May is Borderline Personality Disorder Month. Last week, 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 family in the recovery process.
If your loved one has been diagnosed with borderline personality disorder (BPD), you probably reacted initially with equal parts relief and consternation.
The relief? “Well thank goodness we at least have a name for ‘it’ now!”
The consternation? “What can we do to help?”
The good news is that effective treatment is available. Two decades ago Dr. Marsha Linehan developed a (then) new therapeutic process known as “Dialectical Behavioral Therapy” or DBT. DBT was specifically created to effectively interrupt the BPD emotional cycle and replace those thoughts and behaviors with new coping skills. Students of DBT learn new skills in four core modules – Mindfulness, Emotion Regulation, Distress Tolerance, and Interpersonal Effectiveness. While DBT is used to treat a variety of mood-based disorders today, it was specifically designed to dramatically improve the lives of those diagnosed with BPD.
Family members and loved ones are also an important part of the individual’s recovery process, and knowing how to effectively participate can go a long way towards ensuring eventual full recovery.
In the absence of guidance, it can be tempting for family members and loved ones to pull away, thinking that less is more, and at least the person will not be harmed by the wrong kind of support. However, this will be perceived by the individual suffering from BPD as yet another instance of abandonment, exacerbating symptoms and delaying recovery.
What is needed instead is a two-pronged approach beginning with the realization that no family member or loved one, no matter how well-intentioned, is equipped to manage the recovery process of an individual diagnosed with BPD. BPD is a serious, potentially fatal disease, and is worthy of both the highest respect and comprehensive professional treatment. BPD is not a self-willed disease – in other words, the sufferer cannot help their behavior outside of the intervention of trained professionals who know how to help break through the emotional gridlock inside and guide the sufferer to safety.
So the first step to take as a concerned family member is to ensure your loved one is receiving appropriate and adequate professional medical treatment.
Once this first step has been addressed, family members are now able to join in to support the individual through the recovery process. The National Education Alliance for Borderline Personality Disorder (NEA for BPD) has issued specific guidelines to help family members and loved ones participate effectively and constructively. A brief overview of these guidelines is found below and more information can be obtained on the NEA for BPD website at www.borderlinepersonalitydisorder.com.
The first recommendation is to “go slowly”. In other words – in the initial stages, fear of change and fear of abandonment through change is very high in the mind of the sufferer, who may exhibit resistance to treatment and change for precisely these reasons. This is not unique to a BPD sufferer – family members can build their “patience muscles” by considering areas of their own lives where change is both needed and feared. The NEA for BPD also advises family members to refrain from encouraging the sufferer with “you can do it” messages – these may increase anxiety and slow actual progress. Rather, family members are encouraged to eschew overt praise at noticeable progress and instead validate the hard work involved while still empathizing with how difficult the change process must be. Wrapped in with this is an encouragement to avoid discussion of achieving big goals – again, family members can flex their patience muscles by contemplating how desired change has happened in their own lives, and by setting small, realistic goals for the sufferer with the help of the professional treatment team.
The second recommendation is to modify the home environment in any way necessary to achieve what the NEA for BPD calls a “calm and cool” environment. This may mean something as simple as maintaining predictable daily family routines. Other ideas that are effective are making efforts to moderate intense emotional displays (whether positive or negative), minimize defensiveness in response to the individual’s thoughts and behaviors, and set limits on what will and won’t be tolerated to preserve the sanity and safety of the family unit. Becoming educated about BPD symptoms and fears – for example, intolerance of being left alone, inability to discern “grey” emotional areas, and inability to self-sooth – will also assist family members with developing patience, compassion, and appropriate responses throughout the recovery process.
Finally, the NEA for BPD urges family members to seek prompt professional attention for BPD-related behaviors, such as self-harming, self-medicating through alcohol or other substances, or suicidal thoughts or behaviors. These behaviors are serious and reflect an intolerable inner environment that requires immediate professional intervention. Getting the sufferer prompt attention preserves not just safety and sanity but paves the way for development of secure emotional bonds that lead to eventual full recovery.
At Southlake Counseling, we have more than two decades of clinical training and experience implementing DBT-based treatment programs. Our wealth of individual and group support for males and females, adolescents and adults is unique in the Davidson area. If you or someone you love is exhibiting borderline personality disorder symptoms, contact us today at www.southlakecounseling.com to find out how DBT-based treatment can help.