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In DBT, in the distress tolerance module, there is a concept of willingness versus willfulness. I find this concept particularly important and akin to the being right (willfulness) vs being effective (willingness) concept. Here is some information about willingness versus willfulness:
WILLINGNESS
- Cultivate a WILLING response to each situation
- Willingness is doing just what is effective in each situation, in an unpretentious way.
- Willingness is listening very carefully to your WISE MIND, acting from your inner self and your deepest core values.
- Willingness is becoming aware of your connection to the universe and to the person you are interacting with.
- Willingness engenders listening and mentalizing.
- Ask yourself, in 5 years from now, will the situation that causes the distress matter?
WILLFULNESS
- Willfulness is like sitting on your hands when action is needed, refusing to make changes that are needed.
- Willfulness is about the desire to be right in a situation, regardless of what is needed to get through effectively.
- Willfulness causes you to fight any suggestions that will improve the distress and thus make it more tolerable.
- Willfulness is being rigid and inflexible.
- It is the opposite of doing what works, of being effective. Willfulness is trying to fix every situation or refusing to tolerate the distressful moment.
That last example in willfulness is particularly important to read and consider. Often, I find the loved ones of borderlines to be “fixers” and try to solve each problem for the borderline. Being willing to listen, and really hear what the other person is feeling and going through is usually more effective, despite the distress it may cause, than telling the other person what to do or giving advice.
Adapted from dbtselfhelp.com, with edits and additions by Bon
 The Holidays can be a time of stress The holidays are often thought of as a time of warmth and happiness, family gathered around the table creating wonderful family memories. But for many of us, it can also be a time of angst and anxiety. (link to the article)
There are many reasons you may feel stress. Perhaps you are a student struggling with school and are afraid of criticism from your family. You may be unemployed and don’t want to face questions about your job search or finances. Maybe you’ve put on or lost “too much” weight this year and are feeling self conscious. If you have been struggling with depression, mood swings or anxiety, you may be more emotionally vulnerable. This time of year could remind you of someone who has become ill, passed away or moved.
There are as many reasons for holiday stress as there are individuals. All of them are what we at Silver Hill call “triggers” – they can bring about or literally “trigger” feelings of anxiety, loss and frustration.
The holiday season and family events can be enjoyable and help build meaningful connections with the people in your life, but if triggers set you off, you may instead find yourself caught in a riptide of emotion.
In the Silver Hill Dialectical Behavior Therapy (DBT) Program, we teach our patients strategies to deal with triggers like these. Three of the strategies are Radical Acceptance, Coping Ahead and Wise Mind.
Radical Acceptance
People usually do not change much from year to year. Personality traits you find irksome will still be there. Your snarky nephew will continue to be snarky. The self-obsessed sister will still be self-obsessed. Your mother-in-law will continue to make comments about your appearance or weight.
Expecting them to be kinder and gentler will only lead you to disappointment. Remember, unrealistic expectations are disappointments waiting to happen. Making matters more interesting, people tend to regress when they are around family. You may too. So if your brother really was a “brat,” don’t be shocked if he becomes a grown-up version of his former self. Accepting this fact, and dealing with the people as they are, will reduce your stress.
But Radical Acceptance works to your advantage because the flip side is also true: People who were good will most likely still be good. Your ever warm and wonderful grandmother will continue to be that way. The cousin with the infectious laugh will not let you down, and your always helpful brother-in-law will be his old self too.
Find a way to accept your own personal cast of characters, the good and the bad. It will help you with the next strategy called “Cope Ahead.” Continue reading Family Dynamics Around the Holiday Table →
By her own admission, Talya Lewis was a strange child – as early as kindergarten:
Lewis: Like I remember one day I came in with white sticky tape wrapped all around my arm, and I told everyone that it was a cast and I had broken my arm.
Desperate for attention, she convinced her mother she couldn’t see, and got prescription glasses. By age 8 – her behaviors were self-destructive:
Lewis: I had a game, and I called it TP, and TP actually stood for taking pills. I would rummage in my parents’ medicine chest and I would take their pills.
This was only the beginning. Over the next years, Talya knocked her front teeth out with a hammer, started taking drugs, cutting herself, her behavior out of control in school. Her parents, whom she describes as distant socialites, didn’t seem to notice. But then came the wake up call.
Lewis: I overdosed on a bottle of sleeping pills in my high school, in the front lobby, and that was the beginning of what ended up years of long-term confinements in a private psychiatric hospital.
Talya was diagnosed with Borderline Personality Disorder, or BPD. Philadelphia therapist Edie Mannion describes it as a severe and complex mental illness with many symptoms:
Mannion: Difficulty regulating emotion, like a broken emotional thermostat, and difficulty controlling impulses, and what I see as mostly a profound amount of emotional pain. Continue reading Understanding Borderline Personality Disorder from WHYY →
Or what driving can teach us about living mindfully and effectively.
 Driving and Effective Behavior The other day, my teen-age daughter asked me: “How do you drive a car?” It was an interesting question for me, because I have been driving so long that I don’t even think about it and was really unable to explain this complex, yet conditioned set of skills to her. Of course in a few years, she will have to learn and integrate those skills.
Yesterday, in the ATSTP group, we were discussing DBT and mindfulness. One of the guidelines for mindfulness according to DBT is part of the “how” skills: “One-Mindfully — Focus all your attention to every task you do. When you’re driving, drive. When you shower, shower. When you talk with someone, talk with them. Put everything you have into everything you do, one thing at a time.” One of our group members questioned the facility of leaving the past out of the current situation. He made two statements, one which is typical: “Didn’t someone say ‘those who do not study the past are doomed to repeat it?’” The other was more interesting to me: “The resentment part makes sense, but ignoring the experience part is like telling someone ‘drive the car in the here and now, and not according to your experience.’” That lead me to responding this way (with some modifications for this blog)…
I am glad you used driving as an example of remembering the past. Driving is one of the most mindful activities we do as adults. We are conditioned with the skills of driving and we do them automatically and mindfully on the road. Traffic is a process, not a thing unto itself. It is different each day, each moment in time. You don’t avoid an intersection because there was an accident there two weeks ago. You go and see (or check the traffic report first) and the conditions are bound to be different. The same people are not on the road, the same drivers, the same cars. It ever changes. You also don’t think about the skills when you drive. You’ve made those second nature. It is a very mindful activity.
It is also a very complex activity. When I learned to drive, I learned on a manual transmission (stick shift). At first it was difficult. When you first start driving, you haven’t made the skills and awareness of speed, distance and road conditions second nature. Yet, once you master the skills necessary to drive effectively, you don’t even think about the fact that both of your hands and both of your feet are working in synchronization for the common goal of getting you some place safely. That’s why first-time drivers are not very good (and can be dangerous) and elderly people can be bad drivers. Their bodies and minds are not working together in an agile, mindful way.
When you’re impaired - by drugs or alcohol – or distracted – by cell phones, conversations or tiredness – you shouldn’t drive. It impairs your mindfulness and the skills that you’ve learned and made part of yourself. The same can be said of interpersonal relationships. If you’re impaired by whatever – emotions, substances – it is sometimes best to take a step back from the situation as not to cause a two-car pile-up. Continue reading Baby You Can Drive My Car →
I don’t usually like to defend myself. In fact, in my book, I have a tool that says “Don’t Defend”. Interestingly, in the Essential Family Guide to BPD, Randi Kreger has the same tool. Yet, I am feeling the need to correct something that Randi has said over at her Psychology Today “Stop Walking on Eggshells” blog. In her new post “Take Some Experts and Bloggers with Agendas With a Grain of Salt” she says:
Splitting is not just for people with borderline personality disorder. Some (but not all) people who have expertise with high conflict personalities and borderline personality disorder (BPD) also think in black and white. In my opinion, when you read their books, blogs, message sites, and other forms of media, consider if they have a bias they are passing along–sometimes unknowingly, sometimes quite deliberately.
And goes on to say that these biases arise from stereotyping and:
But people with power to influence others need to allow for the complexity of these issues and not make stereotypes and generalizations.
I feel that Randi is actually doing the very thing that she is decrying here. Because she didn’t specify WHICH “people who have expertise” are “splitting”, I believe that her message can be interpreted as generalizing about these “experts” (myself included). I also feel the timing was interesting, because I have recently posted a few comments on her blog, clarifying my position on BPD and on being an effective non-BPD. Now, Randi assured me that that message was not directed at me. Yet, I believe that by not specifically enumerating the “bloggers and authors” in question, people will generalize and cast a wide net to include those bloggers and authors who DON’T have an agenda or a bias.
Additionally (and here is where I am really defending myself and explaining and clarifying), she cites 3 ways that she sees these bloggers and authors are biased. They are 1) generalizing and mind reading (I don’t think I do that), 2) Sexism (pretty sure I’m not in that category) and 3) Making people’s decisions for them (this is where the perception of my book and blog get a bit stickier). While I have never (that I can remember) told any non-BPD to stay or leave, there’s little question that my book When Hope is Not Enough: a how-to guide for living with and loving someone with Borderline Personality Disorder is a “staying” book. I mean, golly, just read the subtitle. In the introduction of WHINE, I say:
Unlike many books on this subject, this book starts with the premise that you want to continue to have a relationship with this difficult person. If you are a spouse, I assume that you want to stay married. If you are a parent, I assume that you want to continue a relationship with your child (sometimes you may have no choice). If you are a child of a parent with the disorder, I assume you want to learn how to effectively interact with your parent. Finally, if you are a friend, I assume you want to continue to be friends with this person. I do not cover how to sever a relationship with someone with the disorder in this book.
So, while I’m not telling people they SHOULD stay (or leave) or making the decision for them, my work assumes that they have already made the decision to stay and instructs the non-BPD reader of the book the ways (the know-how) in how I was able to transform my relationship with my borderline wife and daughter. I guess the only bias that I have is my own experience, which is staying with someone with BPD. I have no experience in leaving someone with BPD, although I do know many non-BPDs that have successfully left their BPD partner. Of course with kids and parents, the issue gets stickier still.
Finally, Randi says this:
It is clear from some people’s description of their own life–at least to me–that the relationship is unhealthy and needs to change. But in my opinion that must come from the non-BP themselves: list managers/authors/others don’t know if that person is using effective tools to improve the relationship.
I would agree with the first part of the clip, many Non-BPD/BPD relationships are unhealthy and need to change. The question is how? What does one DO to change the relationship? That is what I cover, based on my experience, in my book. The second part of the sentence, “list managers/authors/others don’t know if that person is using effective tools to improve the relationship” I actually have to disagree with. I have met hundreds of people with BPD and their loved ones, both electronically and in person, and have been trained in both DBT-FST (Dialectical Behavior Therapy Family Skills Training) and in Mentalization techniques. While I am NOT a mental health professional (and neither is Randi), I have “discovered” that a synthesis of these techniques, adapted for the partner/parent environment has worked wonders in my life. These skills are effective in a relationship with a person with Borderline Personality Disorder. Of course, you don’t have to agree with them and I have found several people that are unable to accept the skills from my book for various reasons. In WHINE, I say this, without realizing that for some people it would actually be impossible for them to implement these tools because the tools were counter to such strongly-held beliefs, the tools are rejected out-of-hand:
While some of the tools may be difficult to implement in your life and some may seem counter-intuitive, these tools are effective in managing a Non-BP/BP relationship. Depending on your background, biological make-up and sensibilities about the world, you may have an easier or more difficult time understanding and implementing these tools in your life.
I have also discovered that certain other skills are ineffective in the same context. Like any set of skills, these have to be practiced and practiced effectively and from the “proper” stance. They often say that “practice makes perfect” and sometimes people counter with the saying “perfect practice makes perfect”. I’m not one for the idea of perfection. I am one for the idea of agility and “second nature”. The thing is you’ll never hit the baseball out of the park if you don’t practice, with the proper stance, hitting a baseball. And furthermore , you’ll never hit the baseball out of the park if you’re swinging a kayak oar.
I think that Randi’s post actually has done some damage to the non-BPD “support community”. There are a number of individuals that are not mental health professionals and that fall into the “list managers/authors/others” category that in my opinion have been caught in the wide net that Randi has cast in that blog post. If non-BPDs can’t trust the people who now seem to have an agenda and are biased, who can they trust?
I’d just like to caution Randi with her own words: “But people with power to influence others need to allow for the complexity of these issues and not make stereotypes and generalizations.” She is a “person with power to influence others” because of the wide success of SWOE and her platform over at Psychology Today. Using this broad brush that creates doubt as to the motives of people who are actually attempting to help and share what worked effectively for them, does a disservice to the non-BPD support community in my opinion.
Behavioral Research and Therapy Clinics (BRTC) on the University of Washington campus is accepting applications for a Dialectical Behavior Therapy (DBT) Family & Friends Skills Group. Here is some information from their webpage:
The BRTC is primarily a research clinic, offering treatment to members of the community as part of our clinical trials. We are not currently recruiting for any clinical trials, but we periodically have openings for new clients in our Treatment Development Clinic (TDC). Through TDC, clients receive Dialectical Behavior Therapy from doctoral students under the supervision of licensed psychologists.
TDC is currently accepting new clients in our FRIENDS AND FAMILY DBT Skills group. This group is designed for family members, friends, and caregivers of people with chronic mental and physical health problems like borderline personality disorder, bipolar disorder, and Alzheimer’s disease. For more information on this group, please call 206-543-3765.
I would urge all family members to consider attending this class (or a similar class). These DBT-FST (Dialectical Behavior Therapy Family Skills Training) are invaluable in understanding your family member with borderline personality disorder and creating a healing environment in the home.
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Overcoming Borderline Personality Disorder by Valerie Porr is perhaps the most up-to-date and complete book for family members of people with BPD published to date. When I read the book, I couldn’t help but think that Ms. Porr had the therapists and mental health professional more in mind than the family members. It appears as though she is trying to dispel many myths about BPD that exist not only in the family environment but also in the mental health community. This book is steeped in scientific research, including research involving the biological under-pinnings of BPD. It includes many skills for family members from both DBT and mentalization based therapy (MBT). Clearly Ms. Porr is highly respected by the clinical community since many of the leading experts in research and practice in BPD treatment have written blurbs for this book. The book is quite dense and a must read for family members of those with BPD. Yet it might not be the best book to start with because of the complexity of the scientific research, the psychoeducational aspects and the technical details about the various therapies for those with BPD. Still, I highly recommend Overcoming Borderline Personality Disorder.
Recently, in the ATSTP group we discussed the power of saying “when you do [whatever], I feel [whatever else].” This formulation of words is very powerful when dealing with an emotional person. It does a couple of things that are important. First, it lets the other person know that you have feelings as well. Sometimes someone with BPD will feel that they are the only one in the world with feelings to be hurt. DBT actually “encourages” this way of thinking IMO. Since DBT is all about the client’s emotions and behaviors, the “other’s” (the therapist) feelings and behaviors are not often taken into account. This situation is not really ideal for a family member. Saying: “When you did [this], I felt [that]” often does the trick. It’s basically the “inserting your feelings” tool from When Hope is Not Enough. However, you need to make sure that you are communicating your feelings, not your judgments about the behavior. That is, use feeling words (sad, angry, afraid, etc.) and not judgment words (manipulated, disrespected, etc.). If you use feelings words, you can’t be argued with.
Here is an interesting article on emotional validation for parents of people with BPD… from a new blog about understanding DBT.
Dialectical Behavior Therapy Validation Strategies for Parents
By Christy Matta, MA
How Do We Validate
Validation and active listening techniques are specific ways of approaching your child to increase cooperation and balance the change we are often asking for from our children.
1. Responsiveness: Addressing our children with interest in what they are saying, doing and understanding. Expressing concern about his or her wishes and needs.
2. Warm engagement: Approaching kids with warmth and friendliness. Active positive communication with our voice, tone and posture.
3. Self-Disclosure: Communicating our own attitudes, opinions, and emotional reactions to our children, as well as reactions to how they are behaving.
4. Genuineness: Being ourselves, rather than always acting as “parent” or “authority figure.”
5. Vulnerability: Empowering them, rather than having an exclusively high-power-low-power relationship.
6. Cheerleading: Cheerleading is helpful in validating the person’s inherent ability to overcome difficulties and learn new skills. It is believing in our children, assuming the best, providing encouragement, focusing on their capabilities, contradicting other people’s criticisms that are not accurate, and providing praise and reassurance.
7. Articulating their unverbalized emotions, thoughts, or behavior patterns. Children are often unaware of their own feelings and behaviors. It is validating for us to give voice to what they are thinking and feeling.
Remember: what each individual child finds validating is different. One child may respond to simply being listened to, while another may respond when you articulate and express understanding for how he or she feels. Our children are not the only ones who can benefit from understanding and active listening. Husbands, friends, family and yes, even we, ourselves, need it. We all have times when we’ve got an important problem, emotional pain, are having trouble with change or are feeling out-of-control. Validation can help us and our children make necessary changes and face challenges.
In my house, once I stop pushing everyone to ‘get things done,’ I find the solutions come fairly easily. My kids will pick up the toys if I assure them they can keep out their favorite. They’ll put their dishes in the dishwasher if we spend dinner talking about their day and I notice small attempts they’ve made to be helpful around the house. My family life is not a fairytale of cooperation and teamwork, but I do find that when I’m paying attention and listening to my kids, I feel less like I’m alone in the never ending battle against disarray.
See my March 31, 2010 post for more discussion of validation. Comment below to share how you create an atmosphere of cooperation in your family.
References:
Linehan M. Cognitive Behavioral Treatment of Borderline Personality Disorder. New York: Guilford Press; 1993.
One of the things I have noticed about Dialectical Behavior Therapy Family Skills versus Mentalization Based Skills is that they operate at a different link on the behavioral chain. In “When Hope is Not Enough” I have a section called “the BPD Dynamic.” What this dynamic outlines is a behavioral chain. That chain goes like this:
Event -> Interpretation -> Emotional/Physical Feelings -> Action Impulses -> Expression and Behavior
DBT-FST seems to me to operate at the Action Impulses to Expression and Behavior link, while validating the Emotional/Physical Feelings link. Don’t get me wrong, the DBT-FST skills are extremely powerful in communicating with someone with BPD. Yet, the change that is requested is at the end of the chain. I have heard that Marsha Linehan is quoted as saying something like, “Just because you feel like a crazy person, doesn’t mean you have to behave like one.” The point here is that DBT is a behavioral therapy and by modifying behavior, that works backwards toward regulating emotion and tolerating distress. In other words, DBT trains you to behave differently based on your feelings. When you gradually learn that your new behavior is more effective than the previous behavior, you break the conditioned chain between Action Impulses and Expression and Behavior. That is the essence of the DBT skill “Opposite Action.” An interesting side note is that by practicing Opposite Action (that is, doing the exact opposite of what your feelings implore you to do – such as engaging when you feel sad, rather than hiding under the covers all day), you actually feel better, because the action does work backward. Dr. Paul Ekman found that configuring one’s face to mimic a certain feeling actually causes that feeling to be experienced. That is the theory behind DBT’s “Half Smile” skill. Ultimately though, by working at that link in the chain, the person still feels the emotion, yet he or she just behaves differently than the emotion originally informed him/her to behave.
MBT on the other hand takes on the on the problem at the Interpretation link. By asking questions and being open to alternative interpretations, the person with BPD is more likely to have a broader view of other people’s behavior and the events in life. DBT never asks about the intent or motivation of the other person and just takes the interpretation as a given in a person with BPD. If a person with BPD says something happens and that something means X, then in DBT it means X. There is very little questioning of the validity of the interpretation X. In MBT, however, the interpretation X can be questioned and alternative interpretations (such as Y or Z) can be examined. The nice thing about this is that when the person with BPD is faced with a similar situation, he/she is less likely to jump to conclusion X and might consider Y or Z.
An example of the differences in the two approaches is as follows:
My daughter comes home from school after being teased by a boy on the playground. My daughter ends up throwing a thermos at the boy’s head.
With DBT, I would validate her anger and ask her how she could behave more effectively the next time this teasing occurs. So next time she will behave more effectively and not throw the thermos.
With MBT, I would validate her feelings and begin to probe with curious and straight-forward questions as to the intent of the boy. Perhaps he actually likes my daughter and that is why he is teasing. Perhaps he is showing off to his friends. If this approach is taken, my daughter is more likely to consider the boy’s motivation for the teasing. If she understands the motivation, she can actually never get angry and risk throwing the thermos.
All of that being said, I believe these skills have to be learned as a “ladder” to effectiveness. You can’t start at point E without going through points A-D. DBT-FST provide the foundation for more advanced skills, like those in MBT.
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