Anything to Stop the Pain - BPD and Non-BPDs» Anything to Stop the Pain – For Non-Borderlines and Loved Ones of People with BPD

Intention and Consequence

Bon Dobbs — Mon, 09 Aug 2010 17:57:16 +0000

I have written quite a bit about the reason that people with BPD behave in a certain fashion. Much of the impulsive behavior is to stop the pain. Yet, the behavior can still be destructive to relationships, even when it is not the intention of the person with BPD to hurt the other person. Intention is often misread with BPD. Here is one message about that from the ATSTP list (written by me):

MANY times emotionally sensitive people will read intentions and states of mind into the other that are not aligned with reality. They might say that you’re being mean or trying to ruin their life. Clearing up intention can be a way to mentalize the interaction. That is, if my wife were to say that I did something to ruin her life I can come back with “it is not my intention to ruin your life. I’m not sure why that would be my intention. Can you help me understand how you thought that was my intention?” The purpose is to get a person to start thinking about the mental states of the other person more accurately. Consequence of BEHAVIOR is important. Intention, motivation, goals, desires, etc. of mental states is also important when you’re talking interpersonal relationships. As a friend of mine said about her BPD child: “people with BPD don’t read minds, they read INTO minds” – and because BPD is configured the way that it is (threat awareness, mistrust, fear of shame discovery and intense personalization) it is likely that the intention being read into by a person with BPD will be malevolent.

The flip-side of that idea (that malevolent intentions are misread), is the idea that if it is not your intention to hurt the other person, the other person has no “right” to feel hurt. However:

One must also remember that INTENTION DOES NOT NEGATE CONSEQUENCE, Just because you didn’t MEAN to hurt someone with a lie, just because you felt bad about yourself and lied (or bullshitted), it still can hurt the other person and their sense of trust. Just because you didn’t MEAN to burn down the house when you were playing with matches, doesn’t bring the house back.

All people, with BPD or not, need to know that, despite intention, behavior has consequences.

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The power of “When you do this, I feel that”

Bon Dobbs — Wed, 23 Jun 2010 20:26:56 +0000

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.

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Engagement without Entanglement

Bon Dobbs — Wed, 09 Jun 2010 13:54:09 +0000

Is it even possible? The short answer is: yes. I see many nons hopelessly entangled with their borderlines. I don’t use the word “hopelessly” lightly. It is a difficult situation to be in and, unfortunately, in the world of human relationships, it is a natural situation to be in. One of the main issues as I see it is that we get our emotions engaged in the mix. When someone (anyone) is emotional, it is natural to “circle the wagons” so to speak. When we get emotional, other people’s intent, feelings and motivations disappear from our mind. This situation is particularly acute for borderlines. Their emotions become engaged rather quickly and intensely (see “BPD, self-regulation and others” for more detail). Additionally, we, as just regular people, have our own emotional triggers. One way that we get entangled is through assumptions of other’s mental states. We assume what the motivation of others is without ever asking ourselves (or them) what they are feeling or thinking. We rarely ask about intent. Instead, we assume that the other person is “out to hurt/manipulate/disrespect” us.

The most effective way to combat entanglement is a process:

Don’t assume what the intent/motivation of the other person’s actions is. Ask. Be a detective, not a judge.
Be honest and clear with yourself about which issues are yours and which are theirs.
Understand that most people (particularly borderlines) are most often motivated by their feelings. This is why I say in “When Hope is Not Enough”: It’s all about his/her feelings (IAAHF). What that means is that the motivation of his/her actions is typically a reaction to his/her emotions and, for the most part, your mental states are not considered. In other words, you are not even on the radar screen, even though it feels (your emotions) like you’re being “hurt/manipulated/disrespected.
Don’t focus so much on content – instead, look to emotional context. Think about what you’d feel if you were them in a given situation. Ask about intent. Ask about feelings. Validate feelings in order to get a clearer picture of the other person’s mind-set.
Don’t defend. This is quite difficult to do. It takes time and practice. When people are attacked (or feel attacked), the natural reaction is to defend, deny (“That’s not what I meant!”) or to avoid. Instead, engage the other person’s mental states.
Help get thinking back on track by asking for information. You can’t be a mind-reader. If you assume the other person’s mental states, you could be far off. You could assume the worst. If thinking (rather than reacting) can get back on the rails, then a true interaction can take place.
Stay in the moment. Don’t plug in past problems, childhood issues (yours or theirs), history (“she always does this!”) or future fears (“he’ll never get a job!”). The conversation is about now.

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Mentalization-Based Treatment Versus Structured Clinical Management for BPD

Bon Dobbs — Tue, 16 Mar 2010 20:37:34 +0000

An abstract on MBT:

Randomized Controlled Trial of Outpatient Mentalization-Based Treatment Versus Structured Clinical Management for Borderline Personality Disorder
Anthony Bateman, M.A., F.R.C.Psych., and Peter Fonagy, Ph.D., F.B.A.

Objective: This randomized controlled trial tested the effectiveness of an 18-month mentalization-based treatment (MBT) approach in an outpatient context against a structured clinical management (SCM) outpatient approach for treatment of borderline personality disorder.

Method: Patients (N=134) consecutively referred to a specialist personality disorder treatment center and meeting selection criteria were randomly allocated to MBT or SCM. Eleven mental health professionals equal in years of experience and training served as therapists. Independent evaluators blind to treatment allocation conducted assessments every 6 months. The primary outcome was the occurrence of crisis events, a composite of suicidal and severe self-injurious behaviors and hospitalization. Secondary outcomes included social and interpersonal functioning and self-reported symptoms. Outcome measures, assessed at 6-month intervals, were analyzed using mixed effects logistic regressions for binary data, Poisson regression models for count data, and mixed effects linear growth curve models for self-report variables.

Results: Substantial improvements were observed in both conditions across all outcome variables. Patients randomly assigned to MBT showed a steeper decline of both self-reported and clinically significant problems, including suicide attempts and hospitalization.

Conclusions: Structured treatments improve outcomes for individuals with borderline personality disorder. A focus on specific psychological processes brings additional benefits to structured clinical support. Mentalization-based treatment is relatively undemanding in terms of training so it may be useful for implementation into general mental health services. Further evaluations by independent research groups are now required.

http://focus.psychiatryonline.org/cgi/content/abstract/8/1/55

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A new eBook from Bon Dobbs

Bon Dobbs — Tue, 26 Jan 2010 19:56:07 +0000

New "Beyond Boundaries" eBook

I published a new eBook called Beyond Boundaries: the advanced guide for loved ones of people with BPD. This 72 page eBook is packed with information and tools for you to gain a more effective and calmer relationship with someone with BPD. It is the culmination of what I have done in When Hope is Not Enough as well as what I have been working on since. It explains (rather tersely) what you can do and how you can get your relationship to be more of a trusting, loving relationship. It also explains when boundaries are helpful and when they are not.

The cost of the new eBook is $18.00. I think you will find that it is worth it. People in NY will have to pay sales tax. Sorry, blame the NY State legislature.

The eBook is available through Google Checkout below:

Beyond Boundaries

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Just in time for the holidays

Bon Dobbs — Fri, 18 Dec 2009 18:33:04 +0000

Sometimes the holidays can be stressful

Hey all, I haven’t posted much in the way of skills lately, but today, as the holidays are upon us, I think it is helpful to go over some emotional skills and other tools that can help us non-BPD people get through the holidays reasonably unscathed. The holidays are a tough emotional time for everyone. There are expectations that the holidays be “jolly and happy” when, sometimes, the holidays are anything but. The get-together with relatives – many who don’t understand the actions, feelings and behaviors of someone with BPD – can cause huge stress for those with BPD and for the loved ones. Expectations of a low conflict Christmas (or other holiday) are typical, but not often “delivered upon”. Stress and the feeling of being “on-stage” or “good enough” for the family can cause emotional dysregulation and distress. Sometimes an invalidating family can compare the person with BPD with other, less emotional family members. You know, “why can’t you be like your cousin?”

So, in order to skillfully approach the holidays, I’d like to remind non-BPD people and people with BPD alike of the following skills that can help all of us get through. Here we go:

1. Frustration Tolerance. Sometimes we are overcome with frustration. We feel like we “can’t stand it” or “can’t take it anymore.” When you feel that way, I would encourage you to ask yourself some questions that can help build frustration tolerance. Some questions are:

a.   Can I really not stand it?
b.   Am I really going to explode?
c.   How does exploding/raging help me in my relationships?
d.   What can I do to decrease the frustration?

2. Mentalizing with yourself in a search for meaning within other people’s actions. Often people jump to conclusions or assume the intent and motivation of others. Sometimes these motivations are assumed to be malevolent, invalidating or uncaring. You can ask yourself the following questions to help understand the intent within yourself:

a.   Do I really believe that he/she is being mean?
b.   Is there another explanation as to his/her motivations?
c.   What would he/she be feeling that could explain this action?

3. Mentalizing with others to understand others’ internal mental states. Be curious. Ask questions. Don’t “load” these questions. That is, ask “can you clarify what you meant, I’m not sure I understand you intention?” vs. “Why are you being so mean to me?”

4. Be validating toward yourself and others. Remember that emotions are a major influence on people’s behavior. Listen to others and validate the emotions. Validation does not equal agreement with behavior. It shows that you have heard the other person’s emotions and that it is ok to feel however one feels. Normalization can also be helpful here.

5. Don’t label people, label events. In other words, rather than saying “he’s an asshole”, say “he did something that bothered me.” This can be used on your own actions as well. Rather than telling yourself you’re a “failure,” you can say “I didn’t do that as I would have liked.”

6. Be mindful of the moment. Monitor interactions actively and in a way that is non-judgmental. Don’t get caught up in past reactions or fear of future reactions.

7. Cheerlead yourself and others. This is not “positive mental attitude” statements. This is encouraging others to be brave and effective. The essence of this skill is “you can do/face hard/difficult things.”

8. Consider the consequences of mind-altering substances. Too much alcohol and/or drugs can create impulsive situations and ones that you may regret later. Think before you drink.

Here’s wishing you all an effective holiday season!

Take good care,
Bon

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Menninger Clinic Releases Mentalizing Conference Call

Bon Dobbs — Tue, 15 Dec 2009 21:17:23 +0000

From the Menninger Clinic… about mentalizing.:

Mentalizing conference call with Drs. Peter Fonagy & Efrain Bleiberg
At the request of participants and the positive response to this November 2009 presentation on the interactive conference call, we are making this tape availalble.

Download conference call

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Mindblindness and BPD

Bon Dobbs — Fri, 30 Oct 2009 17:34:24 +0000

Mindblindness

A little while ago, I was reading through “Mentalizing in Clinical Practice” (a dense read, but worth it IMO) and I was reading the section on Mindblindness. This is a concept that was originally developed with respect to autism. It means that you have the inability to accurately read the intentions, motivations or emotions of another person, based on their behavior. We each develop (around 3-4 years old) the ability to read others motivations based on their behavior. The example they give in the book is a “mind reading” (in the sense of accurately understanding another person’s motivations – internal states – based on behavior) test – it is as follows:

Maxi is helping his mother unload the groceries. He takes the chocolate chips out of the bag and places it in the GREEN cabinet, remembering where he put it with the intention of coming back later and eating some. He goes out to play. While he is outside, his mother opens the GREEN cabinet and takes out the chocolate and uses some for cookies. She places the bag back in the BLUE cabinet and goes down to grab the laundry. While she is gone Maxi returns to get the chocolate. Which cabinet does Maxi open to try to find the chocolate chips?

Most of us would say GREEN, right? People with mindblindness and little children (less than 3-4) say BLUE. Why? Because they already know the chocolate is in the BLUE cabinet – they can’t put their minds in the mindset of MAXI, who doesn’t know the chocolate has been moved.

Why do I bring this up?

Because both people with BPD and Nons do this sort of thing all the time. We attribute motivations to others based on information in OUR minds and not on information in THEIRS. Next time you attribute a motivation to your BP (i.e. “she’s trying to control me!” or “she’s out to get me” or “she’s just trying to get attention”) stop and think about this post. Instead of assuming, ask.

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How mentalization and attachment might explain “high-functioning” BPD

Bon Dobbs — Wed, 15 Jul 2009 14:52:30 +0000

Some time ago I wrote a post about the “myth of the high-functioning BPD.” The point of the post was to facilitate a conversation about whether the categories of high-functioning and low-functioning apply to Borderline Personality Disorder (BPD). My theory was that there was no fixed state in BPD, and a sufferer can swing from high-functioning to low-functioning at the whim of their emotions. Now that I am learning about mentalization, I have a new appreciation for the “high-functioning” state (and it is a temporary state, not a fixed one). It appears to me now to be contextual. Have you ever wondered how a person you love with BPD can be a raging nightmare with you yet perfectly fine in his/her job? Ever wonder how they can “fake it” with others and never show their Mr. Hyde side?

DBT calls this “apparent competence,” which makes sense with respect to the dialectical model (the dialectic side of apparent competence is “active passivity” BTW). The one thing that never made a whole lot of sense to me was how the behavior can generally be “reined in” when with certain people. Most non-borderlines think, “Well, if she can control her behavior with [whomever], this must be completely under her control. So, she needs to start behaving better with me.” Sometimes, it seems as though a person with BPD can turn it on and off at will. However, this is not really the case.

Instead, mentalization explains this through attachment relationships: The closer the attachment, the more at stake for a person with BPD. This is why there is a fear of abandonment in BPD. When it comes to close relationships (such as partner or parent), the attachment is more important to the person with BPD and the fear of losing that attachment, the fear that the other person will judge him/her as wrong or bad (shame), is much larger. Unfortunately, the method of coping with this fear is usually maladaptive and functions to push the other person further away. Sadly, that can lead to a self-fulfilling prophecy of abandonment.

When Hope is Not Enough
Get the Non-BPD book
that has helped hundreds!
If you have the disorder, give it to you loved ones! It will help.

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The Implicit/Explicit Connection

Bon Dobbs — Thu, 09 Jul 2009 16:19:24 +0000

Implicit and Explicit

When we have a conversation with someone, there are really four “people” trying to communicate. These people are you in your implicit thoughts, feelings, motivations, intent (all things inside your head and unavailable to the other person), you in your explicit expressions, words, body language, actions (all the ways you try and communicate), the other person in their implicit and the other person in their explicit. The most connected conversations are those in which each person can have the other’s “mind in mind.” This state is what complete mentalization is about. It is about understanding the meaning of the other person’s behaviors and words.

In a Non-BP/BPD relationship, this connection is generally broken. There are too many assumptions, too much focus on the content (rather than the meaning/function), too much personalization and too much “baggage” that prevents fully mentalizing. Some of the ways that one can fully mentalize is to approach each conversation from a particular “framework,” the characteristics of which are not a complete list, but a nice first attempt):

Being curious about the other person’s implicit situation. Ask them how they feel. (“How did you feel when he said that?”)
Validation for the purpose of understanding implicit understandings. (“Wow, that must have made you feel awful! Why do you think he said that?”)
Being humble and admitting “fault” where “fault” is warranted. (“Yes, I can see that when I said that it hurt your feelings. That wasn’t my intention.”)
Being compassionate for the other person’s suffering. (“You seem to be in a lot of pain right now. What do you think would help you feel better?”)
Seeing the situation through the other person’s eyes.
Starting afresh in each conversation, without grievances, relationship failures, victimhood, or assumptions that this is the “same” conversation over and over again. (NOT: “Here we go again.”)
Being fully engaged in the conversation.
Noticing words, actions and body language that break down engagement. (“When I said that, you seem to have gotten upset. What happened there?”)
Listen for meaning, rather than just hearing the words.

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