. I do not currently meet 5 of the 9, but did many years ago as I look back. Need to verfiy my 'self-dx'.

qcr 

[Reality]

qcaroir,

I love this video, so I listened to it again. 

The statistics show that if a depression is treatment resistant, there is a good chance that the person has BPD, indicating the importance of BPD being classified as an Axis 1 disorder in the future.  That is my understanding.

40% of people who actually have BPD are misdiagnosed as having Bipolar. 

Reality - at least diagnosis the BPD before waiting for the depression to lift!

I am trying to understand what you mean by this.

I LOVE the way Dr Palmer makes sense of the BPD behaviors and thinking etc.

Thank you so much.

Reality

[qcarolr]

There was a comment that some pdocs want to treat depression first before considering BPD. Maybe I heard it incorrectly. I really appreciated the hopefulness I came away with from this video.  And from some of the others at this conference.

qcr 

[Rapt Reader]

That is a great Article (linked to in the first post: Supporting a Child in Therapy for Borderline Personality Disorder)    I have to say, everything rings true for me, regarding my son who was diagnosed with BPD in April 2013, at the age of 36. This especially:

Remember that change is difficult to achieve and fraught with fears. Be cautious about suggesting that "great" progress has been made or giving "You can do it" reassurances. Progress evokes fears of abandonment. The families of people with Borderline Personality Disorder can tell countless stories of instances in which their son or daughter went into crisis just as that person was beginning to function better or to take on more responsibility.

The coupling of improvement with a relapse is confusing and frustrating but has a logic to it. When people make progress - by working, leaving day treatment, helping in the home, diminishing self-destructive behaviors, or living alone- they are becoming more independent. They run the risk that those around them who have been supportive, concerned, and protective will pull away, concluding that their work is done. The supplies of emotional and financial assistance may soon dry up, leaving the person to fend for herself in the world. Thus, they fear abandonment. Their response to the fear is a relapse.

They may not make a conscious decision to relapse, but fear and anxiety can drive them to use old coping methods. Missed days at work, self-mutilation, a suicide attempt, or a bout of overeating, purging or drinking may be a sign that lets everyone around know that the individual remains in distress and needs their help. Such relapses may compel those around her to take responsibility for her through protective measures such as hospitalization. Once hospitalized, she has returned to her most regressed state in which she has no responsibilities while others take care of her. When signs of progress appear, family members can reduce the risk of relapse by not showing too much excitement about the progress and by cautioning the individual to move slowly.

This is why experienced members of a hospital staff tell borderline patients during discharge not that they feel confident about their prospects, but that they know the patient will confront many hard problems ahead. While it is important to acknowledge progress with a pat on the back, it is meanwhile necessary to convey understanding that progress is very difficult to achieve. It does not mean that the person has overcome her emotional struggles. You can do this by avoiding statements such as, "You’ve made great progress," or, "I’m so impressed with the change in you." Such messages imply that you think they are well or over their prior problems. Even statements of reassurance such as, "That wasn’t so hard," or, "I knew you could do it," suggest that you minimize their struggle. A message such as, "Your progress shows real effort. You’ve worked hard. I’m pleased that you were able to do it, but I’m worried that this is all too stressful for you," can be more empathic and less risky.

Wow! This information was told to us on my son's release from the Intensive In-Patient Dual Diagnosis Program where he was diagnosed with BPD, and taught DBT. And then, in the weeks that followed his release (when he couldn't stop telling us everything he'd learned about himself   ), he himself explained how all of that worked, since it seemed counter-intuitive to me. But, since learning this, I've been careful to put it into practice and weirdly enough, by following those "rules" we've alleviated the pressure on my son in his recovery.

I encourage everyone to read that Article; it's really eye-opening and helpful... .

[Rapt Reader]

Something else in the Article that I've found to be invaluable information for me with my son's recovery, and if you've read it already, it's worth another take:

Listen.



People need to have their negative feelings heard. Don’t say, "It isn’t so." Don’t try to make the feelings go away. Using words to express fear, loneliness, inadequacy, anger, or needs is good. It’s better to use words than to act out on feelings.

When feelings are expressed openly, they can be painful to hear. A daughter may tell her parents that she feels abandoned or unloved by them. A parent may tell his child that he’s at the end of his rope with frustration.

Listening is the best way to help an emotional person to cool off. People appreciate being heard and having their feelings acknowledged. This does not mean that you have to agree.

Let’s look at the methods for listening.

One method is to remain silent while looking interested and concerned. You may ask some questions to convey your interest. For example, one may ask, "How long have you felt this way?" or "What happened that triggered your feelings?" Notice that these gestures and questions imply interest but not agreement.

Another method of listening is to make statements expressing what you believe you’ve heard. With these statements, you prove that you are actually hearing what the other person is saying. For example, if your daughter tells you she feels like you don’t love her, you can say, even as you are contemplating how ridiculous that belief is, "You feel like I don’t love you?" When a child is telling her parents that she feels as if she has been treated unfairly by them, parents may respond, "You feel cheated, huh?" Notice once again, these empathic statements do not imply agreement.

Do not rush to argue with your family member about her feelings or talk her out of her feelings. As we said above, such arguing can be fruitless and frustrating to the person who wants to be heard. Remember, even when it may feel difficult to acknowledge feelings that you believe have no basis in reality, it pays to reward such expression. It is good for people, especially individuals with BPD, to put their feelings into words, no matter how much those feelings are based on distortions. If people find the verbal expression of their feelings to be rewarding, they are less likely to act out on feelings in destructive ways. Feelings of being lonely, different, and inadequate need to be heard. By hearing them and demonstrating that you have heard them using the methods described above, you help the individual to feel a little less lonely and isolated. Such feelings are a common, everyday experience for people with BPD. Parents usually do not know and often do not want to believe that their daughter feels these ways. The feelings become a bit less painful once they are shared. Family members may be quick to try to talk someone out of such feelings by arguing and denying the feelings. Such arguments are quite frustrating and disappointing to the person expressing the feelings. If the feelings are denied when they are expressed verbally, the individual may need to act on them in order to get her message across.

I have found this information and the tips to be so helpful for me in my dealings with my son (here's My Son's Recovery-In-Progress Story). And also with the other BPD loved ones in my life; my Husband has BPD traits and this understanding of his need to vent sometimes without my personalizing it, really does help to de-escalate what used to be "episodes" in our relationship.

I'm curious if anyone else finds this to be true? And do you find it hard to do? Or have you been able to master the methods mentioned in the quote? I'd love to hear your stories  

[jellibeans]

Rapt I think this is very true. I try and listen I do this sometimes by just nodding my head if I am unsure what to say. I do think it is key to acknowledge their feelings. I also think it is good to work through them with your child. I think at times fear can look a lot like anger. This can go back to their struggles with social cues and maybe not being able to understand their own emotions. I guess you could say this about all of us at times.

[qcarolr]

Listening as a way to validate feelings even when not agreeing with beliefs or actions. Hmmmm. I feel like this is becoming more 'natural' for me, unless my dh is in the area. His intervention or comments can undermine totally the progress being made in a situation with either with DD28 or gd9. Well, between him and I as well.

Could it be that he is entering a new level of burn-out in coping with the daily grind of life in our home?

Dh acknowledges that the 'new' ways I have been dealing with both of our girls seems to work. He struggles to see how he responds to that, often in very defensive ways. He keeps breaking the 'no yelling' rule -- then I jump in to set him 'right' and break the rule -- then DD goes out of the room gritting her teeth and feeling how unfair it is that she cannot break the rule and stay in the house. She asked me why dh doesn't have to leave. I really did not have a good answer.

I have been pondering this all day. What is my part? What is out of my realm of control? How do I accept that he is who he is and find ways to step out of the conflict? How do I reduce the stress of all this on gd9?

More pondering and some prayer ---

qcr

[Rapt Reader]

Listening as a way to validate feelings even when not agreeing with beliefs or actions. Hmmmm. I feel like this is becoming more 'natural' for me, unless my dh is in the area. His intervention or comments can undermine totally the progress being made in a situation with either with DD28 or gd9. Well, between him and I as well.

My Husband used to do this as well, but now his relationship with my son at home (the one diagnosed with BPD) is very good as my son has recovered so nicely. And my Husband has learned to stay out of the conversation--by phone or email--with my other son and his wife (who has BPD traits), because he realizes now that he overreacts with emotion when things get "weird" with them, and that I know how to handle it all better than he does. He doesn't even get angry at me anymore for not reacting as he would with them, or for "coddling" them. He sees that we need to communicate better with them in order to preserve the relationship with them, and to be able to see our grandchild.

He got this way by watching my interactions with our son at home, and learning from my conversations with that son what BPD was all about; and how the "feelings=facts" part of it skewed our D-I-L's perceptions of us as a family. He totally understands Validation and S.E.T. now, and though he can't really "do it" himself, he knows enough to back away and let me handle it. I've also used all of those techniques with him too, and he now trusts me to handle things the right way.

Could it be that he is entering a new level of burn-out in coping with the daily grind of life in our home?

That sounds really plausible, now that your daughter is home, and things have changed because of that. Have you and your husband had a good, solid conversation about all of this, using the Listening techniques above? Probably you have, and using Validation and S.E.T. too... .Maybe he wouldn't feel the need to vent or intervene with your daughter if he felt his thoughts were understood and validated? I know that my Husband has backed off, now that he feels that he and I are on the same page emotionally, and he doesn't need to prove his feelings anymore in another way.

Dh acknowledges that the 'new' ways I have been dealing with both of our girls seems to work. He struggles to see how he responds to that, often in very defensive ways. He keeps breaking the 'no yelling' rule -- then I jump in to set him 'right' and break the rule -- then DD goes out of the room gritting her teeth and feeling how unfair it is that she cannot break the rule and stay in the house. She asked me why dh doesn't have to leave. I really did not have a good answer.

I guess since he owns the house with you that you all live in, his hierarchy in the "following of the rules" thing is different than hers is? At least that's how it would work in our house 

I have been pondering this all day. What is my part? What is out of my realm of control? How do I accept that he is who he is and find ways to step out of the conflict? How do I reduce the stress of all this on gd9?

I see my part in our family dynamics to be not only a Validator and Listener for my BPD son, younger son and his BPD-traits wife; but also my Husband, too. Now, mostly that is because I realized soon after my son's diagnosis and my research into BPD that my Husband has BPD traits himself (due to his uBPD Mom), so I had to use these communication techniques to strengthen our marriage and help solve those relational problems we've always had in the past. But I realized why wouldn't I treat my Husband with the same empathy, compassion, validation and S.E.T. that I treat the kids with? I love him, too... .and Radically Accept that our marriage needs it 

More pondering and some prayer ---

Yes, and yes... .Always. This is how I live my life, too... .And you probably know all of this stuff already 

[qcarolr]

Rapt Reader,

Thanks for your perspective. It is always to good to see things from outside myself.

Knowing and doing --- a major paradox in life. As I have found better ways to care for myself, including finding time daily for contemplation and meditative prayer, the calm peace and rest I find an many days puts me in balance with this. Acceptance that I will make mistakes and have tough days, just as each member of the family. Making repairs as needed in my relationships for blunders. Being as clear and direct as possible (ie. fewer words, to the point) with validation and S.E.T. to set and maintain the boundaries.

The past two days I have been able to merge the knowing and doing around DD28's desires to have her newest bf with her at our home. I gave her the choice of being in our home without a friend or being with her friend where he is at. She has been living with him homeless under a bridge since Monday. She called today, cold, seeking a warm place, using "we" in her texts and phone calls. I was able to restate the boundary and her options calmly, clearly, firmly with the reasons why this boundary exists. She hung up on me a couple times. The last call she said she would come tomorrow alone if I could pick her up. She is to call me in the morning. We closed with "I love you".

I am in awe. And to add to my wonder, DH has been stepping back while offering to step in if needed. This works so well with gd9. We have found "the same page" for this week.

qcr