Anything to Stop the Pain - BPD and Non-BPs

Often I see in the support groups on the Internet (especially the “Welcome to Oz” or WTO groups), people providing the “3 C’s” of understanding your role as a Non-BP. I’ve seen it quoted on BPD support websites too. These “3 C’s” go as follows:

• I didn’t cause it
• I can’t control it
• I can’t cure it

While these statements are generally true, I’d like to take some time to analyze these statements and add a fourth “C.” I’d also like to tell you what you CAN do – rather than what you didn’t or can’t do.

These statements help take the onus off the Non-BP for any responsibility for their loved one’s disorder. I can understand that. In part, they are about blame or, better, non-blame. I’ve seen many people say “when I came to terms with those ‘3 C’s’ I was free from FOG!” (which is fear, obligation and guilt, for those of you who don’t know). I want to write something about FOG specifically, but haven’t had the time.

OK, now let’s look at each of these statements and see how they fit into my way of thinking about being a Non-BP.

I didn’t cause it

Actually, this statement is liberating, especially for parents of BPs. I think that many parents carry around a lot of guilt that they DID cause their child’s disorder. Even psychologist and therapists often blame the disorder on the parents. However, there are growing studies that suggest that there are many biological causes for BPD. In the case of Marsha Linehan, she provides a “biosocial” model, in which each element (biological and social) are required to cause BPD. The environmental part of that analysis is the “invalidating environment.” So, while you (either as a parent or spouse) didn’t cause the disorder, you may have inadvertently contributed to the disorder’s severity. By reacting to a BP in an emotionally invalidating manner, the disorder can get worse. That is why I spend over 30 pages in WHINE discussing emotional validation as a tool for healing. Of course, a parent might say “Well, I have other children. I’ve treated them the exact same way. Why don’t they all have BPD?” Which again is where the biological element enters. My suggestion for parents is to read the article referenced below.

I can’t control it

Why would you want to? No one can completely control another individual. Even parents can’t completely control the actions and behaviors of their own children. No, the only behavior (which is BTW what Non-BPs are so confused and angry about) you can control is your own. That is why I have made several statements clarifying boundaries. Boundaries can’t be used to control other people’s behavior. If you try and imposed rules on another person’s behavior, you get resentment, rebellion and (in the case of BPD) a statement: “You’re trying to control me!” How many times have you heard THAT in your interactions with a BP? I’ve heard it a bunch.

I can’t cure it

Again, this statement is true. Only the BP him/herself can “cure” the disorder (usually with the help of a qualified and knowledgeable professional). It is important that you re-read that statement – you cannot make your loved one “all better.” You can’t save him or her – especially from his or herself. What CAN you do then? You can contribute to an easing of the conditions under which the BPD behavior is severe. You can re-frame your relationship with the BP in such a way that the emotional invalidation that they have learned to expect is gone. You can encourage effective behavior and practice effective behavior yourself. How? I explain this in detail in WHINE – which is why I called it a “how-to” book.

Now, I think I need to contribute a fourth “C” to the mix. I didn’t make this “C” up. In fact I found it here, on A. J. Mahri’s “BPD from the inside out” page about a mother speaking out about the illness. Please read that page! It really helps define the feelings and confusion of a mother who needed to know she “didn’t cause it.” She offers a fourth “C” which is:

All I can do is cope with it.

Bon Dobbs :: Aug.27.2008 :: Blame, WHINE Book, Biology, Parenting, Validation, Borderline Personality Disorder :: No Comments »

I have been looking over the keywords that found my blog in the past few days and have noticed that I’m getting more traffic from people seeking information, self-help, advice and assistance with their borderline personality disordered partner. Here is a (small) sample of of these search terms:

helping someone with bpd
bpd crazymaking
levels of validation
“self-destructive behavior” friend
how to get bpd to go to psychiatrist
bpd communication
bpd and lying
high-functioning borderline
borderline how to convince ex i have changed
are emotions painful for bpd
invalidating environment, boundaries
advice for dealing with someone with a bpd
bpd dealing with love
borderline girlfriend
when she clearly has a personality disorder
bpd google groups
how to deal with a bpd
rejection-sensitivity
borderline rage attack
telling someone they have bpd
mental illness that exhibits rage, blaming
borderlines and lying to hurt their partner
did i give my child bpd

If you found my blog while searching on one of the above or on a similar search term, I would suggest you read my book When Hope is Not Enough (aka WHINE), because it contains answers to all of the above search terms and provides a how-to guide for solving those issues. WHINE is available for sale on Amazon and other Internet retailers. You can also buy an eBook version from Lulu.

I’d also like to respond to  two reviews of WHINE from Amazon - one negative and one positive.

First, the negative review…

Sorry, I didn’t care for this book as much as the others on BPD. The techniques were pretty much the same as recommended in “Stop Walking on Eggshells” but the technical background and reasoning behind the techniques was not as clearly discussed. Perhaps this book could be useful to someone who prefers the “lay” or non-professional approach and needs a book written in simpler terms.

OK, the techniques that I discuss are different than “Stop Walking on Eggshells” (although some of the techniques DO overlap). The main reason that my tools are different than in SWOE has to do with the fact that I present a different view of BPD focusing on three main aspects: emotional dysregulation, impulsiveness and shame. Unlike SWOE, I do not take you on a step-by-step review of the DSM-IV diagnostic criteria and, in this way, I feel that WHINE is more practical as a how-to guide than SWOE. Additionally,  I explain the techniques in DETAIL, that is, HOW to do each one, what to say and what NOT to say, etc. As an example of this surrounds validation techniques. I have flipped through SWOE and found very little on emotional validation of the BP’s emotions. There is 1/2 a page on the “triggers” of invalidation and a how a “I know how you feel” response could trigger rage (that’s on pages 113-114 of my copy of SWOE). There is some additional information that MAY be considered validation on pages 142-145 of SWOE about “Acknowledge Before Disputing;” however, this information is not detailed. In WHINE I spent over 30 pages (of a 185 page book) on emotional validation - why to do it, how to do it, how not to do it, when to do it, etc. Why? Because emotional validation is central to learning how to communicate effectively with someone with BPD.

Where SWOE spends many, many pages on boundaries and limits, the message is inconsistent. In the beginning of the introduction of boundaries SWOE says this:

Personal limits are not about controlling or changing other people’s behavior. In fact, they’re not about other people at all. There about you and what you need to do to take care of yourself. (pages 118-119)

THAT I agree with wholeheartily! However, later in SWOE we get this:

If you want the BP to change, you have to be willing to make some changes yourself if the person does not observe your limits. (page 157)

Alright, I would believe in the first part; however, the second part is what I have a problem with. My understanding of boundaries and limits are that they are for YOU and not about other people’s behavior. A person can’t “violate your boundaries” because only YOU can violate your own boundaries. If they do, your “boundaries” are not about your behavior anymore, they are about ANOTHER person’s behavior and those type of “boundaries” are really rules for the other person’s behavior. On this point (and on the importance of emotional validation) is where my book and SWOE completely diverge. (Another note creating such “boundaries” - that are really rules - is a trigger for BPD rage too).

Finally, the two books were written for two separate reasons. If you look at the subtitles of each you can see where each book has a separate purpose. The subtitle of SWOE is “taking your life back when someone you care about has borderline personality disorder.” The subtitle of WHINE is “a how-to guide for living with and loving someone with borderline personality disorder.” SWOE is written to focus on validation of the non-BP (which has its place, no doubt, I got a LOT of validation out of SWOE when I first read it 3 years ago). WHINE is written as a “how-to” guide for (peacefully) living with a person with BPD. The difference is subtle, but important. A member of my Internet list summed it up rather well this way:

I want to add another thought about this…

I think when Randi [Kreger, the co-author of SWOE] wrote her book, she likely recognized the importance of
validation, but her frame of mind was on healing herself.  So, I would
venture to say that is why there was a strong bent towards validating nons.
In addition, Randi got out of her BP relationship, so she didn’t really know
what to advise those who wanted to stay.  If I was her, I don’t think I’d
even care about any of that “staying stuff”… I’d probably just want to
help the nons move on with their lives (something she was familiar with.)

Bon, on the other hand, it seems had already gotten through the stage of
being able to self-validate, and had decided to stay.  So, his focus was, of
course, on problem solving.  And the only way to be effective at that is
through validation of BPs.

Each of their situations are different, as are their target audiences
(Randi’s being X-Nons and Bon’s being Staying-Nons.)  I think they both did
an excellent job speaking to the feelings of those they could sincerely hope
to reach out to.  The audiences that are getting caught up are the
Undecided-Nons.  Those are the ones who would benefit most by reading both
books in the exact order you advise.

So, as you can see both books have their place in the life-cycle of being a non-BP. I think what you have to do it decide where you are in the life-cycle. My book is aimed at making BP/Non-BP relationships more calm without “walking on eggshells.” SWOE is not really a “staying” book - although Randi Kreger does have a new book due out in the Fall with staying in mind.

Ok, so back to the key words… if you are searching on those types of things and WANT to maintain a relationship with someone with BPD, WHINE is an excellent resource for that. If you’re searching on “i hear demon moaning in husband” or “cutting ties borderline personality disorder” I suspect you should look for a book other than WHINE.

I’ll have to review my “good review” in the next post.

Bon Dobbs :: Aug.07.2008 :: WHINE Book, Validation, Borderline Personality Disorder :: 1 Comment »

This is an excerpt from pages 103-104 from my book When Hope is Not Enough: a how-to guide for living with and loving someone with Borderline Personality Disorder. This excerpt comes from my (long) discussion of validation and how and why to do it. In the book, I outline a six step process to validation. This is a part of “Step 3: Making a Validating Statement”:

Examples of validating statements:
- That must have made you feel really angry.
- What a frustrating situation to be in!
- It must make you feel angry to have someone do that.
- That’s so difficult for you.
- Wow, how hard that must be.
- That’s stinks!
- That’s messed up! (or stronger language if you are so inclined)
- How frustrating!
- Yeah, I can see how that might make you feel really sad.
- Boy, you must be angry.
- What a horrible feeling.
- What a tough spot.
- That must be really discouraging.
- I bet you feel disappointed.
- Rats, I know how much that meant to you.
- That’s so painful for you.
- Tell me more. (shows interest)
- Wow, she must have made you really angry.

And, of course, many, many more. If you want a validating statement to feel “true” make it about the truth of the situation for the other person. That truth is the way they feel about the event.
When you make a validating statement you should not:

- Make it about you. “I hated it when that happened to me.”
- Try to one-up the person. “Oh, you think you have it bad…”
- Tell them how they should feel. “You should feel blessed…”
- Try to give them advice. “What you really should do is…”
- Try to solve their problem. “I’m going to call that girl’s parents and…”
- Cheerlead (there is a time for this, but not now). “I know you can do it…”
- Make “life” statements. “Well, life’s not fair…”
- Make judgmental statements. “What you did was wrong…”
- Make “revisionist” statements. “If you had only…”
- Make it about your feelings. “How do you think that makes me feel?”
- Make “character” statements. “You’re too sensitive…”
- Rationalize another person’s behavior. “I bet they were just…”
- Call names. “You’re such a baby.”
- Use reason or the “facts.” “That’s not what happened…”
- Use “always” or “never” statements. “You always get yourself into these situations…”
- Compare the person to someone else. “Why can’t you be like your sister?”
- Label the person. “You’re nuts.”
- Advising to cut ties or ignore the situation. “Just ignore him.”

Remember, the current problem is not what happened; it is what the BP feels about it. So, the problem that must be addressed is her feelings, not the situation. To address her feelings, you must do so using emotional language, not rational or judgmental language.

Bon Dobbs :: Jul.18.2008 :: WHINE Book, Validation, Borderline Personality Disorder :: 6 Comments »

Apparently, someone over at Welcome to Oz (WTO) Internet list posted a message asking about me and what I am all about concerning BPD and Non-BPs. This lead to a huge spike in traffic with my average number of accesses basically doubling over the weekend. I’m still a member of WTO, so I decided to login and take a look at what people are saying about me over there. I haven’t posted in years and haven’t logged in in months.

Obviously, there are many, many new people who have no idea who I am or what I’m about. There are a few members still hanging around who do remember me. There are a couple of people who seem to have a pretty dim view of what I have to offer - although I think that those people don’t know me very well and have interacted with me only cursorily. First, today, I’d like to outline my philosophy about BPD and Non-BPs to clear up some of the mis-statements and mis-perceptions.

• I do believe that BPD is a serious mental illness and not a case of a “behavioral disorder.” In other words, BPD is not merely a case of someone just behaving badly. I further believe that much of the core issue with someone with BPD is emotional and based on poor emotional regulation skills. The reaction to strong negative emotions (and other factors, like  shame and impulsiveness) cause the “poor behavior.” I put that in quotes because the behavior has a function and the function IMO is to make the BP feel better. A person (whether they have BP or not) CAN learn to behave differently in the face of strong negative emotions. It takes practice and requires the acquisition of emotional skills. However, I also believe that the emotional under-pinnings are not going to disappear, just because the person with BPD learns to behave more effectively. Emotionally, they are just more sensitive than other people - that is the way they are. In other words, I don’t believe that I have a “cure” for BPD, which was bandied about at WTO.
• I also believe that the only person that you can change in a relationship is yourself. It is my opinion that once you change your own approach to emotional situations, the person with whom you are having the relationship will react to the change in various ways. Sometimes they will have a fit. Sometimes they will appreciate the “new you.” And sometimes a complex combination of emotions will arise. My “methods” are a combination of emotional understanding (of your own emotions and of theirs), emotional validation (which is complex in itself), positive reinforcement and “inserting your (the Non’s) feelings” into the conversation. There are some other skills and sub-skills, but that’s a quick synopsis. IMO this complex combination of skills (which also require practice) will improve the relationship and make sure that you don’t “walk on eggshells” around the other person. Boundaries can help - however, boundaries are a subject unto themselves, and I find that most people don’t know what boundaries are and how to apply them properly.
• There was some argument at WTO that my motives were suspect, because I am trying to make some money on what I have learned and practiced thus far. I think the operative word here is trying, because I don’t really make enough money to even operate this website at a break-even level. No, I’ve not made much money at all as a “professional Non-BP” (if that’s what I am). What I have been able to do is have an impact on the lives of many people. That is pretty satisfying in itself, and I will not pretend that I wouldn’t like to do it full-time. I certainly enjoy interacting with others in my situation and exchanging advice, strategies, knowledge, etc. more than my “day-job.” But it will be a long time (and probably never) before I will be able to do that. Besides, most of my support activity and knowledge-sharing I do for free - either here on in my Google Group. There’s no charge for participating in that group or to read these posts. At this point, any money I do make just contributes to the cost of operating this website.
• I don’t think that BPs have to be “let off the hook” and that they have no responsibility when it comes to a relationship. I also don’t think that you, as a Non-BP, have to forgo your feelings to live alongside a person with BPD. Both of those ideas were suggested at WTO. Neither is true. I think everyone in a relationship will have emotions, reactions, expectations, etc. Everyone is allowed to have each of these. Everyone has certain responsibilities in a relationship as well. What I DO advocate is looking at the function behind behavior and understanding the dynamic that exists. Many times I’ve seen people suggest that my methods give the BP “undo advantage” in a relationship. Huh? I thought this was a “loved one?” I don’t think that “love is a battlefield.” It’s not us-agains- them. That is just more black-and-white thinking on the part of the Non. If you’re going through a bloody divorce with someone with BPD, I can certainly understand where this might come into play, but, as I have said, my methods are about “living with and loving” someone with BPD. There is responsibility on both sides of the fence. It takes a certain environment IMO to make sure that responsibility is acknowledged - and that environment has to be one that is validating, otherwise you’re going to be caught in a shame hurricane. Nothing will get accomplished.
• Finally, I believe that effective emotional skills are helpful for anyone in any relationship. Anger, sadness, spite, resentment, blame, etc., etc. lead to a corrosive environment within any relationship. My “methods” attempt to reverse some of the corrosiveness and build stronger, healthier emotional relationships. You may not agree with my methods, which is fine. Personally, I’ve had to try everything to find anything that worked.

I guess it’s better to be talked about a little, whether it is positive or negative, than to be ignored. Thanks to a group member of mine who notified me of the discussion and who defended me (you know who you are).

Bon Dobbs :: Jun.16.2008 :: Resources, Odds and Ends, Stats, Blame, Biology, Validation, Emotions, Borderline Personality Disorder :: 1 Comment »

Interestingly, I have sold more downloaded books than print copies thus far. I have sold about twice as many of the downloaded version (at $7.50) than the print copy ($19.95). This is not something that I expected to happen.

I have been asked time and time again why I bothered to write a book. There are other books out there, including the best-selling Non-BP book “Stop Walking on Eggshells” (or SWOE). I read SWOE about 2 ½ years ago and found it lacking. The big problem with it for me was that the prescription for “taking back your life” wasn’t working in my life. The application of boundaries, for example, wasn’t effective. So, I sought out other resources that would be effective. I wrote my book “When Love is Not Enough” for four main reasons:

1. Other books on the subject (most notably SWOE) didn’t work or tell me HOW to do things. I needed the know-how. My book tries to supply the know-how to “deal with” someone with BPD. I learned a lot from SWOE, but again, I wanted to know WHAT to do and HOW to do it.
2. Obviously, the money angle comes into play. I have wanted to quit my day job for a long time now, but I need the income to support my family. I’d like to do this “Non-BP” thing full time. I feel that the Non-BP’s are missing the support resources. While I do run the ATSTP email list to help support Non-BP’s, I didn’t feel like that was enough – plus, it doesn’t pay me anything. I am hoping that I will get better sales once the book makes it to Amazon. That should happen in about a month or so.
3. I wanted to collect all of my tools and skills in one place. Often, I have to re-educate newbies (and even some old timers) on my email list. I find myself going over the same old ground again and again – explaining the disorder, instructing on the proper use of boundaries and validation, etc., etc. It’s difficult for me to step back in time and put myself in the mind-set of someone who knows little about the disorder and what to do in the face of it. I wanted to create a compendium for the attitudes and tools that are effective when dealing with BPD. One of the key tools is, of course, emotional validation. I expect to write another eBook specifically on validation, what it is and how to do it properly. I explain it at length in my book, but there are many other concepts I have to explain before I explain validation. I think a dedicated eBook in which I explain in detail the validation process would help.
4. Finally, the members of my email list asked me to write the book. They were also looking for a single resource that collected all of the knowledge about dealing with highly emotional people in one place. I hope the book will function in this way.

Bon Dobbs :: May.29.2008 :: Resources, Boundaries, Validation, Borderline Personality Disorder :: No Comments »

A comment on the title of my book, When Love is Not Enough. I’ve had several people say the book is perfectly titled and others say they don’t like the title. I decided to title it that because I believe that you need more than love to help someone with BPD and to help yourself. The problem with love is that saying “I love you” to someone with BPD can be invalidating. Saying “I’m proud of you” can be even more invalidating. And saying “You can do it” even more so. Let me explain.

Validation is about the other person’s emotions (the BP). It is not about you and your feelings. The statements of “I love you” or “I’m proud” of you are about you. A person with BP needs to learn that their emotions are normal and that everyone feels that way from time-to-time. If they feel weird or broken, healing cannot begin. In fact, the likelihood of poor (even suicidal) behavior follows those feelings. A simple of expression of your love for them could spiral into a session of self-hate. If you say, “I love you” in response to their poor self-image, a likely reaction (in their minds) is “then you’re stupid, because I don’t love me.” When someone feels like they are not able to cope, telling them they CAN cope breeds mistrust. In other words, if you express positive feelings or “positive mental attitude” statements, they are likely to not trust you, because, on the inside, they believe they CAN’T do it, and you’re not seeing their feelings for what they are.

So, love is NOT enough. What you need is skill. In the book I try to teach the skill (through attitudes and tools) necessary to start the healing – for the BP and for you.

Bon Dobbs :: May.28.2008 :: Resources, Shame, Validation, Borderline Personality Disorder :: No Comments »

I have created a new version of my book, which fixes some typos and clarifies some points. I also was able to drop the price! It’s now $19.95, instead of $20.95. Since it got 3 pages shorter, I will be able to make a decent profit at the lower price. That price anticipates the cost it will have to be when I get it on Amazon (shortly).

Anyway, I suggest you check out the preview, and pick up a copy (shameless self-promotion). You can see the preview or buy the printed or downloadable version of When Love is Not Enough at Lulu.com.

If you are one of my readers with BPD, I would suggest getting a copy for anyone with whom you’d like to have an on-going relationship. Why? Because this book teaches a “Non-BP” the attitudes and tools to be more effective and more validating toward someone with BPD. The purpose is to rebuild the lines of communication. Like I said in a previous post (or comment), if I can quote myself here:

The BP/Non-BP relationship seems to me to be one of misunderstanding and miscommunication. I hope that I can help each learn the language of the other. And I agree most public awareness is important - BUT it has to be the right kind of awareness - not the “stay away from these people” or “these people are evil” kind.

Enjoy!

Bon Dobbs :: May.13.2008 :: Pain, Treatment, Boundaries, DBT-FST, Resources, Impulsiveness, Suicide, Shame, Mindfulness, Validation, Lying, Manipulation, Self-Injury, Emotions, Substance Abuse, Parenting, DBT :: No Comments »

At long last (about six months of work and 2 1/2 years of research, experimentation and practice), my first book When Love is Not Enough (WLINE) has been published!

This book is a quick-start, how-to guide for Non-BPs. It spells out step-by-step WHAT to do in your relationship with someone with Borderline Personality Disorder (or BPD traits) and HOW to do it. Unlike other books on this subject (you guys probably know which ones I’m talking about), WLINE tells EXACTLY what to do. Through the use of attitudes and tools, WLINE can help you build mastery over your relationship, regain control of your life and develop a deeper understanding of your BP loved one. I highly recommend it (if I do say so myself).

Although WLINE is fairly short (about 185 pages), it is packed full insights, advice and practical skills to help you understand your BP and to reestablish the lines of communication. If you are a Non-BP, WLINE is an essential resource. If you have BPD, I would recommend that you recommend WLINE to your family members, partners and friends (that is, if they are aware of your disorder). WLINE helps to build the bridge of understanding, serenity and effective communication between Nons and BPs.

It could be the most effective $20.95 you’ve ever spent.

If you’d like to buy a printed or eBook copy of WLINE, I am selling the book through Lulu:

Buy the Book!

A note on the title… I kicked around a number of titles before settling on this one. It is my feeling that most Nons don’t understand that, in addition to love, they have to develop ATTITUDES and SKILLS to be effective in their relationship with a BP. WLINE actually innumerates these attitudes and skills and provides detailed examples of how to apply them. With a commitment to the relationship, application of the concepts in the book and PRACTICE, a Non can learn what IS enough in their relationship with a BP.

Bon Dobbs :: May.09.2008 :: Pain, Treatment, Boundaries, Shame, DBT-FST, Blame, Best of, Impulsiveness, Suicide, Resources, Mindfulness, Biology, Validation, Lying, Manipulation, DBT, Self-Injury, Anger, Substance Abuse, Parenting, Emotions, Borderline Personality Disorder :: No Comments »

Some time ago on when I was on the Welcome to Oz (WTO) Internet group, I started posting about the benefits of DBT (Dialectical Behavior Therapy) for treatment of Borderline Personality Disorder (BPD). I have since left that group and started my own (the ATSTP Google Group). However, at WTO the discussion turned to DBT and its effectiveness (or lack thereof). There is one member of WTO who came down against all behavioral therapies. He posted the following message as a follow up to a message about DBT:

DBT is a behavioral therapy.

The idea is to learn a new behavior by repeated conditioning.

“Fake it until you make it”

It can be effective…Pavlov showed that a lower species can
learn through behavior therapy.

The question is then…is there a better way?

My thought…learn what you need before seeking a product….then buyer beware.

My reaction to this message was complete disbelief. I can only suppose that this guy (who is a Christian BTW) doesn’t believe that humans are in the category of “lower species” (probably because they have a soul and are made in the image of God, as opposed to animals). Of course, his alternative (or “better way”) was his personal belief in Transactional Analysis (popularized by “I’m OK, You’re OK” in the 70s) and the “inner child vs. inner adult” dynamic. That is garbage and hasn’t been shown to be effective with BPD at all.

So, how does DBT work?

DBT is a behavioral therapy. It teaches skills to modify a person’s behavior. Basically, the client begins to behave in a fashion that is different that the behavior that they previously exhibited. The purpose is behavioral modification. The new behavior becomes reconditioned over the old behavior. There person become “retrained.” One of the main problem with BPD is poor/ineffective behavior. If the behavior can be modified, the results of the behavior will not exist. In other words, if you choose NOT to cut yourself, you will not have to go to the hospital and get stitches. Interestingly, I find that this “theory” follows the Buddhist idea of “dependent arising” - which governs “conditioned existence.” That idea is formulated as follows:

When this is, that is.
From the arising of this comes the arising of that.
When this isn’t, that isn’t.
From the cessation of this comes the cessation of that.

See this Wikipedia entry for more information.

DBT functions in four general areas:

1. Core Mindfulness
2. Distress Tolerance
3. Emotional Regulation
4. Interpersonal Effectiveness

One of the differences between DBT and CBT is that DBT emphasizes acceptance of certain things versus complete change. Why? Here is one explanation from Marsha Linehan in the interview with David Van Nuys on “Wise Counsel”:

Dr. Marsha: All right. DBT or Dialectical Behavior Therapy is an integration of two major approaches. The first approach is the approach of cognitive-behavioral therapy.

Dr. David: OK.

Dr. Marsha: So, it contains within that sort of standard cognitive-behavioral therapy or behavior therapy. As behavior therapy changes and improves, DBT changes right along with behavior therapy, cognitive-behavioral therapy and improve.

Dr. David: OK.

Dr. Marsha: Then it balances a technology of change with the corresponding technology of acceptance. The acceptance is a derivative primarily from contemplative spiritual practices of Zen, primarily, but also other contemplative practices. Mindfulness, mindfulness-based practices and also validation of clients.

The acceptance end of the treatment is two-part. It’s a radical acceptance of a client as the client is at this moment by the therapist and teaching the client the same corresponding ability to radically accept. The reason it’s called “dialectical” is because it’s a synthesis of acceptance and change. Back and forth, a constant transaction interplay all the time.

Dr. David: Yes, when I first heard the term “dialectical, ” of course, I immediately thought of Hegel and Karl Marx and so I wasn’t quite sure of what the relationship was but they did talk about synthesis and antitheses and then the… Have I got that right?

Dr. Marsha: Yeah, it’s the theses…

Dr. David: Theses and antitheses.

Dr. Marsha: The antitheses and then the synthesis. The notion is, “everything contains within it its opposite, ” which really means that nothing exists really without an opposite of it. Even if you take something as mundane as a box, there couldn’t be a box if there wasn’t a non-box, a no-box, a not-box, because a box is very defined as it’s this so there’s obviously something that’s not a box.

Everything that exists has its opposite and Dialectics looks at the tension between; what exists and its opposite, or the theses and the antitheses or the opposite, and looks at the transaction between them, and that tension and that transaction which always brings about change.

Dr. David: In terms then of your therapeutic work and your therapy model, what are those two poles of tension?

Dr. Marsha: Oh, there are many. There are many, many, many poles. One of the most fundamental poles is that within every unwise act, there is some inherent wisdom. Taking heroin, which is long term, a dysfunctional, destructive behavior in our culture. Within there, is the wisdom of, “You feel better immediately.” So there is dysfunction and function always coexisting together.

The tension is finding the synthesis of; “Are there other ways for example?” or “How to radically accept that if one’s in great pain, getting out of pain is reasonable” while at the same time accepting that if one is in great pain, getting out of great pain by doing something that will continue to pain in the future is not reasonable. You’re always looking for a synthesis, where is a point that without rejecting the other side.

Here is another explanation of why acceptance was inserted into DBT by Marsha Linehan:

Dialectical Behavior Therapy represents an integration of two traditions: the behavior and cognitive-behavioral therapy tradition which is focused on developing technologies of change, and the mindfulness tradition that comes out of various spiritual practices including Zen Buddhism and contemplative Christian practices. At the start of her career, Dr. Linehan set out to develop a treatment for chronically suicidal patients and found that many of them were so overwhelmed by significant problems that it was not possible to address them all. Instead of focusing solely on how patients could change, what was required was also to help patients to better tolerate their circumstances. She was familiar with Christian contemplative spiritual practices that emphasized surrender to God, but sought out alternative teachers (e.g., a Zen Buddhist and a Benedictine Monk) who could teach her a “technology of acceptance” that would be more free of particular religious overtones. After taking several months to immerse herself in acceptance practices, she began the task of translating them into a language that behaviorists could accept and DBT was born. Though at first she thought the therapy was for suicidal people, in 1980 when the diagnosis of Borderline Personality Disorder was added to the DSM, she realized that it was really a therapy made for treating BPD and similar sorts of issues.

So, through applying behavioral change (from CBT) and acceptance (from Buddhist practice) DBT effectively treats BPD (and similar sorts of issues).

Bon Dobbs :: Apr.29.2008 :: Resources, Treatment, Validation, DBT, Borderline Personality Disorder :: 2 Comments »

After reviewing Mrs. Treasure’s article on BPD and Demonic Possession, I decided to read at least some of her other posts at AssociatedContent.com. I wanted to find out if she had posted more on Borderline Personality Disorder and why she decided to post on the disorder in the first place. I think she must believe that her new husband’s ex-wife has the disorder, because she wrote another article called “10 Ways to Handle a Difficult Ex? Focus on Borderline Personality Disorder” which refers to the person with BPD as “she” throughout. I’m not going to agree or disagree with the content of that article.

I also found an article called “Spiritual Glasses to Understand the Difficult Child” which was described with the question: When you get frustrated with your child, what is the most effective discipline? I was intrigued and decided to read the article.

I have to say, I was surprised by the wisdom in some of her comments. I find it interesting that what she says about children can be applied directly to people with BPD. Consider the following:

If your child is a chronic liar, parents worry and panic. The spiritual glasses allow you to see a very insecure child with poor self concept or image. Are your expectations of him too high? Why does he feel worthless? Is he bullied around by friends or older siblings?

I get more searches on this blog for “lying,” “liars,” “chronic liars,” etc. than about anything else. (Actually to be honest the most searches I get are about “celebrities with BPD” or some variant of that, but lying-related searches come in a close second.) I’d like to take her words and apply them to BPD and replace the words “spiritual glasses” with “emotional glasses.” I think if you look at a chronic liar, which many people with BPD are, you will find that one motivation for lying is a poor self image, feeling worthless or insecurity. These concepts are interrelated and spring from shame. People with BPD do have a poor self-image. Even though many nons report that their loved one with BPD is selfish or narcissistic, in reality people with BPD actually hate themselves. This feeling arises from shame as well, but the shame also arises from emotional invalidation. Mrs. Treasures doesn’t really provide a prescription for dealing with a liar, other than not to label (judge) the child as a “difficult child” right away and try to understand them and set proper expectations. The same can be said of a non’s relationship with a BP. Judging their behavior as “difficult” right away or setting expectations too high can invalidate the BP’s emotional responses. This sets up an “invalidating environment” for the child’s emotions and the effects of an invalidating environment are summarized by Dr. Marsha Linehan:

[The] effect of an invalidating environment, especially when basic emotions such as fear, anger, and sadness are invalidated, is that a person in such an environment does not learn when to trust her own emotional responses as valid reflections of individual and situational events. Thus, she is unable to validate and trust herself… If communication of negative emotions is punished, as it often is in invalidating environment, then a response of shame follows experiencing the intense emotion in the first place and expressing it publicly in the second.[i]

 

If a person is unable to trust herself, she can not validate herself and a “response of shame follows” emotional experiences. That is one pathway to BPD. If you punish a child for feeling inadequate, for example, if the child is lying to you because he wants to make himself feel better about himself, then you are invalidating his emotional responses.

Mrs. Treasures also say this about temper tantrums:

For your younger children showing tantrums and hitting other siblings, the spiritual glasses permit you to see a child struggling to deal with his immature emotions. The child’s frustration is his inability to communicate his feelings and needs to his siblings.

Again, if we substitute “emotional glasses” for “spiritual glasses” and “BP” for “child,” I believe she is accurately describing the state of someone with BPD. People with BPD are emotionally immature. It’s not their fault; it’s just that they were not raised in an emotionally supportive environment. They feel that by feeling emotions intensely, they are wrong and should be punished. Again, the shame comes into play. They do have an “inability to communicate [their] feelings.” Because of the invalidating environment, the BP becomes unable to trust her own emotions and becomes frustrated and angry. THAT is what fuels rage more than anything.

OK, now what do you do to counter-act an invalidating environment (with both children and BPs)? You learn to validate their emotional responses. I have quite a few examples of validation techniques on this site and if you follow this link, you can read about validation.

[i] Linehan, Marsha, Cognitive-Behavioral Treatment of Borderline Personality Disorder, pg 72

Bon Dobbs :: Mar.25.2008 :: Parenting, Emotions, Anger, Validation, Lying :: 1 Comment »