From family trauma to family support systems

[Parents! Get help here!]

I have recently come across and article which you may be interested in. It is called "From family trauma to family support systems" by Harriet Lefley PhD and was published by American Psychiatric Publishing Inc in 2005, in the book "Understanding and Treating BPD - a guide for professionals and families" edited by John Gunderson and Perry Hoffman.

Harriet has dedicated her working life to the role of 'care givers' in mental health. In this article she gives attention to BPD and the role of families, especially parents. She says much that resonates with we parents I believe. One short quote is: "Families that have a member with BPD inhabit a world of distorted mirrors. Communication is difficult because of vastly different perceptions, and families that contest these perceptions create what has been aptly called the invalidating environment." and "There are major barriers to working successfully with families when clinicians are convinced that the cause lies in defective child rearing."

For those of us interested in this subject, I think a read of the article is well worth it. It can be downloaded free from: Understanding and Treating BPD

It is on pages 131 - 149. There are many other articles there that would be worth a read too I'm sure - but one thing at a time eh?

It is a long url, so if you have any trouble with the link, I googled "Harriet Lefley "From family trauma to family support system"" and it showed up as the third site on my search.

Let me know what you think eh?

Vivek   

[vivekananda]

I have recently come across and article which you may be interested in. It is called "From family trauma to family support systems" by Harriet Lefley PhD and was published by American Psychiatric Publishing Inc in 2005, in the book "Understanding and Treating BPD - a guide for professionals and families" edited by John Gunderson and Perry Hoffman.

Harriet has dedicated her working life to the role of 'care givers' in mental health. In this article she gives attention to BPD and the role of families, especially parents. She says much that resonates with we parents I believe. One short quote is: "Families that have a member with BPD inhabit a world of distorted mirrors. Communication is difficult because of vastly different perceptions, and families that contest these perceptions create what has been aptly called the invalidating environment." and "There are major barriers to working successfully with families when clinicians are convinced that the cause lies in defective child rearing."

For those of us interested in this subject, I think a read of the article is well worth it. It can be downloaded free from: Understanding and Treating BPD

It is on pages 131 - 149. There are many other articles there that would be worth a read too I'm sure - but one thing at a time eh?

It is a long url, so if you have any trouble with the link, I googled "Harriet Lefley "From family trauma to family support system"" and it showed up as the third site on my search.

Let me know what you think eh?

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

[Reality]

Vivek ananda,

Excellent information.  Thank you.

The following excerpts resonate with me:

Family members’ anger, criticism, and rejection can heighten the fragmentation of the patient’s un- controllable world.

Their perceptions of the failings of the major protectors—of the inability of the once all-powerful parents to make life better—can generate terror and rage in their own fragile personalities with crumbling ego boundaries. This existential betrayal appears consistently among all kinds of adults who function at an immature level, and it may be prominent in major mental illness.

Family members can understand that the toxic kind of invalidation is that which disregards or trivializes others’ perceptions and, most especially, minimizes their pain.

It is easy enough to acknowledge that the other person sees things in a different way and then to search for things on which they do agree. An invalidating environment does not create the illness; rather, it reinforces the person’s panic and anger at not being heard or understood.

People with BPD must contend with a frightening and fragmented inner world. Their extremely difficult behaviors are maladaptive ways of coping with that world—an attempt to find security. A support system counters the fragmentation by providing form, structure, limits, and boundaries. Calmness, acceptance, and an avoidance of ambiguity and conflict are probably essential elements in any household.

I appreciate you posting this information, as I share these links with my Will's Way group.

Reality

[sunshineplease]

"There are major barriers to working successfully with families when clinicians are convinced that the cause lies in defective child rearing."

Now there's an understatement.  

Thanks for the post, V.

[vivekananda]

Reality   

Glad you liked it. Powerful words there are in your post... . it is so much to absorb in, isn't it?

I have started to study the article now. Before it was just a scanning, skimming read.

The whole article provides:

• an overview of literature on the family burden in mental illness.



• a discussion on the research on BPD and families

In the overview of the family burden of mental illness, 14 objective burdens are mentioned:

1. the family burden of time and energy negotiating the mental health system, social justice systems and sometimes the criminal justice system;

2. the disruption to normal household routines;

3. the mentally ill person's inability to fulfil the expected role functions;

4. the economic dependence and financial costs of the illness;

5. deprivation of needs of other family members, eg siblings/children;

6. curtailment of social activities;

7. inability to fulfil personal plans;

8. embarrassing situations and impaired relations with the outside world;

9. difficulties in finding hospitalisation or residential  alternatives;

10. mourning the loss of the person who was there before the illness was paramount;

11. grieving for what might have been;

12. empathic suffering for the pain of a loved one;

13. feeling stigma on one's own behalf as well as the ill person;

14. worrying about the future.

It was full on to read all that in one hit... . these objectively researched burdens of the effect of mental illness don't mention the burden of guilt of feeling responsible or being deemed responsible. Perhaps because it's only with BPD that concern with parental (mother) blame is promoted... .

what do you think?

Vivek    

[Reality]

Vivek ananda and others,

What do you make of the statement that an invalidating environment does not create the illness?

I am reading this as a heavy-on-the-biological-causes side of the development of BPD, which I have never seen so explicitly stated, as the author does here.  The vulnerability for people with this highly-sensitive temperament.

This chapter meshes very closely with my experience of BPD with our son.  

Reality

[vivekananda]

This article suggests that it is a genetic predisposition and explains how an invalidating environment encourages that predisposition... . I think. I am still studying it. And yes it meets my experience too. This is the next part of the reading I have studied:

RESEARCH ON FAMILIES AND BPD

The overwhelming majority of articles on families and BPD presume childhood trauma, which then equates to poor parenting and neglect. Sexual abuse is considered one of the strongest antecedents for BPD. But, 1. not all people who report such abuse develop BPD and 2. sexual abuse is more commonly associated with adult depression. BPD patients were significantly more likely to report verbal, emotional and physical abuse but not sexual abuse by parents. If sexual abuse is reported it is most likely to be by someone known to the pw BPD.

While there is acknowledgement of a genetic predisposition to BPD, the research literature emphasises retrospective self reported histories of childhood abuse. So this leads to a conclusion that parents of children with BPD are more abusive than other parents and this abuse is serious enough to lead to disassociation, hypersensitivity to stress and an inability to relate meaningfully to other people.

It could instead mean that 1. a person predisposed to BPD is exceptionally sensitive to the demands & punishments of ordinary childrearing environments and 2. this person is a difficult, hypersensitive child who is not as easy to live with as other children. Research describes "difficult" children as possibly hypersensitive and likely to engage in power struggles to meet their needs in conflict with their parents' needs for order and discipline. Other research suggests children at risk of BPD and NPD as overwhelmingly demanding, self centred, uncannily sensitive and reactive and manipulative.

Phew. To have this spelt out explicitly is unnerving. I'll do more later.

does this cause anyone else to be so unnerved?

Vivek   

[Reality]

Vivek ananda,

What do you mean by unnerved and unnerving?  Could you explain how you are feeling?

I didn't have the same interpretation as you.  I thought it was very clearly explained that often normal child-rearing practices are experienced by pwBPD as being deeply wounding because of their high-sensitivity.  Did the article actually state that pwBPD are overwhelmingly demanding and self-centred and manipulative?

I need to re-read to see what I might have missed. 

Reality

[sunshineplease]

The first paragraph got me so hot and bothered I had a hard time making it to the third: "It could instead mean... . "

My theories on the theories:

Genetic predisposition: Yes. In years to come, this will be front and center, and parents will be told what to look for/how to react.

Trauma and neglect: Absolutely. Perceived trauma/neglect, as well!

The eye of the beholder matters.

[vivekananda]

Hi! I have read it all studiously now and have organised my notes... . why do I feel unnerved etc. I think because the article confirms what I believed but does it so succinctly and uses research evidence to support the proposition of the piece. This is the first time I have had it logically spelt out by someone I deem as an authority, that I am not to blame when I am so accustomed to feeling as if I am being, have been judged as being a cause of my dd's illness from every which way. Not from my parents here thankfully - it is why I so need this place.

My dd32 believes she has been subjected to a lifetime of abuse by me. Her T apparently accepts this and has diagnosed PTSD as a result. He has, I believe, told my dd that he will not even want to accept the payment for his bills. I believe she is considered by him to be in a post treatment phase - which means she doesn't even get any treatment (even if it's the wrong sort), so she has no professional support. You can understand why this is so important to me.

This article was written 11 years ago. I think it is so important to we parents, especially the many of us who are so hurt by the false allegations from our children. We have all sorts of resources readily available, but this critically important piece isn't readily available - unless you know it already exists and try to look for it. Many of us are frustrated with the therapeutic professions. This article helps explain why this is so.

sunshineplease, I think you are right. Reality, it did say what you read - but it also says more. What is in italics are notes and extracts from the article from the first part of it. I'll continue to extract the key points, in the order they appear, to build the whole picture of the article (if I don't run out of pages... . ). In that first extract, I didn't explain that they were 'alternative explanatory models' - I left the headings out... . if I can go back and put them in I will.

AVOIDING BLAMING IN SEARCH FOR CAUSE

There is great danger in blaming the victim. It is not helpful to blame either the person with BPD for faulty recollections, when they may be true. Neither is it helpful to blame the parent when they are not at fault.

This simplest explanation and the one suggested most by sympathetic therapists and parents is that the person with BPD is genetically predisposed and is hypersensitive to and feels more intensely the normal slights, criticisms and punishments endured by most children growing up. Parents raising an exceptionally difficult child may criticise and punish more frequently and this would generate a tension in family dynamics and is later recalled as abusive.

Importance of searching for a cause.

If families are to be involved as a support system, their question of why there is an assumption of abuse needs to be addressed. There is inconsistency in the findings, for example BPD is associated with the presence of overly abusive parents and where there are no parents. Further parents are willing to undergo family therapy, change how they think and behave and belong to advocacy organisations. Why would they if they were abusive?

Further, an identified cause for an illness affects the treatment both of individuals and of families. Theories of defective parenting affects mental health professionals who offer treatment.

[Reality]

This simplest explanation and the one suggested most by sympathetic therapists and parents is that the person with BPD is genetically predisposed and is hypersensitive to and feels more intensely the normal slights, criticisms and punishments endured by most children growing up. Parents raising an exceptionally difficult child may criticise and punish more frequently and this would generate a tension in family dynamics and is later recalled as abusive.

BINGO!

Thank you so much, Vivek ananda, for this thread.  It is very healing for me. 

Reality

[vivekananda]

We parents here want to be a part of our children's lives, we want sound relationships with them and perhaps most of all, we want them to be able to be happy. If we are considered to be the cause of BPD due to abusive parenting, then not only are we deeply hurt, we are seen as dangerous to the good health of our children by those who believe that we are the cause. One other consequence of this is we get stuck in the FOG of guilt - continually questioning what we did wrong - and therefore not being able to see clearly what we can do right.

Which brings me to lbj's words which are so moving and powerful. This is it in a nutshell. Poignant, straight to the point. As a parent of an older 'child' (dd is now 32), while I can change myself, my capacity to support my dd is impaired. While she believes she had been abused and while there is unquestioning therapeutic support for that position, even though I have embraced the concepts of validation, mindfulness, etc I am stuck. My dd rejects me (and from her perspective that is entirely understandable), so my own personal development is of limited value to my dd. I do continue on this journey because it is for my own personal benefit, I don't think my changes have made much difference to my dd. I can only hope that there are future opportunities. I look forward to the time when parents can be encouraged to be a part of the solution, it is heartwarming to know that there are some lucky parents who can be a part of a support system for their child.

Lefley identified some common across different disorders, it is interesting to see the similarities:

FAMILIES EXPERIENCES WITH DIFFERENT DISORDERS

Common concerns across disorders:

1.   handling the patients’ denial and rejection of treatment

2.   their behavioural immaturity

3.   assessing responsibilities to siblings

4.   dealing with conflict in the house

5.   worrying about prognosis and the future

6.   concerns about housing arrangements

7.   an appreciation of the value of support groups

8.   appreciation of the advocacy roles of such groups

Common themes:

1.   Feeling traumatised by the system

2.   Misdiagnosis and minimising of symptoms

3.   Uncertain or multiple diagnoses

4.   Inappropriate medications or difficulty with administration of them

5.   Confidentiality barriers

So, in many ways our concerns are shared by other parents of children with a mental illness. The last of the common themes, confidentiality barriers I know is challenging for many parents of younger children especially. And 7 & 8 under the heading of common concerns are especially relevant for us here. Thank you to those who make this site possible  .

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

[JustWantMyJoyBack]

Hi Everyone,

I haven't posted in a while. 

This past year has been quiet with only about 2 outbursts by DD24.  Currently, she's very upset with me concerning my grandson.  Hubby & I took grandson 3 to the beach and didn't return text & phone calls as quickly as DD24 expected.  So I'm a horrible person & grandmother right now. 

So, I ran here to remember who I am.

Thanks for sharing this article.  Still reading.

LBJNLX, good to see you're still offering such wonderful support.  I hope all is well.

JustWantMyJoyBack

[vivekananda]

Hi JWMJB! Good you have returned to the fold   I hope you enjoy the article... .

I didn't mention an important aspect of being a parent of a child who alleges abuse which is not reality, and that is when we seriously doubt our own  sanity. I know that for me, before I learnt about BPD and began to understand what it was all about, there were times when I seriously doubted my recollections and memories which were so different to dd's accusations. It was thanks to dh's consistent insistence that she was not raised in an abusive household, that I didn't succumb. In more recent times, the positive support I have had from family and friends when we have explained that dd believes she has been abused, has kept me on track.

OK, to continue with what the article says:

Differences in concerns between BPD and other mental illnesses:

1.   BPD is more vulnerable to comorbidity

2.   Dealing with a wide array of disturbed behaviours eg antisocial behaviour or verbal abuse

3.   Parents contend with cognitive irrationality and mood swings since childhood or early adolescence

4.   Histories of self mutilation and suicide attempts

5.   Parents of children with BPD had few rewards and many torments and didn’t expect things to get better, but found support from group encounters

Other differences:

1.   People with BPD tend to respond positively to emotional overinvolvement

2.   People with BPD seem to be more functional

People with BPD attract criticisms of character deficit because of things such as mood swings and manipulation, rather than having a faulty brain chemistry. It is hard for families to see them as sick when they can seems so functional in other ways and their interactions are so inconsistent.

It is this seesawing between being accountable or not for their behaviour that causes such powerful confusion as to the best way to respond.

Then there are those with teenage children who have to face the attitude that it is 'normal' for a teenager to be rebellious and difficult. And there are those who cannot get a diagnosis because of reluctance to diagnose. The important teenage years when parents are still legally responsible are so important for treatment, while the teenage brain is so malleable.

Then, we know that our children understand the differences between right and wrong, but for those of our children who skirt the edge of the legal system, we are confronted with a terrible dilemma. Do we protect them from the system or do we abandon them to it or is there a middle road?

Some people don't understand how an adult can still be considered a 'child' by a parent. Often you can hear a response such as 'let them alone', or 'let it go, they are adults'. This response fails to account for the fact that once you are a parent, it is for life. It is not like a marriage where you can get a divorce and leave a past behind. Parenthood is a permanent role, a responsibility ... .children can grow up and leave the nest and be independent, nevertheless when things go wrong, it is often parents who are expected to pick up the pieces. Children expect to be able to rely on parents to be there for them. When our children have BPD, it is a very complicated relationship.

Vivek    

[vivekananda]

I will continue on in the summary ... .

HELPING THE FAMILY TO BECOME A SUPPORT SYSTEM

The three Rs:

Recognising: the first phase is to recognise behaviours that are purposeful and those that seem inherent in the illness and hard to control. People with BPD feel that they live in a world where those who claim to love them do not recognise and refuse to meet their needs. Similarly they do not recognise the effect of their behaviours on others. Families that have a member with BPD inhabit a world of distorted mirrors. Communication is difficult because of vastly different perceptions. Families that contest these perceptions create invalidating environments. Be validating.

Resisting: the second phase means to resist being drawn into the vortex of dysregulation and irrationality.  Family member’s anger, criticism and rejection can heighten the fragmentation of the patient’s uncontrollable world. Also, if a family refuses to yield to inappropriate demands, emotional outrage can result. Family members need to keep their cool; maintain boundaries without rejection.

Reconstructing: The final phase means to reconstruct a meaningful relationship with a loved one who seems to be incapable of relating in meaningful ways.

It is affirming to know that this is exactly what we work on here at bpdfamily 

Advice to Professionals:

Learn resistance techniques

Correctly assess patient disclosures

Create support systems for families to share experiences, learn coping strategies and gain comfort and encouragement for others who have ‘been there’.

And isn't life easier when we find a professional we can trust and who can work with us. Easier for us and our children with a greater chance of success.

Vivek