Advice for how to get abusive BPD adult sibling to open up to help

[Jackie40]

 :help:I have an adult family member who is a single mom and caretaker of her teenage child. They live in a different country than the rest of the family. She has shown signs of BPD/complex trauma for many years, but recently her behaviour is getting worse and more troublesome. She is very verbally abusive to her child, slams doors, sometimes throws things and recently mentioned not wanting to live. She drinks every day. Her child has no other family member in the country currently, and reaches out for support from me when things get bad. At one point he moved out from the home but later moved back. He is a minor still, but not for much longer.

I am worried for her safety, and the safety of her child. We have repeatedly spoken to her about getting appropriate help, and most often she blows up and won't listen. Even if she does listen at certain points, she doesn't seem to be open to accepting help, or even acknowledge that her anger and aggression is an issue. She is very quick to get angry and abusive, and it's only getting worse.

My question is - how can you approach someone about getting appropriate therapy in a way that might actually work? Is it possible to gently speak to someone about their anger without them getting angry? Are there things that have worked for others?

[Pook075]

Hello and welcome to the family. 

You've asked the hardest possible question that comes across this site almost daily- how do you convince someone to get help?  The short answer is that you can't.  Your relative will get help once it seems like the best possible option for thier life and not a day sooner. 

Why?  That's the crux of the illness...everything is everyone else's fault.  As long as there's someone else to blame, there's no reason to take personal accountability and deal with our issues.  BPD is especially challenging because they're emotional outbursts due to internal pain.  They don't think about hurting others.  Instead, they're hurting so much internally, they lash out to feel better in the moment.  And when it works, they think, huh, that other person is truly the problem in my life.  If only they weren't ruining things, I'd be happy.

You mentioned a few things that could lead to help in the USA.  If someone's suicidal, you dial 9-1-1 and there'd be a mandatory wellness check.  If they were suidical, then there'd be a mandatory hospital stay for a psych evaluation.  But that's in America and other countries have their own procedures.  In Europe, mental health is taken much more seriously.  In Aisa, it's taken less seriously.  So it really depends on where your relative is at and who there could try to get them help.

If the teenage child will be an adult soon, they'll have to make a choice whether to stay or leave.  There's very little you can say or do though that would make a meaningful difference for the parent/adult.  The place to start would be seeing what that country even offered in mental health services.

[zachira]

The most successful treatment approach for getting people who are unmotivated to make needed changes is motivational interviewing. It has been used for many years with addicts and is now mainstream in mental and physical health. It meets the client at his/her level of motivation including having no motivation whatsoever to do anything. It is easy to learn and there are many resources on the internet. Not sure if motivational interviewing is effective with BPD or other personality disorders.

[CC43]

Hi Jackie,

I'm sorry your relative seems to be teetering on the brink, and yet refuses to do what it takes to turn her life around.  It sounds like she has substance use disorder as well.

Unfortunately, you can't force an addict or someone with BPD to get help.  With BPD, the situation is especially complicated, because her disordered thinking convinces her that everyone else is the problem, not her.  Even if you managed to get your relative some therapy, I think it's unlikely to work, because for therapy to work, she has to want to do the work.  Therapy is work, after all.  She has to want more than anything to change, and change is really hard, especially for someone with deeply ingrained habits and routines.  Alas, she probably has to hit bottom first, in order to realize that therapy (and sobriety) is the only available option to her.

I feel really sorry for her son.  On the bright side, he might be able to leave home soon.  But the reality is that after growing up with dysfunction, he probably doesn't understand what a healthy life looks like, let alone how to go about obtaining it.  One thing you might consider doing is spending some time with him, if you could arrange that.  That way, he might get a break from his disordered home, and he might have opportunity to glimpse what a "normal" life looks like.  That might give him some hope, too.  But in practice, it might be difficult to pull off, if his mom is reliant on him or super-controlling.  Maybe a way to frame things would be to offer to spend time with her son, to "give mom a needed break."

[Jackie40]

Thank you everyone for your kind and thoughtful responses, it really helps getting input from people who understand, and feeling like you've been heard.

I take everything that has been said on board, both with a sense of hope and a heavy heart, having confirmed that the feeling of being quite powerless isn't unjustified. I will read more here on the forum and take solace in having found a supportive and knowledgeable group. Above all, I will think of more ways that I can be supportive and present for her son.

[ForeverDad]

While not something to advocate (publicly) the reality is that many teens approaching adulthood do "vote with their feet" when the home environment is abusive, dysfunctional or unhealthy.  Not just to get out, but to find a healthier place.

At the least, it ought to be good for her son to seek a good counselor so he has objective input in his life.  Does his school provide counselors?