CAUSE: Driven by low self-esteem?

[BPDFamily.com]

Happy New Year Ocean,

You said you were helped by the BPD Recovery board... .what about therapy?  And, if so, specifically what kind of therapy?

Bitzee

Dialectical Behavioral Therapy

Marsha Linehan (1991) pioneered this treatment, based on the idea that psychosocial treatment of those with Borderline Personality Disorder was as important in controlling the condition as traditional psycho- and pharmacotherapy were. Concomitant with this belief was a hierarchical structure of treatment goals. Paramount among these was reducing parasuicidal (self-injuring) and life-threatening behaviors. Next came reducing behaviors that interfered the the therapy/treatment process, and finally reducing behaviors that reduced the client's quality of life. In 1991, Linehan published results of a study that seems to do remarkably well at achieving these goals.

The Theory

Basically, DBT maintains that some people, due to invalidating environments during upbringing and due to biological factors as yet unknown, react abnormally to emotional stimulation. Their level of arousal goes up much more quickly, peaks at a higher level, and takes more time to return to baseline. This explains why borderlines are known for crisis-strewn lives and extreme emotional lability (emotions that shift rapidly). Because of their past invalidation, they don't have any methods for coping with these sudden, intense surges of emotion. DBT is a method for teaching skills that will help in this task.

How it works

Dialectical Behavioral Therapy (DBT) consists of two parts:

   1. Once-weekly psychotherapy sessions in which a particular problematic behavior or event from the past week is explored in detail, beginning with the chain of events leading up to it, going through alternative solutions that might have been used, and examining what kept the client from using more adaptive solutions to the problem:

          Both between and during sessions, the therapist actively teaches and reinforces adaptive behaviors, especially as they occur within the therapeutic relationship. . . the emphasis is on teaching patients how to manage emotional trauma rather than reducing or taking them out of crises. . . . Telephone contact with the individual therapist between sessions is part of DBT procedures.

          (Linehan, 1991)

      DBT targets behaviors in a descending hierarchy:

          * decreasing high-risk suicidal behaviors

          * decreasing responses or behaviors (by either therapist or patient) that interfere with therapy

          * decreasing behaviors that interfere with/reduce quality of life

          * decreasing and dealing with post-traumatic stress responses

          * enhancing respect for self

          * acquisition of the behavioral skills taught in group

          * additional goals set by patient

   2. Weekly 2.5-hour group therapy sessions in which interpersonal effectiveness, distress tolerance/reality acceptance skills, emotion regulation, and mindfulness skills are taught (see summaries of sample workshts). Group therapists are not available over the phone between sessions; they refer patients in crisis to the individual therapist.

[renaissance]

Happy New Year Ocean,

You said you were helped by the BPD Recovery board... .what about therapy?  And, if so, specifically what kind of therapy?

Bitzee

Dialectical Behavioral Therapy

Marsha Linehan (1991) pioneered this treatment, based on the idea that psychosocial treatment of those with Borderline Personality Disorder was as important in controlling the condition as traditional psycho- and pharmacotherapy were. Concomitant with this belief was a hierarchical structure of treatment goals. Paramount among these was reducing parasuicidal (self-injuring) and life-threatening behaviors. Next came reducing behaviors that interfered the the therapy/treatment process, and finally reducing behaviors that reduced the client's quality of life. In 1991, Linehan published results of a study that seems to do remarkably well at achieving these goals.

The Theory

Basically, DBT maintains that some people, due to invalidating environments during upbringing and due to biological factors as yet unknown, react abnormally to emotional stimulation. Their level of arousal goes up much more quickly, peaks at a higher level, and takes more time to return to baseline. This explains why borderlines are known for crisis-strewn lives and extreme emotional lability (emotions that shift rapidly). Because of their past invalidation, they don't have any methods for coping with these sudden, intense surges of emotion. DBT is a method for teaching skills that will help in this task.

How it works

Dialectical Behavioral Therapy (DBT) consists of two parts:

   1. Once-weekly psychotherapy sessions in which a particular problematic behavior or event from the past week is explored in detail, beginning with the chain of events leading up to it, going through alternative solutions that might have been used, and examining what kept the client from using more adaptive solutions to the problem:

          Both between and during sessions, the therapist actively teaches and reinforces adaptive behaviors, especially as they occur within the therapeutic relationship. . . the emphasis is on teaching patients how to manage emotional trauma rather than reducing or taking them out of crises. . . . Telephone contact with the individual therapist between sessions is part of DBT procedures.

          (Linehan, 1991)

      DBT targets behaviors in a descending hierarchy:

          * decreasing high-risk suicidal behaviors

          * decreasing responses or behaviors (by either therapist or patient) that interfere with therapy

          * decreasing behaviors that interfere with/reduce quality of life

          * decreasing and dealing with post-traumatic stress responses

          * enhancing respect for self

          * acquisition of the behavioral skills taught in group

          * additional goals set by patient

   2. Weekly 2.5-hour group therapy sessions in which interpersonal effectiveness, distress tolerance/reality acceptance skills, emotion regulation, and mindfulness skills are taught (see summaries of sample workshts). Group therapists are not available over the phone between sessions; they refer patients in crisis to the individual therapist.

[Bitzee]

Hi Ren,

Are you answering for OceanHeart?  I'm all for DBT, and quite familiar with it, but are you saying you know this is the treatment OceanHeart had?

-B

[renaissance]

Hi Ren,

Are you answering for OceanHeart?  I'm all for DBT, and quite familiar with it, but are you saying you know this is the treatment OceanHeart had?

-B

sorry, no... don't mean to imply any knowledge at all as to the specifics of the treatment that oceanheart received.   

[johnhoffman]

Marni... .just reread the thread... .in particular your last post... .and I,m deeply moved

1... .the full realisation that the only way way out of BPD is in the hands of the sufferer

2... .that it is truly loving to leave a BPD sufferer to confront themselves

3... .that self love is the start... .and that self love is in small steps,is deliberate and is hard work


Marni... .have you read scott pecks "the road less travelled"... .your last post encapsulates much of the essence of his book... .real life and love is hard fought and won... .it needs perpetual commitment... .and above all is an active conscious choice... .we choose to love... ."falling in love "is  not a choice... .its part of a primeaval process deep within all of us to allow our ego boundaries to drop... .a precursor to sex and reproduction... .and is full of soothing chemical release to the body... .scott calls this period "cathexis"

Somehow its now easy to understand why  a person with BPD chooses  cathexis... .its a fix... .its does,nt require deep introspection... .and it comes with a chemical fix... .but cathexis always comes to an end... .and its then the problems in aBPD relationship emerge... .the BPD person is faced not only with the "work and honesty" of real love  but with the shame of the untruths of their life  of their very being told during cathexis... .no wonder running to a new relationship seems preferable... .I,d do it myself in the circumstances


The dilemma for a BPD sufferer is vicious... .run to a new relationship knowing deep down full well the outcome and the pain... .run again... .and again untill the prospect of escape is as near zero as possible... .or face the music... .knowing full well the music is the loudest in the world... .and your ears are real sensitive... its gonna hurt... .and its gonna be hard work... .no suprise the narcissitic side thats in all of us kicks in and says no thanks... .or worse suicide seems preferable to a BPD person

I am not excusing the behaviour... .but as one who felt the searing pain of such behaviour... .I feel I am somewhere near understanding... .what I doknow is that my searing pain is not  even 1% of hers

Happy new year

John

[oceanheart]

I think sometimes people may forget - or not know outright - that I came here to bpdfamily.com not to "champion the rights of people with BPD" or whatever it is I'm doing here , but as a non. In the beginning, i downplayed my BPD-ness because I really needed help on the non side of things adn because I didn't want to rub salt in the open wounds of those here who had been through so much shte at the hands of their BPs. As my healing progressed in regards to my ex, I began to speak more from the BPD perspective, tho I didn't plan to, it just kinda unfolded that way.

My relationship with R., my uBPDexbf, was short and not as fraught with the level of abuse as most of those I read about here. But it was intense, made more so by the stereo effect of both our PDs (I'm certainly not putting all the blame on him. I contributed to the toxicity of the relationship no doubt). It was extraordinarily painful to make the decision to leave him, for many reasons, not least among them that I wanted so desperately to help him because I knew intimately the hell he was in. I was on my way out of that hell, I was escaping the demons. But I had to turn and walk away, leaving him there because he refused to believe he was in it. While he didn't create that hell (his childhood was bad), he chose to stay in the fire rather than save himself; it was easier to burn.

Like Turtle perfectly said previously:

What a twisted life. It's like setting fire to the house while you're still in it and then sitting in your bed waiting for the flames to consume you because you don't know how to get out even tho there's an open window right there, and then attacking the firefighters when they come to rescue you from a fiery death... .

Bitzee, to answer your question - and yes, further enquires now can be sent through my new agent ren   just teasing! - I didn't take DBT, it wasn't available in my area. I bought the treatment manual that's for counselors who give the group adn since I have a BA in psychology (no surprise there), I was able to understand it where a "layperson" probably would not have. I did the exercises on my own, tho it was of limited help since it wasn't set up for that purpose.

If you want to know more of what I did as therapy, I'll PM you, since it's kinda a long story... .Basically, just remember what I said about militant self-reliance and apply that to self-motivation plus having a cognitive-behavioral therapist and that's how I got better. I got better because I wanted to (and because I'm smart and because my BPD was in-acting, and other things).

ren, thanks for that great breakdown of DBT, even though I'm not experientially familiar with it, that was spot-on. I think your comments about BPD were really insightful and true.  I would expand on them only in two ways: in the beginning of recovery, an intimate relationship probably is not possible and is more harmful than good (for both involved). However, as recovery progresses to a stable level, being in relationships can have a positive effect on the person with BPD's growth. I'm not advocating people use relationships as "practice", but that in terms of dating casually, it's really quite helpful to take on bigger challenges. As to medication, one drug really has been indicated to be especially helpful in the impulsivity and mood swings that are hallmarks of BPD: Lamictal, an anti-convulsant. It allows the person to get their emotions under control enough to do the more arduous work of cognitive therapy (challenging negative thought patterns and learning new healthy skills).

John, you summed it all up so beautifully in one short sentence (hey, can I take lessons on brevity from you, I uh, seem to need them badly! ): "the shame of the untruths of their life, of their very being". You showed real understanding of the plight of the person with BPD while not devaluing the real pain they (we) cause their loved ones. Thank you for your compassion and your desire to sympathise, it really means a lot. I'm going to have to check out Peck's book. ive heard about it for years but haven't gotten to it yet... .I like what you say he says, especially the idea of cathexis. A brilliant psychiatrist of mine once pointed out quite matter-of-factly that my tendency to seek immediate bonds with bfs (through sex) was merely a way to get a quick connection, the fast-food equivalent of emotional intimacy. And we all know how healthy fast food is... .

Thanks everyone for your wonderful contributions to this thread: it has helped me so much to see others' perspectives. I'm not going to be able to keep up on my replies in the thread for a little while due to a family emergency, but I will try to follow the conversation if it decides to keep on truckin

Again, to all a wonderful new year (it's gonna be a great one!)

Marni

[DreamingFreedom]

Hi Marni, I've been away for a while (NC with my mother and an overall general time-out, mostly), and it's great to "see" you again. I see you're still growing and learning--I expected nothing less, LOL--and I'm glad to say I think I am, too.

You give a lot to this board, and your insights are valuable. As always, sincerely, thanks for being here. You are da bomb! And you have a far-reaching (okay, talkative) philosophic temperament like me, so I don't feel so silly.    Thank you, thank you!

I hope things are going well with you, my friend... .and I hope things will be okay with your family, too. Take care.

Dreaming

[renaissance]

My relationship with R., my uBPDexbf, was short and not as fraught with the level of abuse as most of those I read about here. But it was intense, made more so by the stereo effect of both our PDs (I'm certainly not putting all the blame on him. I contributed to the toxicity of the relationship no doubt). It was extraordinarily painful to make the decision to leave him, for many reasons, not least among them that I wanted so desperately to help him because I knew intimately the hell he was in. I was on my way out of that hell, I was escaping the demons. But I had to turn and walk away, leaving him there because he refused to believe he was in it. While he didn't create that hell (his childhood was bad), he chose to stay in the fire rather than save himself; it was easier to

Bitzee, to answer your question - and yes, further enquires now can be sent through my new agent ren   just teasing! - I didn't take DBT, it wasn't available in my area. I bought the treatment manual that's for counselors who give the group adn since I have a BA in psychology (no surprise there), I was able to understand it where a "layperson" probably would not have. I did the exercises on my own, tho it was of limited help since it wasn't set up for that purpose.

If you want to know more of what I did as therapy, I'll PM you, since it's kinda a long story... .Basically, just remember what I said about militant self-reliance and apply that to self-motivation plus having a cognitive-behavioral therapist and that's how I got better. I got better because I wanted to (and because I'm smart and because my BPD was in-acting, and other things).

ren, thanks for that great breakdown of DBT, even though I'm not experientially familiar with it, that was spot-on. I think your comments about BPD were really insightful and true.  I would expand on them only in two ways: in the beginning of recovery, an intimate relationship probably is not possible and is more harmful than good (for both involved). However, as recovery progresses to a stable level, being in relationships can have a positive effect on the person with BPD's growth. I'm not advocating people use relationships as "practice", but that in terms of dating casually, it's really quite helpful to take on bigger challenges. As to medication, one drug really has been indicated to be especially helpful in the impulsivity and mood swings that are hallmarks of BPD: Lamictal, an anti-convulsant. It allows the person to get their emotions under control enough to do the more arduous work of cognitive therapy (challenging negative thought patterns and learning new healthy skills).

A brilliant psychiatrist of mine once pointed out quite matter-of-factly that my tendency to seek immediate bonds with bfs (through sex) was merely a way to get a quick connection, the fast-food equivalent of emotional intimacy. And we all know how healthy fast food is... .

Thanks everyone for your wonderful contributions to this thread: it has helped me so much to see others' perspectives. I'm not going to be able to keep up on my replies in the thread for a little while due to a family emergency, but I will try to follow the conversation if it decides to keep on truckin

Marni

  hi marni, it's your new agent,just 'checking in' (guessing your check got into the mail late... usual postal bottlenecks during the holidays, etc.)... .8)

lot's of more great input to respond to... but where to begin? first, likewise will be keeping you and the subject of your family emergency in my prayers...

i was in a similar situation as you... my estranged wife... an extraordinarily beautiful woman, gifted intellect, emotional connectivity straight to the soul - yet suffering the soul-dampening effects of BPD, as said before, honestly obtained no matter how unfortunately dire the developmental origins. intensity? i expect that i'll never again know the incredible, breathtaking, soul-connecting highs... .nor the devastating lows... .of this now 'no contact' marriage. something strikes me as different, however, and that is that my wife acknowledges and accepts her BPD and so far as i know, continues to see her therapist. although, i'm certain that a portion of this time gets devoted to learning to deal with the realities of the 'no contact' and a future... .separate and apart forever. so, while on the one hand, as opposed to your former partner who didn't acknowledge mine did.

however... .something else you mention is critically important to this topic, and relates to you in particualr - the fact that a BPD-sufferer may act-out or... .act-in... .

mine very definitely acted-out... and this led to the volatility that appears to characterize most of the relationships on this forum with the BPD/non. myself being basically a very soft-hearted and tender soul, all 6'2" and 230 lbs. of me, i would doubtless reacted to her acting-inward far differently - far more sanely, lovingly, compassionately - than with with her outward-acting self, which at times wore me down to the level of screaming and slinging my fist into walls/doors in a frustrated effort to 'scare' her into stopping her 'borderline moment'. that was a long sentence, and i'm tired, but my suggestion is that we'd have had a far greater chance were she an inward-acting person. in that case, what you suggest would have been quite true - i could have always, always been able to be there for her. there's an old saying, 'you draw more flies with honey than vinegar'. we'd still be together today had she been an inward-acting BPD-sufferer i'd wager... the outward volatility proved too much for us... and she needs now to heal alone...

as much as i hate to admit, it's likely true, too, what you say. at some point in her recovery, some casual dating may be a good thing. i'm not yet to the place where i can embrace this notion for her with wholeheartedness, but i recognize its validity. what greater thing... may i ask of my love for her than to hope that one day, she finds that peace and yes, new love in this life... at some point... i ask you... .:'(

interesting that you mention an anti-convulsant, as i take another - neurontin - to help with symptoms of ptsd that i acquired via years of very hazardous commercial-related flying. i'm sure that anything that decreases anxiety would be beneficial to treating some of the symptoms, or co-morbidity factors in BPD, meanwhile agreeing that meds alone do nothing to correct the cognitive distortion/inappropriate affect that required the 'militant use of cbt' that you found a successful route to cure.

using sex to form intimate bonds? guilty as charged...   i'm co-dependent for sure and also attend a 12-step program for sex and love addicts anonymous. if it's about sex, sensuality and how powerfully inviting it may be in my mind and body to the idea of increasing emotional intimacy... i've done it. i could write a 'how to' book on the topic. this is one 'BPD trait' that i shared in abundance with my former partner, as she could quickly identify herself in patrick carnes landmark book on sex and love addiction 'out of the shadows', as a co-sex addict. shame... ... cause, 'when you're hot you're hot!'  8)

well, hope we keep seeing you around, marni. don't worry about sending the check... i'll continue to provide you with excellent representation...   xoxo  btw, been meaning to ask... your avatar... is it a woman wearing a skin diving mask? it's always what i think of when i see it and have wondered what if, if anything, of its significance? just curious...

best as always,

ryan

[Randi Kreger]

Low self esteem is one of the biggest reasons why people with BPD resist the idea that they have BPD. Randi KregerRandi @Author, "The Essential Family Guide to Borderline Personality Disorder: New Tools and Techniques to Stop Walking on Eggshells"Available at www.

[tammy]

Understanding the low self esteem and the pain which generates a great deal of BPD behavior and thoughts, I just wonder; how do we communicate our own needs or dissatifation about something to a BPD without getting caught in a tornado of hurt feelings, retalitory actions and wind up in a mess of confusion, misunderstanding and chaos? I know my d is hurting. I also know she is amazing and wonderful. I just can not say anything to her without her turning into me attacking her weight. I am active on the parent board but I think this may go across enough interpersonal relationships that it could apply to anyone. I also think it would be helpful to hear from recovering BPDs how they process criticisms, suggestions or even another person's expression of needs for themselves.

[oceanheart]

I just can not say anything to her without her turning into me attacking her weight.

Could you make a rule for yourself that anything about her appearance is off-limits? I ask with respect, please know. Comments about appearance - especially from one's mom - are kindof a boundary violation and there's no way someone with BPD, especially one with weight issues, is going to be able to see anything you say on that topic as anything other than criticism. It feels very intrusive no matter the good intent. And people in the throes of BPD go by how it feels, because it feels so bad and intense. We're not talking logical reactions here.

That's different than conveying your own needs, which is very important for both the person with BPD and the loved one trying to communicate. It's essential you honor your own needs, but dang can it be hard/confusing when the reaction you'll get back is unpredictable and often way overblown. There are many threads here that talk about how to do this successfully, so I'll leave it to that.

But I can "handle" with some sort of experience (tho not expertise) how I've learned to change this to a more healthy way myself. Mostly I use humor to deflect the initial feeling. For example, my dad once said I was washing the grapes "wrong" and I cracked a joke about my fruit-cleansing expertise and let it go at that. Later at home I processed the feeling of never being good enough into putting it back onto my dad, thinking how it said more about him than it did me. And then I laughed it off again, because that's just my dad and he doesn't mean anything hurtful about it - he's just insensitive and rigid at times. Of course that's easier in low-stress situations. If I'm in high-stress ones, I usually take myself to a time-out if I can, and approach the problem later when I'm not so emotional, even if it takes days; I've trained myself to respond rather than react, which has been wonderfully freeing for everyone.

It's different when someone expresses their needs because that can feel threatening - at least to me when historically that meant my needs had to be subsumed to a powerful others and I had a feeling of powerlessness. My last relationship my bf was able to express some of his needs and I was able to take them into consideration and see where I could compromise without compromising myself, but unfortunately he didn't turn out to be similarly inclined and the more I gave up the more he wanted (demanded).

Sometimes you have to unapologetically state what you need. Use "I" statements, as in "I feel hit_." Try not to manage or foretell the pwBPD's response and/or emotions, if this is something you do. You are being good to yourself and your loved one when you are honest about what you need. You deserve that respect in being heard and if the pwBPD can't do so, you may not be able to talk to them about it, but you still need to enforce your boundary regardless.

Best of luck to you.