A free eBook – 4X4 for Nons
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Reinforcement, especially positive reinforcement, is a powerful teaching tool. You could more accurately say “training” tool. You have probably used reinforcement in your life without even realizing it. Consider potty training. If you have ever potty-trained (or as many modern texts call it “toilet taught”) a toddler, you know how difficult that task can be. However, all kids eventually learn to use the potty – I don’t know of a case of a kid going into high school without knowing how to use the potty.
Potty training provides an excellent example of positive reinforcement and the ignoring of “backsliding.” That is the essence of this tool. When you teach a child to use the potty, you make a BIG positive deal about it when it is successful. The first time you see the poop in the potty, what happens? Typically, the parent praises the child, positively reinforcing the behavior in a way that is out-of-proportion with the accomplishment. You may say, “Yeah! You did it! That’s fantastic! Good Job!” and clap your hands and cheer. You also will tend to do it within seconds of the completed behavior. That is where positive reinforcement differs with general praise. Praise can be given much after the fact and can be bestowed for a number of reasons, including character traits. That is, you could say, “Wow, you are so smart” after your child receives a 100% grade on a math test. That is praise. (Although I’m not sure it is effective, but that is not the topic at hand). Positive reinforcement is for behaviors and should occur right when the behavior is completed. That is how animals are trained. The positive reinforcement (feeding, for example) occurs within seconds of the completed behavior so that the two can be connected in the mind of the animal. Continue reading Reinforcement and “Behaving Better” →
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Release date April 19, 2011.
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I am pleased to announce that my eBook Beyond Boundaries is now available on the Kindle (and other Kindle format devices/readers). The price has been dropped dramatically because I had to remove the graphs, pictures and change the format slightly to make the content make sense on the Kindle. Some information about Beyond Boundaries:
My new eBook needs some explaining I think… It is an attempt of mine to bring together the ideas that I presented in “When Hope is Not Enough” plus some new ideas with which I have been working. I adjusted my “model” of BPD slightly beyond that which was presented in “When Hope is Not Enough”. I also speak more to attachment, cheerleading, mentalizing and goal-directed behavior. “When Hope is Not Enough” is a book that is all about the person with BPD. It is to help them (the ESP/BPD/ERD person) feel better. My theory with that one was if they feel better, they won’t act out in order to attempt to feel better. While modeling and reinforcement are behavioral modification techniques that ARE presented in “When Hope is Not Enough”, I have found that once you have mastered what is in “When Hope is Not Enough”, you’re left with a feeling of “what about MY feelings?” because, although things are (sometimes markedly) better, calmer and easier, it still isn’t a 50/50 relationship. That can cause frustration.
I believe I have discovered how to make the relationship closer to 50/50, which was assembled in the new eBook “Beyond Boundaries”. I wanted to get something out there to help people move toward a more 50/50 situation.I believe that it is necessary to read “When Hope is Not Enough” to fully understand “Beyond Boundaries”. I think that many people who buy it might not read “When Hope is Not Enough” first, because of the title. It is amazing how nons get the impression that boundaries are the only “tool” for BPD relationships. I am also trying to debunk that.
I don’t think you can properly apply techniques that move toward a 50/50 relationship without first gaining the trust that comes through “When Hope is Not Enough” (and other books too). Even if you SAY your intent is not malicious, the other person will not believe you unless you have demonstrated benevolent intent that “When Hope is Not Enough” helps facilitate.
Beyond Boundaries is essentially a transitional book that can get you from a calm, but sort of one-way relationship (which can be developed through the skills in When Hope is Not Enough) to a more two-way relationship. It can help you on your path toward emotional skillfulness and mastery.
The NIAAA study begins to spread out and spur on new views of the findings regarding BPD. Here is a study about Major Depressive Disorder and BPD.
Can Epidemiology Translate Into Understanding Major Depression With Borderline Personality Disorder?
Myrna M. Weissman, Ph.D.
Epidemiologic surveys have mapped the terrain of psychiatric disorders. Personality disorders have bedeviled the clinician’s practice. Rarely have these two been rearranged in a meaningful clinical dialogue. Using the largest psychiatric epidemiologic survey ever, the National Epidemiologic Survey on Alcoholism and Related Conditions, and among the few to venture into axis II disorders, Skodol et al. (1), in this issue of the Journal, give a community-based national view of a common clinical question: What is the effect of specific personality disorder comorbidity on the course of major depression?
The original sample included over 40,000 adults, and 2,422 met criteria for DSM-IV current major depressive disorder. Three years later, 1,996 of the original currently depressed subjects were available for reinterviewing, which makes both a respectable sample size and response rate for generalizability. However, some caution is needed, since the sample was over-represented with Caucasian, college-educated, and married respondents. Fifteen percent of participants had persistent major depressive disorder, and 7.3% of those who remitted had a recurrence over the follow-up period. These figures are within the range of longitudinal studies of patients with major depressive disorder (2). While the presence of any personality disorder elevated the risk for persistence of major depressive disorder, when all axis I and II disorders, age of onset of major depressive disorder, number of previous episodes, family history, treatment, and duration of illness were controlled, borderline personality disorder remained the most robust predictor of major depressive disorder persistence. Neither personality disorders nor other clinical variables predicted recurrence of major depressive disorder. Thus, an epidemiologic survey yielded a practical jewel. The finding, undoubtedly, does not surprise the clinician but is now confirmed nationally. As the authors conclude, borderline personality disorder should be assessed in all depressed patients and considered in prognosis and addressed in treatment.
One can raise a number of methodologic issues about this study, including the use of lay interviewers or the instrument for assessing axis II disorders. The diagnostic interview, the Alcohol Use Disorder and Associated Disabilities Interview Schedule, DSM-IV version (3), was developed for this survey. The personality disorders included were adapted from items in the Structured Clinical Interview for DSM-IV Personality Disorders. The test-retest and internal consistency results reported for all personality disorders are fair to good, not great. However, the agreement with clinician interviews for borderline personality disorder (kappa=0.71) is about as good as it gets (4). The only other national survey to venture into assessing all axis II disorders was the National Comorbidity Survey Replication (5), which used the International Personality Disorder Examination. The investigators carried out a clinical reappraisal in a sample of 214 subjects using clinically trained interviewers to follow up screened, positive subjects and reported excellent predictions of classification. They also noted that the International Personality Disorder Examination is commonly regarded as a conservative diagnostic assessment of axis II disorders. The community rate they generated for any personality disorder in the United States was 11%, and in the World Health Organization World Mental Health Surveys (6), involving 13 countries, the rate was 6.1%. These rates seem to be lower than those reported in the National Epidemiologic Survey on Alcoholism and Related Conditions, but different presentations make it difficult to directly compare rates between studies. No articles from the National Epidemiologic Survey on Alcoholism and Related Conditions reporting overall rates of axis II disorders could be found. Unfortunately, given the findings in the Skodol et al. article, not all personality disorders were included in the first wave of the survey, and borderline personality disorder was added in the second wave. Both of these landmark studies used state-of-the-art measures. While they are imperfect, these are the best available. It is too bad they could not share the same methods.
The major issue now is not a debate about the methods of personality disorder assessment but about the future of personality disorders. The DSM-5 committee is working on the next version of psychiatric classification (7). In parallel, the National Institute of Mental Health is working on moving diagnosis away from clinical presentations to understanding of syndromes based on pathophysiology in a new project called Research Domain Criteria (8). These efforts will certainly effect how personality disorders are described, classified, or reimbursed in the future.
DSM-5 raises issues about the categorical conceptualization of personality disorders because of the high concurrence among disorders, both within and across axes, and the difficulty in differentiating normal from pathological. How dimensions will solve the problem of a lack of understanding of the pathophysiology underlying the disorders is unclear. Some cutoff along the dimension will need to be established for clinical practice.
The Skodol et al. study, based on an epidemiologic survey, may add light to the issue or, at least, generate a hypothesis about diagnosis that can be translated into a more experimental approach. Borderline personality disorder, defined categorically, and not the other axis II disorders explained the persistence of major depressive disorder over 3 years. Other axis I disorders may map out to different axis II disorders. The National Epidemiologic Survey on Alcoholism and Related Conditions, because of its large sample, could be mined for these clues about the relationship between specific axis I and II disorders.
The Research Domain Criteria project, in the long run, may offer more enlightenment for personality disorders if its goals can be achieved. The primary focus is on neural circuitry, with levels of analysis progressing from measures of circuitry function to clinically relevant variation or downward to the genetic and molecular cellular function (8). In the final analysis, the new molecular and neurobiological parameters will need to predict prognosis or treatment response. They will need to do as well as borderline personality disorder in predicting major depressive disorder persistence. If the Research Domain Criteria approach is successful, more than prediction of prognosis might be achieved, including a deeper understanding of the biological mechanism underlying the joined symptoms.
The epidemiologic finding that borderline personality disorder contributes to poor prognosis of major depressive disorder might be viewed as a hypothesis that can be translated into methods in the neurosciences to understand the mechanism behind this association. The features of borderline personality disorder, particularly the pervasive instability of the regulation of emotions and impulse control, would seem ripe for the Research Domain Criteria approach. When these symptoms occur in conjunction with major depressive disorder, a different syndrome may be present. Further experimental work may test how the symptoms of borderline personality disorder contribute to the prognosis of major depressive disorder. But what about the persistence of borderline personality disorder without major depressive disorder? Can the epidemiologic data provide any clues? In the meantime, the clinician treating major depressive disorder would be wise to assess for borderline personality disorder, even as currently defined.
In my book “When Hope is Not Enough”, I recommend to Non-BPD folks that they “Don’t Defend”. This advice has caused many a member of the ATSTP Goggle Group Support List to be concerned and to struggle with the idea of defending oneself against day-to-day accusations. Some times this “defending” is actually “justification or explaining”. Sometimes it is even done pro-actively – heading off criticism or misinterpretation ahead of time. Well, recently, a member of the group pointed us to a posting from Russell Bishop entitled “Why You Should Never Defend, Explain or Justify”. I think it captures the spirit and nature of my directive: Don’t Defend.
Here is the text of the article, as seen on the Huffington Post:
Russell Bishop Author, Consultant, Executive Coach
Posted: March 7, 2011 06:10 AM
Why You Should Never Defend, Explain or Justify
Why do some people seem to be forever defending, explaining or justifying themselves? Do you enjoy being around this person? Are you one yourself?
Quite the opposite from the critics who have been the subject of recent articles on complaints and criticism, this person becomes tiresome not because of a string of complaints, but more because of the somewhat toxic nature of self-defense.
Years ago, as the personal transformation wave was cresting via large group seminars, several of us started using a made-up word to highlight the toxic nature of self-defense and explanation: dexify. The word even seems to connote something toxic all by itself.
Certainly, someone who engages in dexification (there’s another use that may suggest something kind of dark) seems to be sliding down a spiraling path of negativity. What’s so negative about defending yourself, you might ask?
On the one hand, nothing really, especially if there’s something there to defend. However, I am not referring to the kind of self-defense you might need when wrongly accused of something, especially something heinous or criminal. However, there’s a difference between that kind of self-defense and the more common defend-explain-justify behavior that many of us seem to engage in almost daily.
To be fair, I know I have certainly done my fair share of dexification. The main problem in day-to-day life is that when you choose to dexify, you almost always sound guilty-as-charged. I know that when I find myself in justification mode, there’s almost always some part of me that feels insecure about the area, perhaps even wondering-fearing-believing that it must be true.
There may well be several moving parts here, but allow me to underscore a critical aspect that may be operative and why dexification is usually not all that helpful. The worst possible scenario might be that the criticism is accurate and I’m simply digging myself a deeper hole by dexifying.
Some time ago, I wrote an article on this subject, citing a lesson learned from Bucky Fuller about how we can benefit from our perceived enemies. The gist of the story: after a wonderful lecture on the value of seeking to understand and be understood, Bucky took questions from the audience. One gentleman took the microphone and proceeded to tell Bucky that he was full of beans, didn’t know what he was talking about, and had no basis for his point of view. Bucky considered the comment, and replied, “Thank you.”
After a couple of more rounds of this kind of exchange-attack, wherein the gentleman kept going after Bucky, trying to provoke a reaction, Bucky taught us all a great lesson in self-awareness by saying something like this:
Did you not notice that each time I paused to consider what you had to say? I looked inside myself to see if some part of me was reacting to what you had said about me, particularly if some part of me were upset, prone to counterattack, or otherwise affected. I have found that when I am in that kind of reaction, there is typically something there for me to learn about myself, something for which I need to improve. In this instance, I found no reaction. Thus, you were simply sharing your opinion to which you are fully entitled and with which I have no argument. Therefore, “Thank you” seemed most appropriate.
Indeed, Bucky Fuller demonstrated considerable self-awareness and personal integrity throughout his life, and this little exchange has been a guiding light for me for years. Learning to see the reaction inside myself as feedback about me, pointing out areas of growth, not something to be defended, has been both expansive and liberating for me.
I have learned that when I feel the need to dexify myself, some part of me is almost always of the opinion that they must be right and I must be wrong. The defending, explaining and justifying never seems to change anything and, instead, tends to anchor me more deeply in the issue that needs to be addressed.
If you recognize this tendency in yourself, here’s a little tip that I have found personally useful whenever I have the courage to use it. Courage, by the way, is an interesting word that typically means something about physical or mental strength or bravery. Its roots, however, go to the Latin and French words for “heart.” I have heard it said that the suffix of the word, “age,” means something like “wisdom.” If you put the two together, you get “the wisdom of the heart.”
The next time you find yourself under attack and are about to resort to dexification, consider the wisdom of your own heart. Look inside yourself to your own reactions. If, like Bucky, you find yourself in reaction mode, consider that there might be a kernel of truth here for you, perhaps an entire bushel-full. If there is something there, then draw a bit more on that source of heartfelt wisdom and dive into the question even further, perhaps saying something like, “That’s very interesting. Can you say some more about what you see or how you see this playing out in my behavior?”
I know that for many this seems somewhere between silly and incomprehensible. Why on earth would you invite even more criticism, especially in an area where you might already feel uncomfortable?
It’s simple, really. You just might learn something that will liberate you. You may find yourself growing in confidence and inner strength as you choose inquiry over dexification. You might also wind up closing a gap between you and the other person. After all, it does take great courage to step closer in the face of criticism, and your sincere inquiry may melt away something that prevents you from being even more effective.
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Please leave a comment here or drop Russell an e-mail at Russell@russellbishop.com.
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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.
Hello all,
Today I cleaned up the links on ATSTP. I found that several of the links were dead and the directory links were linking out to spammy sites. I will have to check those more frequently. It’s been a while since I did a manual check of them. I think they are cleaner now. Enjoy!
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:
Validation (or emotional validation) is an extremely powerful tool when it comes to emotional situations. It is complex and multi-stepped and it takes a lot of practice to master. On my Internet list, I talk a great deal about validation because it is essential to managing a relationship with someone with BPD. If you learn to master validation, you can see a marked change in the way your loved one with BPD interacts with you.
Validation is a tool that verifies that the other person’s feelings are valid, but doesn’t necessarily condone or agree with their behavior. Remember, the behaviors come from feelings, beliefs and “action impulses” so they can be separated from behaviors. You are not “giving into” the person with BPD if you learn to validate their feelings. And, if you master validation, you might eventually receive validation back from your BP, which is a remarkable improvement over IAAHF (“it’s all about his/her feelings”). Don’t expect it right way, but after some time, it can happen.
With validation, you are basically saying, “Your feelings matter. It is OK to feel that way. It is normal to feel that way.” The way in which you validate someone else’s feelings is important. Many people believe that saying “It’s OK. I love you” or “You are safe with me” is a form of validation, but it is not. Those statements are about your attitudes toward the other person, not about his/her feelings. Validation is always about the OTHER person’s feelings, not about our own feelings. In some ways, this can get frustrating for us, because everything always seems to be about the other person’s feelings – and in the beginning, that is true. There are other tools that get your feelings on the table, but for now we need to focus on the other person’s feelings and how to validate them.
Validation is not giving advice. In fact, if you do give advice when the other person is emotional, they are likely to get angry with you. People don’t like to feel that they are being told what to do about an emotional situation – that is quite invalidating. It feels like you are telling them how they should feel and they can’t control the emotions.
This is where things get interesting. You see, I believe that since BPD is a very relationship-oriented disorder, changing the way in which you interact with the person with BPD will in turn change them. Mostly, the point is to make your life easier. If you learn and apply emotional tools, you will have less raging, less acting out and more peace in your life.
Exercise in validation
I sometimes like to assign homework assignments for my list members. I don’t do it very often, but I think it’s easy to learn from one another’s experience if you are all having a very similar experience. One of the exercises we worked on last year was one to help us learn the benefits of validating another person. My suggestion to the group was to make a validating statement to someone with whom you have a temporary interaction. This person could be a server at a restaurant, a clerk at the grocery store or an acquaintance at work. Here is an example conversation that I had with a co-worker who I knew by sight, but with whom had never really had a conversation on an elevator. She was about 8 months pregnant and it was the middle of the summer. She looked hot and stressed. I said that it must be frustrating and painful to be pregnant in the height of the summer. She immediately brightened up and talked to me about her feelings and her family.
My suggestion to you is that your emotionally validate someone in your life today. Test it out on someone with whom you have a passing contact. Remember validation is about their feelings, not about you. Just validate and listen and see what happens. If you don’t know how to validate, you can read all about it in When Hope is Not Enough.
 What should I do? Today, I have uploaded a new free tool for you to use when making decisions. The purpose of the tool is to help you make more informed decisions and help to combat impulsiveness. The tool is a “decision matrix” where you can map out the advantages and disadvantages of doing something (or not doing it). Here is a link to the tool (instructions are on the second page of the tool):
ATSTP Decision Matrix Tool
I have been working on a second edition of When Hope is Not Enough, in which I am adding some exercises as well as some new tools and perspectives to make the book even more effective. One of the exercises is in learning how to be mindful of one’s judgmental attitudes. I often say that people with BPD are almost allergic to judgment. I find that this can be tracked back to shame which in turn can be tracked back to an unstable sense of self. Here is the first draft of the exercise:
One way to become non-judgmental is to become aware of your (often) unconscious and conditioned judgments. I often hear Non-BP’s say, “My BP is acting crazy” or some such. The labeling of anyone’s behavior as “crazy” is a judgmental label. The behavior that anyone does makes sense (even if it is emotional sense) to the person at the time they are doing those actions. Certainly, a person with BPD might perform certain actions that someone without BPD would find objectionable or “crazy.” However, because of a number of symptoms of BPD, especially shame and fear of judgment, labeling another person’s actions as invalid or crazy can undermine the trust that you are trying to build.
In this exercise, I would encourage you to take a specific time-frame – it could be an hour, two hours or a full day – and identify your judgments of other people’s actions, attitudes and interactions. In other words, if you find yourself thinking about another person (whether with BPD or not), “that person is an idiot,” that is a judgment and should be counted as one. Continue to practice this exercise such that you can become more aware of the judgments about others and about life that you make, even if those judgments are ingrained and unconscious. By making the unconscious biases conscious, you can more easily slip their grasps and become less judgmental of others, including your loved one with BPD.
Keep and mental or written tally of these judgments to see if, after time, the number of judgmental thoughts is reduced.
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