Fostering Realistic Hope

[vivekananda]

On another post I was asked about a course I am doing... . here is some info. Ask away if you want to know more... .

Ok, I have been participating in a 10 week course called “Fostering Realistic Hope” for carers of those with BPD based on Narrative Theory.

It has been really good. The group consists of mainly parents and some siblings, no partners. It has been running for some time now and the program is also being evaluated etc for research. There is one facilitator, who is highly knowledgeable about BPD and what it means to be in our shoes, he is also a darned nice person.

The weekly session lasts for 3 hours with a short break. It starts and begins with a 3 minute ‘mindfulness’ practice. Then one of us is ‘interviewed’ by the facilitator who helps us tell our story. This goes for at least 30 mins while the others watch and listen. When that is done, one by one the others, following a structure, give feedback to the facilitator, while the storytellers listen. Then the facilitator ‘debriefs’ the storytellers. After the short break all return for a brief ‘lesson’ on a skill that is helpful, eg validation based on the Schema model.

It says: “Through the experience of practices such as Relational Mindfulness, Outsider Witnessing, Restarting Reflection/Re-Storying the Conversation, Acknowledgment & Validation and Relational Limit Setting, we develop skilful means to:

•   Better understand the effects of BPD on families’ lives through  the sharing of experiences and knowledge

•   Identify and resource our own coping initiatives that have made a difference

•   Mindfully notice habitual and unhelpful relational-interactional patterns that we often become stuck in

•   Foster a mindful space for reflection and realistic action”

In this process it aims to: “Explore and evaluate both participants’ and professional knowledge and practices that foster realistic ways to promote, inform and support the harm-minimisation for relationships and initiatives that work with the effects of BPD on families”

I am so glad I am doing this.

Vivek   

Our objective is to better understand the struggles our child faces and to learn the skills to improve our relationship and provide a supportive environment and also improve on our own emotional responses, attitudes and effectiveness as a family leaders

[heronbird]

Oh very interesting, as you probably know I have started one in UK. who is the person running the group? clinician or carer?

We are running a 5 week programme and also they are doing some sort of research on it.

There is nothing like it in UK, its based on MBT really. We go through validation and did a bit of role play etc

I like the sound of yours too.

[griz]

That sounds wonderful.  I will have to look to see if there is one near by.  How did you find this?  Any ideas on how I could go about finding a group like this.

Griz

[Fay]

Hi,

This sounds great.  I too would like to know how to find one in my area.

Fay

[Rapt Reader]

Thanks for this, Vivek  

I, also, would like to learn more about it... . Not sure if something like this exists in the U.S. or anywhere near where I live; if it did, I would probably like to get involved.

More, more... . (with a bowl of popcorn in hand and some good unsweetened iced tea) 

   Rapt Reader

[vivekananda]

I think this type of programme is just here in Melb at the moment.

Narrative Theory fits in with Schema Theory (mentalisation) I think. I think that it calls on all the successful theories/therapies (incl DBT) and the underlying Narrative therapy is the process of 'witnessing' and 'restorying/retelling'. It needs a skilled clinician as a facilitator in order to keep its focus and to keep it moving forward.

There are lots of 'support groups' though. In USA you have stuff like:

Family Connections Registration

This is a 12 week program. While not all areas are covered, you can also do 'Tele-Connections' which is the course conducted via weekly conference calls. This is DBT based.

If you are anywhere near NY, there is of course the TARA centre:

TARA National Association for Personality Disorder

They have an 8 week course, weekend courses and a Wednesday Webinar. TARA was started by Valerie Porr and is Schema therapy based.

Here in Melb we have an organisation just for carers which runs courses at night and during the day on a variety of subjects. For example I missed the one I wanted to attend on how to organise your finances for when you die, ie starting trusts for the pwBPD - because I was at 'Fostering Realistic Hope'. We also have a monthly carers meeting where last time there was a guest speaker a young woman recovered from BPD.

If you don't have anything, easily accessible for you, perhaps you need to link in to your local resources and become 'organised' (along with everything else eh?)

cheers,

Vivek    

[vivekananda]

At the last meeting dh and I had our turn at telling our story. You know much of it already, so no need to repeat myself.

I learnt that there is still hope. I was given feedback that it probably wasn't as bleak as I thought and that still having had that contact with dd that I had, was, in the context, a positive. So, from teetering on the edge of depression I have stepped back to refocus myself on what I need to do. And apart form exploring all sorts of thoughts as I do here, I need to get back to basics. Redefine my priorities - exercise and meditation and reorganise my time to focus on what is best for me.

Also in the feedback from the other 'carers' was that dh and I had each other and that was what was important for us. Our dd was an adult and we needed to care for each other and stay strong and not let BPD wedge in between us. This was really important to hear. Like most of us here it has been a hard time to both be on the same page.

The other thing which was commented on was that we were still in there after all these years and that was commendable. The inference here is that if we have been able to survive all that we have for the last 32 years, then having learnt what we have in the last 18mths so we are well armed, we should be ok for whatever comes next.

It is interesting to hear the stories of the others: the different situations, the different 'children' (all adult) and it is interesting to see how others manage their relationships. It is possible to see things that others do that you wouldn't and yet it is possible to see the mistakes that you make that are also the same as others make.

It is a gentle process 

Vivek    

[Rapt Reader]

Hi, Vivek    and thanks for all the information! I don't live near NYC, but I will check out all the links you gave; I remember reading about TARA in "Overcoming BPD" and I was interested in that anyway (you reminded me about it).

I think the meetings you go to sound GREAT! It is wonderful that they are helping you to process your relationship with your daughter, and helping with the stress of that. I think they are all right about their positive attitude about how you and your husband are doing, and about your most recent meetings and communications with her. Hang in there... . there should be some sort of breakthrough soon. Don't know why I think that, but your most recent events just seem to be opening some door to the light at the end of the tunnel. You are a good Mom... . you have been teaching yourself (and others!) and learning and growing and actually changing for the better; if nothing else, your journey to yourself is going well! And, I do think your journey to a better relationship is going well, also~~I think you will find that out pretty soon   

[heronbird]

Viv   

It sounds really good, is there any info on line about it, what is it called. Id just like to see what info if any there is.

We often take the positives for granted dont we. It is true that its good you are still keeping everything up and if we are lucky enough to have a good partner weather it be spouse or even close best friend, we should acknowledge it, I often take it for granted too.

So they reminded you of the positives in your life, that always helps

[Reality]

Narrative Theory fits in with Schema Theory (mentalisation) I think.

Vivek ananda,

Just wondering... . I thought Schema Therapy and Mentalization were distinct therapeutic approaches.  In a way, Mentalization is a process by which the client is encouraged to tell their story, their perspective, their way of thinking and expressing. 

This course sounds fascinating.  I, too, would appreciate any information. 

Reality

[vivekananda]

Reality,

I suspect you are right about the differences between Schema and Mentalisation. I will get back to my notes on it and see how I can clarify it. And I will do some research on links and stuff too HB.

I have some interesting stuff on 'validation' to feed back to us... . stuff we know (it will strike a chord with you esp Reality - I thought of you when I first saw it  ).

But I have to log off now and it may take a bit for me to get back.

We're off again on hols   a week in warmer climes coming up.

back soon,

Vivek    

Our objective is to better understand the struggles our child faces and to learn the skills to improve our relationship and provide a supportive environment and also improve on our own emotional responses, attitudes and effectiveness as a family leaders

[heronbird]

Oooh lovely Viv, where are you off to, UK? you know we have had boiling weather for last two weeks or more, its a record.

Actually its not nice, living in a city with the heat, I nead the beach or a massive pool. We dont have air con on most trains and defo not on the buses. Most shops do not either, if they do its not effective often.

Have a lovely break

[vivekananda]

I'm on the Gold Coast, Qld ... . across the road from miles of glorious beach. It's 22 degrees (about 58 Fahrenheit - maybe) and a bit rainy, but so pleasant. I am studying up a bit on schema and mentalization etc... . will post soon.

Vivek  

ps I am dressed in Melb clothes - all black. I stick out like 'you know what'. Pale faced black pants and long sleeved top, nothing tropical about me!

[vivekananda]

In the meantime, here's an interesting article I found:

Exploring the Recovery Vision and its Relevance for Carer families

It's informed by the 'Fostering Realistic Hope' work in the course I am doing. You have to either skip or skim read the first page to get to the article.

I found it interesting.

Vivek  

[heronbird]

Whats melb clothes? and 22 is cold isnt it well compared to UK anyway.

Do they have West midlands in Austrailia?

Gosh, I dont get out much do I 

Im off to finish reading it now  

[heronbird]

Oh wow, silly me. It is UK haha

Wow, Im in shock something from UK

[qcarolr]

Vivek - this sounds so much like what Russell Meares was doing in the books I was reading early this year. Got bogged down a bit with his scientific way of writing. So very glad to see it being applied in this awesome family based way. Australia seems to be on the front edge of putting a decade of research into practice.

I am reading the article.

Wish I could run away to Melbourne for 3 months and take this course -- and sit on the beach a bit with you!

qcr  

[vivekananda]

wish you could too ... . but the beach where I am at the moment and am warm is 1,000 miles from Melb where it's bitterly cold. We can't have warmth and the course at the moment, it'll have to wait for another time qcr 

Just to have us spinning in anther direction too. I am getting back to my muddle with Schema and Mentalization therapies. I prepared this, which is an overview of therapies. It doesn't explain why I got muddled (but I understand why - maybe when I know more I can explain better).

There are many different types of therapies that have proven success with BPD or with some BPD behaviours. These were identified by the recent Aust’n National Guidelines for the treatment of BPD:

CBT: cognitive–behavioural therapy;

DBT: dialectical behaviour therapy;

DBT ST: dialectical behaviour therapy standard treatment;

DDP: Dynamic deconstructive psychotherapy; MACT: manual-assisted cognitive therapy;

MBT: mentalisation-based therapy;

MOTR: motive-oriented therapeutic relationship;

SFT: schema-focussed psychotherapy;

STEPPS: Systems training for emotional predictability and problem solving;

TFP: transferencefocussed psychotherapy

You will see that here Schema and Mentalization are identified as separate therapies (as Reality pointed out and I incorrectly suggested otherwise). You will also see that neurofeedback is not mentioned because of the lack of meta analysis – although we have anecdotal evidence as to its success.



Schema therapy is a therapy developed by Dr. Jeffrey Young for personality disorders, chronic depression,  and other difficult individual and couples problems.  It integrates elements of cognitive therapy, behavior therapy, object relations, and gestalt therapy into one unified, systematic approach to treatment.  Recently it has been blended with mindfulness meditation for clients who want to add a spiritual dimension to their lives.

Mentalization-based treatment (MBT) was developed by Peter Fonagy and Anthony Bateman. MBT has been designed for individuals with borderline personality disorder (BPD), who suffer from disorganised attachment and allegedly failed to develop a mentalization capacity within the context of an attachment relationship. Fonagy and Bateman claim mentalization is the process by which we implicitly and explicitly interpret the actions of oneself and others as meaningful on the basis of intentional mental states. The object of treatment is that BPD patients increase mentalization capacity which should improve affect regulation and interpersonal relationships.

The Narrative Therapy that underlies the course I am doing, is not a therapy for BPD. It is a therapy to in part facilitate peer review through the telling of stories.

I'm off to do more reading 

cheers,

Vivek    

[qcarolr]

The article, Exploring the Recovery Vision and its Relevance for Carer families , linked above, really hit a lot of good points in our families recovery focus with DD27. And this is also the focus of the new Recovery Program DD has done the intake for.  Her goals are to get a job, a place to live, and a car. To do this she needs to participate in a job skills program, a living skills program and then the other things can come to pass. She also has to manage all her legally required probation classes. A lot for her to manage all at once. We are both overwhelmed as she leans on me heavily to keep her reminded and deliverd to all these appointments.

She seems more determined that ever to make it - then I am resistant to getting so involved. It is hard to define and then accept the support role I need to play for her to find success. She is not at the place to do this independently yet. Being more independent is a goal -- not yet a reality for her.

This leads me to talk with her about the support I am trying to build. And that for her to be successful she needs to build a support network too. To have some fun, stay motivated and stay away from the toxic friends. She wants all this - just is overwhelmed by it. Gets hopeless that things can ever change.

I think there needs to be many changes in the system of care for mental illness that includes support networks. Family, peers, mentors or coaches, and other professional staff. And the teams of people have to join in open communications to work toward common goals. Currently this would require a large sheaf of releases signed my client, then coordination of schedules. I am hoping the new Recovery Program can help acomplish this for DD. Hope the young and inexperienced RCC (recovery case coordinator) can manage this for D. She is not a T. Her purpose is to link DD to other resources. There are lots of local resource scattered in many organizations.

An I feel at the hub of this along with the coordinator. And the one diffusing the anger that comes with the overwheming stress for both of us.

Good article. So much more needed.

qcr  

[vivekananda]

sorry, posted this twice, so deleted this one.

Vivek    

[vivekananda]

OK, this is what we last covered in the course, Fostering Realistic Hope that I am doing. This has been prepared by Peter McKenzie (Exploring the Recovery Vision and its Relevance for Carer families) of Melbourne, Australia.

Re-Stor(y)ing the Conversation: Restarting Reflection

(Based around the therapeutic approaches of Narrative and Mentalisation Theories.)

Our purpose is to promote harm minimisation for our relationship with the person with BPD when they become upset, emotionally charged and are unable to think or reflect (when they can ‘lose their mind’). It is important to understand that implicit in the actions of the person with BPD is hypersensitivity to the responses of significant others. They feel out of control, impulsive, threatened, rejected, ashamed, hopeless and helpless.



Our task is to take the stance of ‘the detective’, ‘the human interest reporter’, the researcher’ so that we can engage them – to restart reflecting and support them to regain their ‘mind’.

1. Validate their feelings.

2. Explore: ask an ‘exploring’ type questions.

Get the details of the story, not just ‘the facts’, in order to support them to re-stor(y) the conversation.

Don’t get sidetracked from focusing on repairing the rift and reconnect the relationship by arguing who is ‘right and who is ‘wrong’.

We need to demonstrate our desire to know and understand their experience.

   2.1 Explore the details: “Tell me what happened?” (the where, when, who was there questions)

   2.2 Explore the effects: “What was it like? (eg upsetting) then validate that “that sounds like it would have been really difficult”

   2.3 Explore coping: “How did you cope with all this going on and being so upset?” “What got you through this?”

3. Reflect on the intentions of others: “I wonder what the reasons might have been why they acted like that towards you?” “Why would they have been like this?” “Could there have been something else that explained their actions?”

4. Check your understanding, clarify with questions: “I’m not sure that I got this right?” “Are you saying…?” “Might I have misunderstood what you said?” “Have I got it wrong?”

5. Explore relationship conflicts: “Can you talk to me about why you’re angry with me?” “Is there something I could have done differently?”

6. Stop, rewind, explore: “Hang on a second, I really want to understand what happened….” “Can we go back a bit and you can tell me what you think happened, what I did to upset you so?”

So the idea is to encourage story telling to develop a reflective response. In this situation we have to be authentic, suspend our judgement and our desire to tell the story... . we have to let go of our ego and practise our listening to see if we can learn and if we can support our loved one's learning.

(you may be able to see why I got messed up confusing Schema and Mentalisation within this... . )

I reckon, if this is done properly, it's a very gentle way of supporting our children. I don't know that it would have instantaneous results, but over time I can see it would be very effective. I wish I could turn the clock back a few years and keep the knowledge of what I have learned... .

Vivek     

Our objective is to better understand the struggles our child faces and to learn the skills to improve our relationship and provide a supportive environment and also improve on our own emotional responses, attitudes and effectiveness as a family leaders

[heronbird]

This is so brilliant, so glad this is going on. Who started it, and how long has it been going on for

[vivekananda]

Peter McKenzie is behind it, the guy who wrote the article for the Meriden Family Programme in the West Midlands, UK, in 2007. He gave it as a paper in 2006 for the Partnerships Towards Recovery Conference April 2006 and was also published in New Paradigm: The Australian Journal on Psychosocial Rehabilitation (McKenzie 2006).

So the ideas have been around for a while. The course itself has been going for at least a year, probably more... .

If you know where to look there are a lot of resources for us here in Aust.

cheers,

Vivek    

[Reality]

Vivek ananda,

Thank you so much for your list of therapies helpful for pwBPD or pwBPD behavior.  Very clear.  Your logical, analytical approach is very useful.

You were right.  The narrative approach does resonate strongly with me.  I found often as a teacher that I just needed to listen to the children's stories or ways of seeing a situation in order for them to be settled and able to complete their tasks.  People of all ages need to tell their stories.  I guess that is also what we do here at bpdfamily, tell our stories and get feedback.

There is a kernel of truth always.  A reason for behavior.  Always.

I am looking forward to hearing more about this course.  I think it is brilliant.

Reality

[Reality]

Vivek ananda,

How did you find the Australian Guidelines for the treatment of BPD?  I wonder if Canada has such guidelines.

Reality

[mamachelle]

OK, this is what we last covered in the course, Fostering Realistic Hope that I am doing. This has been prepared by Peter McKenzie (Exploring the Recovery Vision and its Relevance for Carer families) of Melbourne, Australia.

Re-Stor(y)ing the Conversation: Restarting Reflection

(Based around the therapeutic approaches of Narrative and Mentalisation Theories.)

This is really good stuff. I haven't had time to read this post until today but I love the name of the course and I like this approach. I am going to do some research and try to work it into my parenting of SS 10. I am thinking it may help defuse when SS10 argues with SS9 too and I can't figure out what is going on. So, I may come back with questions for you though 

 mamachele

[vivekananda]

I have missed one of our Realistic Hope meetings while on the Gold Coast soaking up the sun, but the next one is tonight.  I'll pass on any helpful info   mamachelle, you can ask anything - I just hope I can answer   

Hi Reality,

I don't think Canada has such a guideline yet. I am sure there are guidelines of sorts but not formally prescribed such as we have only just done.

Ours has only just been published here. I found out through a 'carers' group that I attend once a month. It is part of a slow process of writing up Clinical Guidelines for all diagnoses of mental illness, for example the one for PTSD in Aust was published in 2007. Because ours is so recent and is based on meta analysis, it is thoroughly up to date with the latest 'proven' treatments and findings. Stuff not yet 'proven' eg neurofeedback, don't really rate. So, it is an excellent guideline for any country:

Clinical Practice Guideline for the Management of Borderline Personality Disorder (2012) - Aust

I believe the system of guidelines like these is based on the UK model. The one for BPD in the UK was published in 2009:

Borderline personality disorder:treatment and management (2009) - UK Guidelines

If you compare the two documents, you can see how far we have advanced in just 3 years. You could be sure that the authorities who have responsibility for providing national guidelines would be aware of these documents. I would expect that Canada would be working on a similar thing. The Aust guidelines would act as a sort of up to date 'lit review' of the subject and would inform all those working on BPD.

... . I found often as a teacher that I just needed to listen to the children's stories or ways of seeing a situation in order for them to be settled and able to complete their tasks.  People of all ages need to tell their stories.

not only do we need to tell our stories, we need to be listened to, yes? We need to be heard, to be validated. Reality you can tell your stories with warmth and openness, and you listen with warmth and openness.

Vivek      

ps it seems to me that there are some good things happening here in Aust... . an 'Aust BPD Foundation' is being established here to advocate for BPD and more. But this is in gestation, not yet reached infancy.

[Reality]

Vivek ananda,

Thank you so much for these links. 

This is an excellent thread, very thought-provoking.

I will use this information in my mental advocacy work here, such as it is. 

Reality

[vivekananda]

Hi all,

Just a brief update for the moment. Last night we had the last of our 'witnessing' the stories of others in the group. It is so interesting that you can see what others are doing so much more than you can see what you are doing... . that's why this opportunity for reflection on our own situation is so valuable.

Apart from reinforcing stuff I think know, I did learn some things a bit more:

1) here we often talk about our boundaries being to protect ourselves. In the group the emphasis seemed to be more on how setting boundaries teaches our loved ones a sense of structure and that they have the ability to set their own boundaries which helps them regulate themselves. I found this different perspective very helpful.

2) We have 'workshopped' four things: What BPD is; Acknowledgement and Validation; Restarting Reflection (see above); and Relational Limit Setting (boundaries). Running throughout the sessions was mindfulness practice. What struck me last night was the focus on working on our relationships. So there is 'relational mindfulness', 'relational limit setting' etc. While I have understood that we are here working on our relationships with those we best wishes, this focus on the word 'relational' seemed to give this a reinforcement that is important. It resulted in a slight shift in thinking for me... .

Our next and last session is in a fortnight - this one will be a wrapping up session. What a pity it is ending.

cheers,

Vivek    

[qcarolr]

Our next and last session is in a fortnight - this one will be a wrapping up session. What a pity it is ending.

Another way to think of this perhaps: instead of 'ending', start of going out and 'practicing' -- the growing stage. Imagine what you can soon harvest from these seeds that have been planted. 

qcr