Is anyone else bothered by the term "BEHAVIORAL therapy"?

[BioAdoptMom3]

BEHAVIORAL therapy, health, treatment centers, illnesses, etc.?  In my opinion it makes it sound like these are illnesses which for the most part can be controlled because that is what the term behavior signifies. Granted, many of the behaviors which are part of mental illness can be controlled if the patient is taught to do so, but many cannot.  We need to educate society in the validity of mental illness as actual illnesses, most of which start in the brain and are indeed physical illness which manifest themselves with a lot of emotional and behavioral symptoms.  Since we choose our behaviors this reinforces the idea that mental illness, like behavior, is a choice.  I just don't like it!

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

[woodsposse]

First off... . Hi.   

I'm not an expert by any means, but I will try and reply with how I see things.

I think you may be getting hung up on symantics... . and/or thinking about how the words are playing out in reverse.

You say that we choose our behaviors.  This isn't entirely true.  And, from what I understand for someone suffering from any PD, they don't choose the behaviors.

Much like a person who is a substance abuser (let's take Alcoholism) - you would think the simplest way to stop being an alcoholic is to change the behavior and stop drinking.  It's a choice.

But it isn't.

There are mental and physiological components to substance abuse.  Some of the reasons stem back to unconscious reasons which may have started in childhood and are not actively on a persons head. 

And, in the case of when a drinker goes from substance abuse to full blown alcoholism... . it is a physical addiction.  it is no longer a choice - their bodies and minds have been altered.  They can no sooner choose to stop than we can choose to stop our hair from growing.

Yes, there are behaviors which someone with a mental illness can "control"... . if they seek help and are committed to want to get "better".  Many folks (BPD) don't.  They can't.  It isn't because they don't want to - it is because they can't.  Some of them don't even know they have it.  And the ones that do... . maybe they can't.

Like I said, I'm no expert and hopefully there are more "qualified" folks to help answer this. 

All I know is I always knew there was something else going on in my relationship than just we didn't get along.  I knew it.  I just didn't know what it was.  Well, now I know.  I wish I could rush in and get my loved ones suffering the help they need - but first I would somehow have to get them to understand how dire their condition is in order for them to get the help they need... . and, in my case, they don't want to.

Not because they choose to have the illness - but because they have the illness and they can't.

[qcarolr]

BioAdoptMom3 - I think this is a great topic question. Yes, I am bothered by the focus on behavior/consequences without taking anything else into consideration. I will try to keep my reply focused and out of the sociological/political realm.

All I know is I always knew there was something else going on in my relationship than just we didn't get along.  I knew it.  I just didn't know what it was.  Well, now I know.  I wish I could rush in and get my loved ones suffering the help they need - but first I would somehow have to get them to understand how dire their condition is in order for them to get the help they need... . and, in my case, they don't want to.

Not because they choose to have the illness - but because they have the illness and they can't.

This is so true for my r/w with my BPDDD27 for all of her life. She has resisted all treatments and therapies (mental, medical, educational... . ) since the age of 2 in daycare home. All around her, including me, believed we could teach her to change and find more success in her activities, relationships, within herself by focusing on her thinking. During most of her life the focus has been one of rational, logical based plans using behavior/consequence based dynamics. An example of this can be found in the "Love and Logic" parenting books.

These strategies can work, once the emotional upheaval is calmed. Inside a consistent, calm, loving environment without distractions. With people that have stable, balanced brain development and genetics. At least until the next crisis or high stress life situation. My DD, who refuses to learn new strategies, does have brief periods of seeming focused calm. In these tiny windows she does reach out for help, does seem to hear what strategies are being shared --- they just don't seem to 'hold' when the inevitable flip under happens.

In the past couple years I have been exposed to a new paradigm that looks at the emotions that are under the behaviors, and looks at many issues of attachment and life traumas (as perceived by the individual). This is labeled in different ways: attachment based family therapy, self-care for caregivers with validation & boundaries, "Beyond Consequences" stress based model of love based emotion/behaviors vs. fear based emotion/behaviors... .   This has been from a more intellectual perspective - I have read lots and lots of books this past 15-18 months. Parenting, BPD, neuroscience research... . Some have been reviewed here at bpdfamily.

For those of us here at bpdfamily, that live inside of the chronic traumatic lives that we have, the labels are not what is important. The practices and understandings we get that can make a difference in how we relate to our family members day to day is what matters. The list of tools and lessons on the sidebar can guide us to find a more stable place for ourselves in this chaotic life. Sometimes our pwBPD responds to the changes we make in ourselves and how we relate to them, sometimes not.

For the general public, our contacts in the community (school, mental health and medical providers, neighbors that our kids play with, co-workers and employers... . ) and extended family these labels can be very stigmatizing, confusing, and undermining to the changes that can make our lives better and the lives of the pwBPD we want to be in relationships with better.

There is also a cultural piece to this which has to do with generational impacts of values, beliefs and experiences. At a personal level, I am doing all this work and study and practice to create a new direction for my gd8. She lives with dh and I, currently has no contact with her parents, is already beginning to struggle with potentials for the list of labels her mom and dad grew up in -- ADHD, PTSD, anxiety, depression, BPD traits... .

It is hard work to change how I parent - I made many many many mistakes with my DD27 out of how I was parented, my own attachment issues growing up, and my bipolar II cycling. I am determined to make a difference with gd, with DD as she allows me to impact her adult life without my being enabling (hard to change this too), and in all areas of my life where I relate to people.

I desire to be an activist, one person at a time. One post or reply at a time. This is my challenge to myself. It is so good to know that I am not alone. There is more and more support here and in my community that is digging beneath observed behaviors to what is driving those behaviors.

Hope some of this is relevant to the question. I have to stop now as my mind is jumping off in so many directions with this.

qcr

[theplotthickens]

One reason they might use "behavior therapy" is because this is one field where the practitioners don't look at or directly treat the organ they are doing therapy on.  There is a lot of guessing, trial-and-error and such.

[qcarolr]

Both CBT and DBT do have some success for BPD when the participant is able to engage in the therapy. Cognitive Behavioral Therapy; Dialectical behavior Therapy. The hard part is getting the pwBPD to be a participant engaged in the therapy.

These behavior therapies have strong research based foundations. They do treat 5 of the 9 criteria for BPD. They do not address the lack of sense of self criteria. So a pwBPD can learn to manage their behavior some of the time and need other types of therapy to incorporate these into a more 'whole' personality. This is where Schema  and Mentalization therapies seem to show a lot of promise.

Lesson 5 talks about this area if you are interested. I am a mind-based kind of person, so this stuff holds my interest -- the books, research, workshops, etc. I still struggle mightily to put it all into practice with my DD27. And often with my gd8 as well now.

Most of the BPD books published in the past few years incorporate much of the research and other therapies in their discussions. Have you read "Overcoming BPD" by Valerie Porr?

qcr

[lever.]

I am finding this thread very interesting.

When my DD was younger I read a lot of parenting manuals based on behavioural interventions. I got frustrated that she did not appear to be learning from consequences.

Using "time out" as recommended was a mistake as she just became more dysregulated.

However using behavioural tools to respond when she was overdosing and self-harming did work. (ie not rushing to visit her immediately after an OD or giving it any drama but giving lots of attention when she tried to problem solve in other ways).

I recently read Valerie Porr's book and looked at the tools on here. I wish I'd seen it all years ago. Responding to the underlying emotion looks like it will help more.

I am interested in the mentalization therapy too but found it slightly difficult to understand.

I'm now thinking that behavioural therapy has the capacity to extinguish certain dangerous behaviours but doesn't touch the underlying pain, so that it is just acted out in a different way.

Qcr. I would be interested in which books you have studied have been the easiest to understand and most useful. I want to understand more and help other parents here in the UK where I can.

I am glad I found this site. I am learning a lot from reading the posts and I am finding that people who have struggled with their children have become very compassionate to others.

[griz]

Sometimes i feel like this is one of those questions: what came first the chicken or the egg.  DBT and CBT focuses very much on the behaviors.  I think the reason for this is that the behaviors although they are ways of dealing with the underlying problem are addressed first.  It is almost like working backward:

Behavior A is a poor way to deal with emotion X- but for some reason this is how the BPD person deals with it.  It may not be effective but for them it often works (drugs, alcholo, cutting).

If you can get the BPD person to realize and work on having effective behavior to deal with a stimulus, it breaks the cycle.  Once you can stop dwelling on the behavior you can now work on the emotion that is causing it.  Don't know if this makes sense.

Griz

[qcarolr]

Qcr. I would be interested in which books you have studied have been the easiest to understand and most useful. I want to understand more and help other parents here in the UK where I can.

I am glad I found this site. I am learning a lot from reading the posts and I am finding that people who have struggled with their children have become very compassionate to others.

Have you watched the video (find it click on foundational reading in right sidebar, first section) with Dr. Fruzetti -- Validation - Encouraging Peace in a BPD Family

This is a quick resource that gives a great perspective on living in our families with BPDkids. I can apply some of his strategies more to my gd8 (dealing with ADHD, anxiety, trauma) right now, than to my DD27 (BPD+).

Let us know what you think?

qcr

[PleaseValidate]

Yes, i am bothered, and i have very strong feelings about it.

*ALL* "Psychiatric Disorders" (not just BPD) are referred to as "Behavioral Health" in the health insurance and in clinical practice. I think it diminishes the disease and adds to the stigma.

There was a huge uproar re "Mental Retardation (MR)" amongst parents and teachers even though this was the *correct clinical diagnosis* in the DSM-IV.  Now it has been changed to "Intellectual Disability" in the DSM-5. THAT uproar actually bothered me because I feel MR better depicted the disorder and "Intellectual Disability" sounds way too broad. I can understand people's sensitivities re the word "retard," but i bet that in a generation the new put-down will be- "What are you 'intellectually disabled' or something?"

I prefer "psychological" or "neurological" over "behavioral." I think diagnoses and umbrella terms should be *accurate descriptors* yet while still *conveying the seriousness* of the disorder.

Some of my other peeve semantics:

":)epression"- i hate that this is the same name for a mood AND a potentially deadly psychiatric disorder? I would prefer something more serious sounding like "Melancholia." (I know this is also a mood but we just don't use the word "melancholic" in the same way.)

"Circadian Rhythm Disorder"- i have this and even i think it sounds like a "made up" disorder! Accurate? Yes, but in no way conveys the disabling seriousness of the disease. When i explain this to people, i usually don't use the title.


I am one of the few i think that DOES appreciate the term "Premenstrual Dysphoric Disorder (PDD)." I think that if you meet the criteria, you deserve to have it validated rather than the ubiquitous and minimized "PMS."