Getting out of the hospital

[BTA145]

My partner with BPD has been hospitalized for a week so far for suicidal threats.  She is getting discharged soon and I am experiencing fear and anxiety about the state she will be in when she comes home. In today's conversation, she said her outpatient therapist refuses to work with her anymore because he feels she needs an inpatient program but she can't afford one so she plans to agree to whatever referral they give her and then come out with no therapist or program.  She threatened me that even though I sound "detached" now, I won't be so detached when she comes home and is in my face and suicidal and crying and angry and she has no therapist to call.  I am working with my own therapist and it is taking every ounce of me to maintain my own sanity and regulation throughout this process, but I am utterly afraid of what's going to happen when she comes home.  I want to leave the relationship and move out but I am not ready yet logistically and I have no idea how to do that safely.  Any suggestions?

[RELATIONSHIP PROBLEM SOLVING]

RELATIONSHIP PROBLEM SOLVING This is a high level discussion board for solving ongoing, day-to-day relationship conflicts. Members are welcomed to express frustration but must seek constructive solutions to problems. This is not a place for relationship "stay" or "leave" discussions. Please read the specific guidelines for this group.

[Inquisitive1]

This is a very difficult situation. The ideal solution would be to help her get stabilized and then separate, but that may never happen. You need to develop a plan that includes supporting her return and your exit strategy under different circumstances.

Set boundaries. What behavior of hers will lead you to choose to leave regardless 'logistics'. think outside the box. Find someone, anyone who would put you up for a few nights if needed, while you made more sustainable plans.

What behaviors of hers would lead you to decide to call the authorities. Familiarize yourself with how to get her re-admitted should she become a threat to herself or others. Who do you call to get her re-admitted if things really go bad. How can you expedite that? Talk to the your therapist, the police, the hospital from which she's being discharged.

Call the hospital from which she's being discharged and tell them the threats she's already making. Tell them your keeping notes--keep notes--and if things go bad you will be bringing the fact she was discharged without adequate planning to journalists, attourneys, etc... .Be reasonable, but express some of your concern, frustration and anger.

Realize that she is suffering horribly and probably petrified to be discharged. Her threats are probably not meant to intimidate, they are probably just a reflection of her inner fear. Some empathy and validation of her fears may help her.

This is the best I can do with the limited time available to me. You may want to provide a few more details. That may help others give more and better advice.

[babyducks]

Hi BTA,

I am glad you found this site, although I am sorry for the reason for it.

I've read both of your posts here on this board and I can see you are in a difficult position.   From what you describe there sounds as if there has been a tremendous amount of turmoil in your relationship.  That had to be very hard on you.

If you haven't already done so, please take a minute and go over to the right hand side of the page and click on the Safety First link.   I know you said in your other post that you have a safety plan and that you have used it.   That's beyond great.   You are one step ahead.   Just take a second to review that link where it talks about domestic violence to see if jogs some new thoughts to the surface.   I know when I first came here I had to read things more than once for thoughts to float to the surface.

The stress you have been under and the strain you have been living under has had to have taken a huge toll. It would have on anyone.    I know when I first got here I had lost 15 pounds in about a months time and I was dangerously close to PTSD myself.   What you are experiencing is unfortunately the result of being in the close proximity to a severe mental illness.   It makes perfect sense to me that it's taking every ounce of your own effort to maintain your own sanity.    You are in the middle of a maelstrom.

I think it's a great step that you have your own therapist.   And I am sure you have discussed this in depth.   

Here are my two suggestions.   First,   have an ironclad and dead simple safety plan for what you are going to do if she leaves the hospital and continues her suicidal ideation.   If things start to escalate into dangerous territory, do you have detailed plans?    Full names and contact information in your cell phone?  A bag packed and stored in the trunk of your car?   A spare set of keys hidden somewhere safe outside the home?   Credit cards available in case of emergency?   Trustworthy friends who you can call to lean on for support?   It's much better to organize all this stuff in advance and never use it than to try to come up with a doctor's phone number at 2AM when your hands are still shaking.   :)o not tell your partner you are preparing a safety plan.   She does not have a need to know.

Second suggestion, and this a suggestion only,  you are boots on the ground,  for now, do what you can to diffuse conflict and minimize drama.   some one this volatile needs to be treated carefully for both your sakes.   you should absolutely do what is best for you.   try to not feed into the cycle of conflict, which I absolutely know is easier said then done.   If you need to take long walks to get out of the apartment, do that.   take as many breaks to be by yourself as you can.   

and I am going to strongly advocate that you keep coming here. 

one of the things we focus on here is to improve the quality and the safety of our day to day interactions with our partners.   that applies regardless if we stay or go.   it will be necessary to communicate even if you decide to end the relationship.   communications that are not fraught with pain and anger will make any process you decide on better for both of you.   take a look at the Lesson that run down the right hand side of the page.   wander around in those links.  

does this make sense?   what other questions do you have?

how are you doing today?   

'ducks

[an0ught]

Hi BTA145,

good advice by others. Boundaries protect you. Here is one more less practical but more emotional thing to consider:

I am utterly afraid of what's going to happen when she comes home.

Fear can easily transfer to the other side and be amplified there even more. It is likely she is as afraid as you. It is excellent that you recognize your fear and admit it - keep working on it and get help from your T.

[BTA145]

Thank you for your words and input.  I wanted to post an update and questions.

My partner was discharged from the hospital two days ago.  In the days leading up to discharge she was still angry, suicidal, blaming, threatening, and dysregulated when I talked to her on the phone.  But upon her discharge and since she has been home, she's been docile and sweet and loving and pretty much back to herself (the herself between the raging and dysregulation).  She is on a new med so that might have something to do with it. But now looking back on the whole hospitalization I am wondering if this whole situation was an extinction burst?  I was researching this last night. The reason I think this is because the night before she was hospitalized, I left. I followed my safety plan for the first time.  Even though I had talked to her about it before (when you are yelling and throwing things and I don't feel safe I will leave to take care of myself but I will come back in a few hours or the next day) this was the first time I left.  I stayed the night somewhere else and her messages were threatening and full of rage and after the first text response that said I would contact her in the morning, I stopped responding.  The next morning her therapist called 911.  So in eight years, this was the first time I didn't stay and soothe and try to calm her down.  The reinforcement was taken away, right? And even though she was decompensating before this occurred, did this event cause an extinction burst?  Because after I left things became a lot worse.

Then while she was in the hospital for eight days, I talked to her on the phone but I maintained a state of detachment and did not get involved and try to fix things and I only visited her once.  Even though it was devastatingly hard for me, I was advised to do this.  And she seemed to be getting worse and worse in the hospital but now she's out and she seems better.  Which actually makes me feel crazy as if I must have imagined the last few weeks of torture and the last eight years of on and off again episodes.

So, my questions:

Do you think this was in fact an extinction burst?

Can someone further explain extinction bursts and also spontaneous recoveries?

How do I stay alert and aware of a possible spontaneous recovery and how do I respond if and when it happens?

What type of emotional and mental state would be healthy for me to be in now? Hopeful for her recovery? Enjoying the peace? Not giving into false hope and staying detached and ready for another episode?

How should I be responding to her now? I Don't want to intermittently reinforce the behaviors again?

And I am concerned because her therapist is not working with her now and she has an appointment for a new outpatient program that the hospital found for her but it doesn't specialize in BPD.

Feeling relieved, confused, concerned, and exhausted... .and a little hopeful too.

BTA

[babyducks]

Hi BTA,

Likely there is more than one or two things going on.   

Here is my experience with BPD's in hospitals.   What I have observed is pwBPD don't tend to do well in an inpatient setting for a couple of reasons. 

First, they are sensitive to emotions and environments and tend to soothe themselves externally.  Being inpatient tend to escalate dsyregulation because there is so much stress in the environment.   They have issues with shame and guilt and being inpatient is viewed as shameful.   And it's possible she was being asked to address her own behavior which would have been dumping lots of negative energy into the air.

Second here is the link to extinction bursts

https://bpdfamily.org/2010/10/partner-have-borderline-personality.html

My two cents is you were given excellent advice and you should stay the course.   She is going to revisit the only coping mechanism she knows, and try to push her harmful emotions on you.   Don't pick them up.   Gently but firmly hold to your boundaries.   

What I had to do was script out a couple of possible fall back responses to default to if things got tough.   Very much what you are doing now.   

Continue to reinforce positive behavior,   if she starts to yell before she reaches the point of throwing things take the time out.  Leave the room, try to stop the escalation earlier in the cycle, if at all possible.   You don't have to tell her you are doing it,... .protect your energy for now.

hang in there... .

'ducks

[an0ught]

Hi BTA,

first off, follow the quacking bird, she has very good points.

Another point is - your thoughts seems to be racing - take good care of yourself. One energy saving point: Don't over-think crazy. Yes, there is lots of things to understand about your partner but right now it is more important how you act with what you know. There are some complex and deep strategies behind the LESSONS based on what is known about BPD. But when it comes to application is often boils down to timeless advice on how to deal with others with respect and understanding while making sure you are not steamrolled.

Do you think this was in fact an extinction burst?

No, this was shame, fear and anxiety related to upcoming change. Basic overload leading to dysregulation.

How do I stay alert and aware of a possible spontaneous recovery and how do I respond if and when it happens?

Have you seen a teen spontaneously growing up by half a decade? There are times you can be fooled in thinking you are looking at an adult until you suddenly realize you are not. This condition goes way deeper than you grasp at the moment - it takes a long time to unlearn what has been learned for a lifetime.

The improvements you see at the moment are partially owed to boundaries (or built up distance over the past weeks), relief getting out and *maybe* some small learning she has taken on. But with the latter the roots are shallow and won't hold in a storm. Overcoming BPD is learning behavior and practice, practice and practice.

What type of emotional and mental state would be healthy for me to be in now?

Rule 101: You take good care of yourself so you are balanced. Your wellbeing is central to the stability of the relationship. You having a balanced and stable stance allows you to deflect or outmaneuver attacks. It allows you to validate her and by slinging it back use her negative emotions against her inner negativity.

Hopeful for her recovery? Enjoying the peace? Not giving into false hope and staying detached and ready for another episode?

You don't know. You can't know. When you are strong you don't need to know as you're value is not depending on her. You have prepared and a clear idea where your boundaries are. You are willing to deal with the consequences of protecting your boundaries. You are safe so you don't have to worry.

How should I be responding to her now? I Don't want to intermittently reinforce the behaviors again?

Validate positive. Validate negative. Avoid invalidation. Treat her with respect. Do not tolerate disrespect.

And I am concerned because her therapist is not working with her now and she has an appointment for a new outpatient program that the hospital found for her but it doesn't specialize in BPD.

It is certainly worth asking future T's what specific experience they are having with handling pwBPD and what therapy they typically embark on. DBT is the gold standard as it has been researched the most but there are other valid approaches too. In the end a lot depends on whether the T and your partner can get along well enough to form a stable T-relationship and the T has enough clue to not get hood winkled by the pwBPD.

[babyducks]

Hi BTA,

I thought I would check in today and see what's new with you?

I liked what an0ught said about continuing to take good care of you.

- take good care of yourself. One energy saving point: Don't over-think crazy. Yes, there is lots of things to understand about your partner but right now it is more important how you act with what you know. There are some complex and deep strategies behind the LESSONS based on what is known about BPD. But when it comes to application is often boils down to timeless advice on how to deal with others with respect and understanding while making sure you are not steamrolled.

You have been through some stressors so you need to replenish your energy banks also.

Continuing on the topic of extinction bursts and spontaneous recovery... .  I understand an extinction burst to be similar to when you quit something cold turkey, like when I give up chocolate,   Oh Man my brain and body go through all sorts of gyrations because I am craving chocolate.   I understand spontaneous recovery to mean that craving spontaneously returns after I have successfully given up chocolate for 6 months or more.  (on a side note, who names this stuff anyhow?  this is almost as dumb a name as borderline)

Spontaneous Recovery - Behavior affected by extinction is apt to recur in the future when the trigger is presented again. This is known as spontaneous recovery or the transient increase in behavior. Be aware of this eventuality. It is a part of the extinction process. Don't be discouraged

I think an0ught was correct that

The improvements you see at the moment are partially owed to boundaries (or built up distance over the past weeks), relief getting out and *maybe* some small learning she has taken on. But with the latter the roots are shallow and won't hold in a storm. Overcoming BPD is learning behavior and practice, practice and practice.

What are you doing to take care of yourself today?

'ducks

[BTA145]

Thank you An0ught and  Babyducks for sharing your experienced insight about my situation.  I find both education and comfort in your words.  I am letting what you said continue to marinate in my head while I move forward.  I think you are correct, An0ught, I have a lot of information about BPD swimming around in my head right now and maybe I need to take a breather and simply follow your timeless advice.

To answer Babyducks, today I did several things to take care of myself - meditated, saw my T, went on a bike ride, and saw a friend.  It is still challenging for me to be at home with my partner.  She is still doing well at the moment and things are calm, but it is very hard for me to trust it and to let go of the past few weeks which were extremely volatile and traumatic.  I'm trying to just stay in the moment and trust that I have the tools and the support system to keep me safe if necessary.

BTA145

Thank you again for your support.