My sister is suicidal, from this aspect I feel more trapped than ever in being able to set healthy boundaries with her
Oof, this one is the hardest. How have things gone in the past when you called 911?
Has your sister accepted she has BPD and if so, has she participated in any kind of treatment? Not many people here have family members who have experienced those two things. My stepdaughter was dx'd bipolar but she clearly has more going on and recently they walked back that diagnosis without offering something different (at least to our knowledge), meanwhile the emotional lability is there and unstable identity, frantic efforts to avoid abandonment, etc.
I cannot have the threat of suicide every time she is upset. She plays so many mental games and sets expectations on you that you will never be able to achieve or better yet have no idea what the expectations are. I am an RN so I am not completely ignorant with mental health disorders but I am out of my league. How do I set a healthy boundary without abandoning her.
In Loving Someone with BPD by Shari Manning there is a chapter on dealing with suicidal ideation. I remember she describes suicidal ideation as a way for pwBPD to get relief from distressing emotions.
SD26is chronically suicidal and we were told she uses it to regulate overwhelming emotions and provide relief. It's not easy to understand but it did help explain how SD26 began to use suicidal ideation to elicit helping behaviors. The key was to understand whether we were reinforcing those helping behaviors (like talking longer after expressing suicidal ideation, or changing behaviors after an incident of SI, being kinder/gentler in response to SI).
I don't know if that helps with your question about establishing healthy boundaries. In our family, my older stepdaughter (29) seems to be best at establishing boundaries. She is also the angriest about being parentified by a BPD mom and is the most draconian in setting boundaries. Her response to her sister is along the lines of "I know you feel bad, you wouldn't text this if you didn't. Have you called grandma/dad/LnL/ aunt/psychiatrist/therapist/hotline. If I don't hear from you in 15 minutes I'll text them so they know what's going on."
H takes a more proactive approach. He texts SD26 at least something everyday, even if it's just an emoji. He's driven to her place on a few occasions when things were particularly rough. He's a 110 percent type dad, going above and beyond, but he hit a limit a few years ago and has said he's done everything he possible can and the rest is up to SD26. We've offered to pay for outpatient day program DBT treatment and she turned into us wanting her to be committed to an insane asylum. He continues to do all the same things he's always done except he doesn't push treatment.
Right now, we treat her chronic suicidality as a maladaptive way she gets relief when she's particularly stressed by something. Since reading Manning's book and talking to two therapists, our current approach is to keep up with the need for excessive caretaking by sending cat and dog videos, emojis, pictures of stuff we come across that SD26 might find interesting. I do this less than H.
When there is an expression of SI, things kind of stay at the same tempo, although H does call and asks pretty direct questions, like whether she has a plan, did something happen that might be causing her to feel particularly bad that she feels like talking about, etc.
H is her favorite person (maybe second to a BF at the moment, but definitely her FP in the bigger scheme of things). H is also in health care like you. He focuses on incremental change, has a good dose of gallows humor, likes to focus on solving problems, so for him, it's definitely a switch in demeanor to kind of get into the swamp with SD26 and validate her dark feelings.
This is a dark thing to say but it's almost like he still has the rope around his ankle but it's loose and he can take it off. For a long time, it was wrapped tight and he was struggling to not go down with her. Sometimes he will talk about taking it off completely but I think that's his own version of getting relief, talking about doing something drastic that isn't realistic given his bond.
SD29 refuses to have that rope on her. She passes it to family members and has told H she'll call 911 because she's not trained to deal with SI.
