Tag Archive for 'relationships'

Your “Say Yes to Life” Monday Motivator: Staying Away From the Borderline

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May is Borderline Personality Disorder Month. This month, in honor of this important topic, we began a new blog series that focuses on the nuts and bolts of borderline personality disorder (BPD), and each week in May we will address a different aspect of recovery from this highly treatable disorder.

This week, we look at the role of the professional in the recovery process.

Perhaps no other disorder has been so extensively misunderstood, misdiagnosed, or misrepresented as BPD, so much so that mental health professionals are often reluctant or downright resistant to working with BPD sufferers. “I stay away from the borderlines,” one professional was heard to say at a recent conference.

Three decades ago, before the creation of Dialectical Behavioral Therapy (DBT) by Dr. Marsha Linehan, a response like this would have been more than understandable. However, in light of all the resources professionals have at their disposal today to treat BPD sufferers, hearing this at a conference in 2010 is puzzling.

BPD is essentially a disorder of relationships. As such, understanding the nuts and bolts of how the disease arises and what sufferers need to overcome its effects can go a long way towards reducing stigma and offering sufferers the type of professional treatment they need to get better.

According to the National Education Alliance for Borderline Personality Disorder (NEA for BPD), representative BPD symptoms include:  fears of abandonment, intense mood shifts, impulsivity, problems with anger, recurrent suicidal behaviors or self-injurious behaviors, and patterns of unstable and intense relationships that often create chaos in the lives of sufferers and their families.

In short, individuals with DBT can’t stand to be with themselves, inside their own intensely emotionally-charged skins, but through their behaviors they often recreate the very relational abandonment they fear, which exacerbates their symptoms, and so on and so on. It is thought that the stage is set for BPD, which is often diagnosed in early adulthood and primarily in females, through early emotional invalidation with a possible genetic biological component.

What is most important for professionals to know, however, is that it is highly treatable.

Even with this awareness however, one initial challenge treating professionals will face is to separate out BPD symptoms from other frequently co-occurring disorders. As the NEA for BPD reports, borderline symptoms rarely occur in isolation, and are frequently exacerbated by other concerns such as substance abuse, eating disorders, depression, anxiety, and bipolar disorder. While individuals suffering from BPD symptoms are often medicated, it is also important to know that no medication has been specifically approved for use to treat BPD symptoms as of yet.

Additionally, there are many ways in which the core symptoms of BPD can manifest, and those symptoms may vary based on each individual’s background, life experience, and prior treatment experiences. With an estimated 2% of the population suffering from BPD symptoms, it can quickly become a source of professional frustration to find one method to treat so many individual cases.

This is where Dialectical Behavioral Therapy (DBT) comes in. Dr. Marsha Linehan, the founder of DBT, categorized the six major categories of BPD symptoms into four skills-building modules. These four core modules include Mindfulness, Emotion Regulation, Distress Tolerance, and Interpersonal Effectiveness. DBT, while used today to treat a variety of mood-based disorders, was created specifically to treat individuals with borderline symptoms, and is scientifically proven to be a highly effective and lasting treatment approach.

Dr. Linehan’s goal when developing DBT was not to separate out, categorize, and individually address all 200+ permutations of the core BPD symptoms. Rather, she aimed to – and succeeded at – identifying instead the four core areas of coping skills that were missing from each BPD sufferer’s internal life coping toolkit. BPD sufferers all struggle to maintain mindfulness about who they are and how they fit in with others. BPD sufferers all wrestle with regulating their emotions and managing feelings of distress. BPD sufferers all have trouble developing trust-based, healthy relationships with themselves and with others in their lives.

In summary, BPD sufferers can all benefit from the four core modules taught through DBT.

For sufferers, loved ones, and referring or treating professionals, DBT is a bright light of practical hope amidst the darkness of a struggle against BPD symptoms.

At Southlake Counseling, we have more than two decades of clinical expertise in treating individuals with BPD symptoms through our DBT outpatient programs. Our combination of individual and group support, with additional phone support if necessary, puts BPD sufferers on the road to lasting recovery. We are happy to talk with loved ones and referring professionals about how DBT skills-building treatment can positively intervene in the life of someone struggling with BPD. We have expertise with adolescents, females, and males and offer individual and group support for individuals at each stage of the recovery process. Visit us at www.southlakecounseling.com – we look forward to hearing from you.

Be Well,
Kimberly

Published on Monday May 24, 2010 in Borderline Personality Disorder. 0 Comments Tags: , , , .

Your “Say Yes to Life” Monday Motivator: On the Borderline

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May is Borderline Personality Disorder Month.  In honor of this important topic, we will spend the month of May addressing different aspects of recovery from this highly treatable disorder.

This week we will focus on the nuts and bolts of what borderline personality disorder (BPD) is, what treatments are available, and recommendations for finding support for yourself or a loved one.

Just hearing the phrase “borderline personality disorder” can strike fear into the hearts of the most resilient loved ones.

But for the individual who is diagnosed with borderline personality disorder (BPD), there is probably just a question mark where comprehension should be. This person is probably thinking, “BPD? What is that? This is just how I am!”

Therein lies the difficulty in accurately diagnosing, assessing, and treating BPD. To the professional untrained in BPD treatment, a sufferer can seem like an exercise in unpredictability, not to mention a source of continual professional self-doubt and frustration.

To the loved ones, often unwittingly caught in the disease’s trap along with the sufferer, BPD can appear as a nightmare of confused interpretations that never ends.

To the sufferer, it is just another day in a life filled with emotional pain.

Statistically-speaking, studies indicate that 2% of the population is thought to suffer from BPD. Additionally, up to 20% of all psychiatric hospitalizations stem from BPD. It is thought that nearly three-quarters of all sufferers are female, which is why current research and treatment continues to focus on females.

But what is it? What does “borderline personality disorder” even mean?

Simply put, BPD places the individual at odds with her own emotions. Emotional ups and downs are experienced as equally painful, chaotic, and unmanageable. Any other symptom traditionally associated with BPD can be traced back to this internal emotional war. Because the emotional instability is so severe, BPD is considered both serious and life-threatening. Self-harming and suicidal thoughts and behaviors are common. Relationships are a continual challenge due to continual mood swings and poor sense of self-identity. Treatment is a must – for the sufferer’s sake, and for the sake of those around them.

What causes BPD? While research is not yet able to pinpoint the exact causes, one thing is clear – it is not a self-willed disorder, and it is not the sufferer’s fault. Newer scientific evidence strongly points to a dual dance of biology and environmental triggers. For instance, while studying the brains of individuals diagnosed with BPD, researchers noted higher activity in parts of the brain that control emotional expression and experience, including the limbic system, the brain’s emotional processing center. For these and other reasons, it is widely thought that BPD-predisposed individuals’ brains differ not just in function but also in structure. This evidence also illuminates one possible reason for the tendency the disorder has shown to run in families.

Environmentally, an individual is considered at higher risk for developing BPD after experiencing childhood trauma or an invalidating emotional bond with early caregivers – or both. Since the disorder tends to first show itself in early adulthood, environmentally it appears that an earlier experience of traumatic emotional invalidation is a key factor in determining who is at risk for BPD later on in life.

But while it can be tempting to spend vast amounts of time digging into a sufferer’s past for clues as to why BPD has developed, the most important call to action is to get that person HELP.

Up until a few short decades ago, treatment options were scarce. But thanks to the pioneering work of Dr. Marsha Linehan, the founder of Dialectical Behavioral Therapy (DBT), there is much hope for successful treatment of this persistent and often resistant disorder. Dr. Linehan developed DBT specifically for the treatment of individuals suffering from BPD after studying their symptoms extensively and determining a range of four core building blocks needed to successfully overcome the disorder.

This is good news for sufferers, loved ones, and professionals. Sufferers who become students of DBT learn key coping techniques in Mindfulness, Emotion Regulation, Distress Tolerance, and Interpersonal Effectiveness. These four core modules are introduced over a period of time in an atmosphere of comprehensive individual and group support, including extra phone support if needed. The end result is an individual who is equipped with all the tools and resources she needs to combat her tendencies toward emotional overextension and self invalidation. Since the instruction is done in a nurturing and emotionally-validating environment, the individual is repairing old hurts while learning new skills, and emerges a stronger, more confident person within herself and in her interpersonal relationships.

If you or someone you love is exhibiting signs and symptoms of BPD, it is important to seek help immediately. BPD is a serious disorder and deserves the highest respect. Do not attempt to manage symptoms of BPD for yourself or a loved one. The professionals at Southlake Counseling have dedicated more than two decades to proficiency in supporting individuals with borderline symptoms through the recovery process. We are here to help. Southlake Counseling offers a wide variety of DBT-based individual and group support, including phone support. Our support groups are offered for both females and males, adolescents and adults. Our comprehensive DBT outpatient program is designed to make immediate, measurable progress in reduction of symptoms and improvement in emotional functioning. Visit us at www.southlakecounseling.com to learn more.

Be Well,

Kimberly


Published on Monday May 10, 2010 in Borderline Personality Disorder. 0 Comments Tags: , , , , .

Your Say Yes to Life Monday Motivator: The Rebel Within

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We all like to think that we are not passive-aggressive. Even if we are not sure what that term means, we are pretty sure it does not apply to us. “Passive-aggressive” doesn’t sound like something a nice person, a loving person, a person like us, would do.

Even as you are thinking this, however, a recent incident weighs on your mind. Last night your mom called asking if you could watch her twin dachshunds while she and your step-dad went on a mini-vacation. The problem is that you know that your mom knows that her dachshunds get along like oil and vinegar with your basset hound.

And you know it too.

So why were the first words that popped out of your mouth, “Of course, Mom – no problem!”

Not to mention that, no sooner had she sweetly thanked you – for the third time this month – than you proceeded to volley off a series of conditions upon which the dogs could stay, including specific times your mom must drop off and pick up her babies, provision of an ample amount of food (because we all know how much dachshunds can eat and your basset Harry doesn’t need to starve all weekend just because your mom doesn’t want to pay to kennel her pets) …. you get the picture.

But you are not, would never act, in passive-aggressive ways towards your mother whom you love. Right?

The trouble with passive-aggressive behaviors is that they signal an uprising within – an inner conflict that is so immediate and unexpected that we do not feel like we have time to stop, investigate, and address the source of the conflict prior to interacting with the instigator of the conflict. To compound matters, since passive-aggressive behaviors most often arise when we are interacting with individuals we are familiar with and know fairly well, the stakes get even higher and cycle becomes more vicious over time.

So how do we change the flow of passive-aggressive language and behaviors?

Internal Family Systems (IFS) is one way to begin to uncover hidden motives and messages that are causing us to engage in passive-aggressive interactions. IFS is a unique therapy model that encourages students to think of themselves in terms of aspects of self rather than a single unified personality. IFS teaches us that we have not one single “personality”, but personalities within ourselves. All of these personalities have our best interests at heart, but each perceives that achievement of our best interests can only be obtained through conflicting means. This is why getting to know each of our parts or personalities, and then getting them to dialogue and work together, is the goal of IFS.

To illustrate how this might work, let us revisit the issue of your recent interaction with your mom regarding her dachshunds, Winnie and Sue.

In this example, there are at least two aspects of you interacting with Mom when she makes the request to kennel her dogs at your house. There is the Pleaser (for more on the Pleaser see this previous Monday Motivator), who automatically says “yes” to every request your mom makes. The Pleaser likes – drum roll please – to PLEASE. This aspect of you enjoys making others happy, and fears their displeasure with the same intensity it fears abandonment because of displeasure. The Pleaser has been convinced through past experiences that saying “no” equals displeasure, which equals abandonment. To the Pleaser, a “yes” ensures your social survival.

Underneath the Pleaser, however, there resides another aspect of you. This aspect, the Rebel, idolizes James Dean, the Fonz, and any other character who regularly chooses to go against the flow. The Rebel has her own assessment of the mother-dachshund scenario. In the Rebel’s opinion, your mom is taking advantage of you for free kenneling. The Rebel resents your mom for continuing to ask you to care for her aggressive, whining, bottomless pits when she knows that you know that she knows that you are inconvenienced more than a little by the repeated favors. To make matters worse, the Rebel remembers every single past experience you have had when you have been taken advantage of – only to find out after the fact, to its horror and disillusionment. The Rebel has vowed to do whatever it takes to uphold your integrity and respect by refusing to let those close to you use you as a doormat yet again.

This is why, even as your Pleaser is saying yes, yes, yes, your Rebel is yelling at the Pleaser – and at you – telling you not to be a pushover. Your Pleaser is afraid of social annihilation and your Rebel wants to annihilate your Pleaser, the requester – and Winnie and Sue.

And you are caught in the middle.

Using IFS, you can begin to dialogue with the Pleaser and the Rebel, hearing each part out, commiserating and empathizing and then introducing a third perspective – balancing out each part’s needs so that all three of you together can accomplish your shared goal – to safeguard your own wellbeing even while maintaining valued relationships with others in healthy, self-affirming ways.

If you are frustrated by persistent internal and external conflict in valued relationships, and you are at your wits end for how to handle the interactions of your Pleaser and Rebel, IFS and Southlake Counseling can help. Contact us today at www.southlakecounseling.com to find out how to say “no” to passive-aggressive behavior and YES to collaboration, partnership, and positive relationship skills.

Be Well,

Kimberly


Published on Monday March 8, 2010 in Monday Motivator. 0 Comments Tags: , , .

Your Say Yes to Life Monday Motivator: Couples in Conflict

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You love me…you love me not. I love you…I love you not.

Whether it’s Valentine’s Day, an anniversary, or any other chance to renew our commitment to our partner, have we ever stopped to wonder why these reminder events are such a marketer’s playground, or why when they come around each year we are suddenly able to find the time, energy, and money to drop whatever we would otherwise be doing to make plans for displays of affection?

Love isn’t easy, period. Love is not easy to come by, and it is not easy to keep.  And it is extraordinarily painful to lose, but couples who once were madly in love with each other fight, split, and divorce on a daily basis. They also spend months and sometimes years after the split still struggling to figure out why it happened and how to pick up the pieces and move on.

If it is not easy to love a deux, it can be traced back to our own difficulties with loving ourselves. We cannot love someone we do not know – and often, each half of a new couple comes into the relationship willing and able to spend more time getting to know the other person than getting to know themselves.  We don’t know why we get angry, or what triggers it. We tell new partners about how past partners have deliberately “pushed our buttons,” and then we blame those past partners for love’s earlier unhappy endings. We tell ourselves we are sure it will be different this time – new partner, new love, new beginning.

Until it starts happening all over again with our new partner, and we suddenly begin to smell a rat. We may then start to wake up and realize that, if the only constant in a recurring pattern is us, then we are the one who holds the power to change that dynamic rather than risk yet another painful loss.

In Internal Family Systems (IFS), a powerful and dynamic therapeutic model that explores our inner world interactions in all their many parts, we learn that both in and out of love, we are multi-faceted beings.  We are fascinating, really – we have so many thoughts, so many emotions, so many memories, so many experiences. And within the context of a love relationship the environment is especially ripe for all of those thoughts, emotions, memories, and experiences to collide in our attempt to preserve the love we have while protecting ourselves from more pain.

IFS students soon learn that we have the Hurt Child, who remembers the very first breakup and wants to make sure she never, ever has to go through that again. We have our Inner Critic, who remembers past harsh words from former loves that hit too close to home, and reminds us that we are our own worst enemy and that any pain we have felt in the past is our own fault. We have our inner Champion, who will do battle to ensure that no interloper – even a loving one with good intentions – gets close enough to harm us. And we have the Blamer, who steadfastly maintains that, regardless of whatever repeatedly unfortunate circumstances may befall us, we have no one to blame but somebody else.

Couples in conflict can benefit greatly from becoming students of themselves, and IFS is a model uniquely well-suited to that exploration. In IFS couples therapy, each partner can start to learn how “pushing buttons” actually arises when an inner facet of self that bears past painful memories gets triggered into self-protective action by a partner’s comment or action. IFS’ self-awareness training enables each participant in the relationship to check their reactions against their inner awareness before responding in customary knee-jerk reaction ways to their partner. For instance, is the Blaming part of you judging your partner because it is easier than bearing the self-judgment of your own Inner Critic? Is the Hurt Child going away just when he should come closer because one hurt was enough, and when that original hurt happened he was a child and didn’t know what else to do but flee?

IFS training in the context of couples communication helps each participant to recognize that each of these parts is doing the best they can to protect us. We can then begin to learn new communication skills that start with self-awareness and self-evaluation. We can forestall knee-jerk reactions that may further damage our treasured relationship and create new patterns of interaction that are healthier, more mature, and more self- and love-affirming.

If you are feeling stretched and challenged by the dynamics of a valued love relationship, Internal Family Systems therapy can help. At Southlake Counseling, we have over two decades of expertise with guiding couples to salvage, restore, and rebuild the love they have worked so hard to cultivate. Contact us at www.southlakecounseling.com and experience for yourself just how wonderful saying “no” to unhealthy conflict and YES to love and life can be!

Be Well,
Kimberly

Published on Monday March 1, 2010 in Monday Motivator. 0 Comments Tags: , , .

Your “Say Yes to Life” Monday Motivator: Interpersonally Speaking

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Welcome to week four of our discussion about Dr. Marsha Linehan’s Dialectical Behavioral Therapy (DBT).

Over the last three weeks we have addressed three of the four core modules that make up the DBT Skills Training –Mindfulness, Emotion Regulation, and Distress Tolerance. For our final week of exploration, we will tie it all together with an adventure into the fourth and final module – Interpersonal Effectiveness.

For many students of DBT, interpersonal effectiveness can feel like the most challenging module of all, because even if we think that the issues that motivate us to seek out the help of therapeutic professionals are caused by other people, we eventually discover that they are best solved by strengthening our relationship with the most important person in our life – ourselves.

So in the first three modules of our DBT work, we get to examine our traditional mental, emotional, and relational responses to the day-to-day experiences we have in our own lives, and then from there we begin to explore how adding new skills can increase our self-confidence and efficacy in meeting our own personal goals.

In the final module, we get to “take our skills to the streets”, so to speak, as we apply our newfound intrapersonal skills to learning the art of interpersonal effectiveness.  For most of us, when we take a closer look at how we have been approaching and managing our relationships, we realize there is a lot of room for improvement. But if we have been faithfully studying and applying the skills we’ve learned in the first three DBT modules, by the time we get to the fourth module we have a foundation of confidence that allows us to tackle this final challenge with our awareness of the payoff for doing this hard work firmly in place.

So when we first begin studying DBT’s interpersonal effectiveness module, we begin with a self-assessment of how we have traditionally handled issues like conflict, asserting our opinions and preferences, and meeting our needs in relationship with others. We look at whether we have been able to attract and foster relationships that are healthy and stable, weather tough times while keeping the connection and respect we feel for ourselves and others intact, and achieve personal satisfaction and fulfillment in the midst of interpersonal growth and development.

We then begin learning new ways of addressing interpersonal issues we have identified as less than satisfactory.

For instance, let’s say your spouse has a habit of barking orders at you the moment you walk in the door. You are usually tired when you get home from a long day at work, and after fighting to make your voice heard with your boss and co-workers (an opinionated lot to say the least) you have little energy left over to make the same degree of effort with your husband.

But now, with your newfound interpersonal effectiveness training, you understand that not speaking up for yourself actually takes more out of you, and uses up more valuable energy, than staying quiet. The next time you come home and the barking orders commences, you lay a hand lightly on your husband’s chest, meet his eyes directly, and calmly and clearly say, “I am tired. I need to shower, change into my comfy clothes, and have something to eat. You are welcome to sit with me while I eat and unwind. But I cannot talk with you about what you need from me until after I have had a chance to rest a bit from my day. Do we have a deal?”

From there, depending on how your spouse responds, you can progress accordingly with rolling out your new interpersonal effectiveness skills. Furthermore, since DBT training is most often conducted through a combination of weekly individual and group meetings, with optional individual telephone sessions for added support, you have the support of an entire team who is working with you to help you refine, manage, and develop your skills for the benefit of all concerned.

So give yourself the gift of new, shiny interpersonal skills in the New Year. Relationships are the heartbeat of what makes life feel like living, what motivates to us to crawl out of our warm beds on cold mornings, what encourages us when our job doesn’t deliver on its promises or our boss has a bad day, and what keeps our chin up when the economy takes a nosedive or natural disaster strikes. We naturally turn to our relationships for support, comfort, meaning, and reconnection – to share both sorrow and joy – and to remind ourselves that all the hard work we do throughout the rest of each day finds its fulfillment in the rewards of our relationships with ourselves and others at day’s end.

At Southlake Counseling, we have been studying and teaching the four core modules of DBT for more than two decades. We have seen hundreds of amazing transformations as individuals have learned, participated in our groups and in individual therapy sessions, and emerged to experience all the wonderful benefits that DBT skills-building has to offer. If your New Year’s intentions or resolutions include strengthening and deepening your relationships with loved ones, colleagues, friends, and family, we look forward to hearing from you at www.southlakecounseling.com very soon!

Be Well,

Kimberly

Published on Monday January 25, 2010 in Dialectical Behavioral Therapy (DBT) and Monday Motivator. 0 Comments Tags: , , .