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 Tough Love and BPD Tough Love is not an effective approach with children and teenagers with Borderline Personality Disorder. Although some therapists and self-help authors recommend tough love as what should be done with BPD, it is ultimately detrimental to the borderline and to your relationship with the borderline. The problem comes in regarding the nature of the disorder. While behavioral therapies can work, those based on reinforcement and shaping, those therapies usually include acceptance strategies and non-judgmental approaches. The nature of BPD is that the individual with the disorder is in deep emotional pain because of the dysregulation of the emotional system. They are exquisitely sensitive to emotional experiences and many of these experiences are physical in nature, especially with children. There is intense physical pain and social rejection (to which borderlines are also intensely aware) causes more pain. The borderline will then seek to end the pain in any way they can, including substance abuse, casual sex, thrill-seeking and other dangerous methods. While these methods will stop the pain temporarily, the pain always comes back.
OK, now back to why tough love doesn’t work. A person with borderline personality disorder wants more than anything to communicate his/her pain with those with whom he/she has an attachment relationship. Understand that BPD is not just a case of the person “behaving badly”. The behavior has a function and generally that function is to either stop the pain or to communicate the pain. If you try to deal with behavior with tough love (rules, contracts, boundaries, punishments, etc.), the person with BPD will feel more rejected, more abandoned and unable to communicate the pain. This causes MORE pain and requires more pain-quelling behavior. It causes more of what made you start using tough love to begin with.
A little while ago, I was speaking with someone about a friend of my daughter’s. This girl probably has BPD. Her behavior was totally off the charts – drugs, turning tricks, running away, cutting herself, suicide attempts, etc. When the person I was speaking with expressed sympathy for the girl’s mother, I responded like this: “I think what happened with [girl’s name] was that she was in a lot of pain and didn’t know why. All she really wanted was for her mother to see her pain. All she ever wanted was for her mother to understand her and her pain. But her mother only saw bad behavior and tried to deal with that. So, the girl tried anything and everything to stop her pain.”
The word compassion actually means “to suffer alongside” (or co-suffering). If you’re a parent of a person with BPD, are you seeing and understanding their pain? Or are you fed-up with their “bad behavior”? Developing non-reactive compassion is the answer, not tough love. Tough love sends a message that the borderline can’t communicate their pain. Are you co-suffering? Or are you punishing the borderline for doing anything to stop the pain?
I decided to share my video in slide form on slide share. Here is the 4 X 4 presentation that I used for the video on slide share.
http://www.slideshare.net/bondobbs/the-4-x-4-of-bpd
I am also sharing another presentation that talks about the I-AM-MAD emotional validation skill.
Here is the I-AM-MAD presentation:
Article about empathy and coping with BPD:
Moran: Inspiration through empathy: Living with mental illness
Published: July 22, 2010 6:00 PM
Updated: August 05, 2010 8:00 AM
For Lorelei Andrews (not her real name), volunteering to offer support to local individuals living with mental illness is cornerstone to her daily life.
I had a chance to talk with her about her story and the current state of services in Kelowna for individuals living with mental illness.
She has worked as a server, a wedding planner, a full-time student (earning two degrees), and a bridal consultant.
In fact, she started one bridal gallery in Vancouver that has now become the largest in Canada, which may even be the venue for an upcoming television reality show.
However, about five years into her whirlwind career, she began experiencing anxiety.
“I was used to delivering 100 per cent all the time, I required it of myself,” recalled Lorelei.
She came to the point that with so much pressure, she started to think of the sale instead of the client. As a very thoughtful and empathetic person, she felt her self-worth sliding.
What began as a dip in productivity ended up with her entering “self-preservation mode,” and being prescribed various medications to balance out—resulting in a near comatose state for several months.
Lorelei is living with a mental illness. As productive and successful as she was, it struck her where she least expected it. It can happen to anyone: the successful executive, the homeless man asking for change, the young woman serving your coffee.
In fact, one in three Canadians will experience some form of mental illness in their lifetime—one in five will experience it this year.
After several rounds with psychiatrists, hospitalization and group therapy sessions, Lorelei was diagnosed first with bipolar disorder, which involves extreme mood swings.
She has since been more correctly diagnosed with pervasive post-traumatic stress disorder with symptoms of borderline personality disorder.
Lorelei was lucky. She had the drive and motivation to pick herself up and learn about her illness.
After the incorrect diagnosis, she began to self-advocate and attend various meetings and courses regarding mental illness.
While in Vancouver, she was offered a position in providing wellness and recovery planning for individuals with mental illness. “I found I had a talent for translating the doctor talk to regular people” said Lorelei.
She is now living completely organic. With her newfound skill set, she came to Kelowna and started a peer support group session that occurs once a week at the Kelowna and District Branch of the Canadian Mental Health Association.
“Our group is passionate, loving and empathetic, and they are so good to each other. A lot of us are hypersensitive, and with that comes great responsibility to control and manage our emotions,” said Lorelei, who maintains a positive outlook.
“It keeps me well and grounded and balanced; if I’m not living what I’m teaching, things don’t go well.”
What makes this group unique is the focus on mental health, rather than mental illness, which is steeped in stigma. Peers learn how to self-soothe and tolerate stress, as well as about the impact of mental illness in living a happy, healthy life.
“I’m inspired by what I see when I help someone change their perspective about what’s been bothering them. It’s the same thing I used to see in a girl’s eyes when she realized she was wearing the dress she was getting married in.”
To learn more about living with mental illness, and to hear stories such as Lorelei’s, visit the CMHA Kelowna website at www.kelowna.cmha.bc.ca.
***
CMHA Kelowna, in partnership with Interior Health, is also holding a community forum regarding the state of mental health and addictions services, which occurs July 28, 5:30 p.m., at 504 Sutherland Ave.
For more information or to register, contact Charly Sinclair at 250-861-3644 or email charly.sinclair@cmha.bc.ca.
Watch for another story of another member of our community who is living with mental illness in Sunday’s edition of the Capital News and online at www.kelownacapnews.com. The Canadian Mental Health Association is a charitable association, which promotes the mental health of all and supports the resilience and recovery of people experiencing mental illness.
Jamie Moran is the director of promotion and development for the Okanagan branch of the CMHA.
When new members “wash up on the shores” of the ATSTP list, they are confused, angry, helpless and exhausted. One thing I also noticed is that new members are emotionally entangled with their loved ones with BPD. Sometimes when people speak of “boundaries,” they use the phrase “where you end and I begin.” The word boundary has many meanings, and have talked about effective boundaries a lot on this blog. Yet, this idea of “where you stop and I begin” is very important when you’re entangled in another person’s emotions. A Non-BPD must learn to heal, to unpack emotional baggage, to acquire the emotional skills to help to detangle the morass of emotional issues that may be keeping him/her in confusion and pain.
If your emotional well-being is dependent upon a loved one’s behavior, you’re in a difficult and painful situation – one in which you have little control over. This leads to a feeling of helplessness because you have no ability to direct your emotional life since your feelings are dependent on another person’s words or actions. Instead, you can state: “My emotional well-being will be whatever it will be no matter what he/she does/says.” Easier said than done, I know, especially when the other person is telling you you’re a loser or a failure or whatever other insults that may have been foisted upon you. Ask yourself: Is my emotional well-being dependent on his/her behavior?
Here’s a quote about this subject from the I-Ching which a member of the ATSTP list posted on this subject:
Here the source of a man’s strength lies not in himself but in his relation to other people. No matter how close to them he may be, if his center of gravity depends on them, he is inevitably tossed to and fro between joy and sorrow. Rejoicing to high heaven, then sad unto death-this is the fate of those who depend upon an inner accord with other persons whom they love. Here we have only the statement of the law that this is so. Whether this condition is felt to be an affliction or the supreme happiness of love, is left to the subjective verdict of the person concerned.
Some more from “Beyond Boundaries”:
Each person has a unique emotional profile. This profile is based on five independent factors. When I say “independent” here, I am saying factors that can each be unique in each individual. The emotional profile factors are:
- Tolerance. This is the sensitivity a person has to triggering events. Those with a high sense of threat awareness (like people with BPD) are likely to have this factor set at “hair trigger.”
- Onset. This is how quickly the emotion gets to full intensity.
- Intensity. This is how intense the emotion affects a particular person.
- Duration. How long the emotion lasts and continues to affect the person’s thinking.
- Return to baseline. How long it takes a person to “get over” the emotional reaction.
A person with BPD will likely have an emotional profile in which all five aspects are poorly regulated. That is, the tolerance will be low and they will react at the slightest provocation. The onset will be fast and they will react quickly to the trigger. The intensity will be high, and their experience and expression of the emotion is likely to be strong. The duration will be long and it will last a longer time at top intensity. Their “return to baseline” will take longer and they will be emotionally upset longer than others might. In other words, people with BPD are likely to be an emotional volcano, ready to erupt at any minute.
For this reason, a person will BPD can be difficult to deal with and to understand how they get upset at the most “trivial” of things. However, the experience of the emotions is valid and real. Just because something seems trival to you (i.e. below your tolerance) doesn’t mean it’s not perfectly real to the other person.
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.
 Non-BPDs and self-image I have starting thinking about the concept of “trade” words. What that means is that we nons “trade” certain words for other words. The purpose behind this is to re-make our ways of thinking – it helps to combat black-and-white thinking, shame and fear in ourselves. One of the concepts that I expound on in “When Hope is Not Enough” is the idea that one’s own language shapes one’s thoughts. While in that section of the book, I focus on the non-bp’s thoughts and words in relation to the person with BPD, here I am interested in how a non-BP thinks about his/herself.
Here are some examples of “trade” words and phrase that I have either discovered or developed:
Old Word: Must
Trade Word: Prefer, would like to
Old Word: Should
Trade Word: Choose to
(from now on the old word/phrase will appear first, the trade word next – just so I don’t have to type “Old Word:” “Trade Word:” over and over again…)
Can’t
Choose not to
Have to
Want to
Ought
Had better
All
Many or most
Always
Often or typically
Can’t stand
Don’t like
Awful
Undesirable
Bad Person
Bad Behavior
I am a failure
I failed at
Anxious
Concerned
Depressed
Sad
Angry
Annoyed or frustrated
Hurt
Disappointed
Guilt
Remorse about
Jealous
Concerned about the relationship
Never
Not often
is
seems like
is
feels like
I am certainly open to more suggestions. Here are some examples when thinking about yourself:
“I must do well” = “I want (or wish) to do well”
“I shouldn’t do that” = “I prefer not to do that”
“I am a bad person” = “I did a negative thing”
“I need love” = “I want love, but not need it to live”
“I can’t stand this” = “I don’t like this”
“I am a loser” = “I lost (or failed) at a task”
 Megan Fox and BPD A little while ago, I wrote a piece on Megan Fox and her statements in an interview that she was considering the possibility that she had a “borderline” personality. I got several reactions that she probably didn’t know what she was talking about or that she was merely emulating/reflecting her “heroine” – Marilyn Monroe. (Fox has a tattoo of Marilyn Monroe on the right forearm).
I read the interview with Fox in “Rolling Stone” this month and found that, if she was being honest in the interview, there is a distinct possibility that she does have BPD. Here are some of the salient points…
In “When Hope is Not Enough,” I point to three features of BPD that I think are common to all people with the disorder. They are: emotional dysregulation, shame and impulsivity. So, let’s start there:
Emotional Dysregulation
Fox: “…But it doesn’t mean I don’t struggle. I am very vulnerable. But I can be aggressive, hurtful, domineering and selfish, too. I’m emotionally unpredictable and all over the place. I’m a control freak. My temper is ridiculously bad. I’ve destroyed my house.”
As a child she had, “panic attacks that manifested themselves as violent, rageful temper tantrums. Like I didn’t know how to control myself or what to do.”
 When Hope is Not EnoughGet the Non-BPD book that has helped hundreds! If you have the disorder, give it to you loved ones! It will help. Shame
Fox: “I’m really insecure about everything. Like what those reporters said about the movie, all I could think was, ‘They’re mocking me… I have a sick feeling of being mocked all the time. I have a lot of self-loathing.”
Impulsivity
Fox: “I go batshit. I’ve had to say to Brian (her boyfriend), ‘You have to go and stop talking to me, because I’m going to kill you. I’m going to stab you with something. Please leave.’ I’d never own a gun for that reason. I wouldn’t shoot to kill. But I’d shoot him in the leg, for sure.”
More evidence…
As a child, she started seeing a therapist because of her real “emotional problems,” but it didn’t seem to help.
She is sensitive about the environment. She can’t sleep with someone touching her. She requires a “cocoon” of pillows to make her feel safe. She can’t sleep in the quiet and dark. She doesn’t like to look in the mirror. She admits to drawing blood during sex, but doesn’t elaborate. She admits to self-injury, but doesn’t elaborate. She hints at an eating disorder, but doesn’t elaborate. She is a “bi-sexual.”
And more. If half of the things in the interview are honest and true, I think Megan Fox may have leaped over my other “celebs with possible BPD (but not for sure)” list.
 Are you and your BP on the same team? I often hear people with BPD/ERD say that they feel that their loved ones are “not on my side” or that the loved ones are “supposed to be on my side.” This phrase stuck out at me when I read the story about the suicide of Megan Meier (the “MySpace suicide” case), because, although I have no insight into Megan’s mental health, clearly when she was insulted and rejected on MySpace, and she was emotionally dysregulated. She came to her mother, and after her mother admonished her for the use of foul language on MySpace, Megan cried and said, “You’re my mom. You’re supposed to be on my side!” ( This according to her mother’s reports).
When someone is highly emotional, they need to know that they have an advocate and that someone is on “their side.” I often ask my consulting clients (especially partners of people with emotional regulation issues) if they feel that their partner and they are “on the same team.” Many times the answer is no. Why does someone have a desire to have someone on their side, even when the “sides” are not desired, intended or even clearly delineated? The answer in my mind comes down to shame and rejection sensitivity.
If a person has shame (or even low self-worth, which is similar), then the person is likely to have a high level of rejection sensitivity. Being rejected by others is painful, especially for emotional people. Having an advocate of their “side” of the issue, which is essentially answering, “I am on your side no matter what the situation,” is tantamount in these highly emotional, social interactions that involve rejection. One can be “on their side” emotionally without condoning whatever behavior that one doesn’t agree with.
There are teaching moments and there are times that one doesn’t teach. If you try and teach, punish or impart values during a period of emotional dysregulation, the relationship will be damaged and nothing effective will be accomplished. Instead, emotional validation and support can be used to cool the bonfire. Once it is cool, then a teaching moment can present itself.
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