See larger image The Power of Validation: Arming Your Child Against Bullying, Peer Pressure, Addiction, Self-Harm, and Out-of-Control Emotions (Paperback) By (author) Karyn D. Hall, Melissa Cook List Price: $16.95 USD New From: $10.77 In Stock Used from: $11.01 In Stock

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I found validation isn’t as effective until the underlying agenda tilts more towards acceptance rather than change.  This may sound strange, but after we accept that the situation may not change (and behave accordingly), it then grows room to change.

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Q:  Why do you emphasize emotional validation so much?

A: Emotional Validation is a very powerful skill, or set of skills, for any relationship with an emotionally sensitive person (ESP), including those with BPD traits. There are a number of reasons that emotional validation is important for a family member of someone with Borderline Personality Disorder. Emotional Dysregulation is a core feature of BPD. Another core feature is shame. If you invalidate a BP’s feelings, you are likely to fuel more shame, because they actually feel those emotions, whether or not they seem right or appropriate to 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 BP if you learn to validate their feelings.

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.

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.

The process of Emotional Validation can be summarized as follows:

I-AM-MAD

1. Identify the emotions.

It’s best to do this with “feeling” words, like “look”, “see”, or “sound”, rather than “know” or “understand”.

Examples:

• “I see that you are frustrated.”
• “You sound aggravated.”
• “You look really upset.”

2. Ask a validating question.

This encourages them to share their feelings about whatever triggered them.  Do not use “what’s wrong?”  If you use “what’s wrong?” they will hear “what’s wrong with YOU?”  Also, don’t assume you did anything wrong.  Remember, IAAHF (It’s All About His/Her Feelings).

Examples:

• “What happened?” (most effective because it is open-ended, requires more than yes/no answer)
• “Did something go wrong at work [school] today?”
• “Want to talk about it?”

3. Make a validating statement about their emotion.

Validate the feelings expressed in step 2.  This helps reinforce that it is natural and valid to feel what they are feeling in the situation.  Again, remember IAAHF.  Don’t defend against blaming or projecting.  And don’t apologize at this point, even if you are guilty.  (Apologies for things you are actually guilty of can come later… after they have returned to their emotional baseline.)

Examples:

• “Wow, it must have made you feel awful to have done poorly on that test.”
• “Yes, it is frustrating when it seems that someone is taking advantage of you.”
• “Yeah, that’s really disappointing.”

4. Make a normalizing statement about their emotion.

By relating the situation as common to all people or “normal” for them, this helps alleviate their stress about feeling judged or unaccepted.

Examples:

• “I think anyone would feel angry if they had to do that”
• “I would feel the same way if that happened to me.”
• “I can see why you feel that way.”

5. Analyze the consequences of their behavior.

By examining the consequences of both negative and positive behavior with the person, you help them to separate their emotional reaction from their behavior. The behavior may need to be changed, but the emotions are natural and should not be punished for.

Examples:

• “When you don’t ask questions about something that confuses you, I don’t realize that you are struggling, so I can’t help you. When you do ask questions though, I can either give you the information you need to solve the problem yourself or we can work together to figure out the best solution to the problem.
• “When you yell at me, I feel disrespected and become upset too.  However, when you speak calmly to me, I know you have respect for me, so I am able to listen to you better.”
• “When you refuse to talk to me, I don’t know what else to do except give you space.  When something is bothering you, it’s best to be open and honest with me so I know what’s going on and don’t make the wrong assumptions about what you need.

6. Don’t solve the problem for them.

Solving one’s own problems helps to build self-confidence.  Empower the person by getting them to come up with a solution themselves.  When given the opportunity in a non-judgmental setting, most people will find that they can come up with solutions to their problems.  You can guide them through this process by asking helpful questions to ascertain what they need or want.

Examples:

• “How would you like to handle this?”
• “What would help you make a better choice next time?”
• “Is there anything I can do to help?”

(Note:  Sometimes you have to go back and forth to help them find the most effective solution. They may say, “I don’t know” or “I don’t care.” This can be tough.  Go back to step one to deal with any additional emotions that become apparent.)

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A: This is an excellent question and one that I have grappled with for years. My wife’s behavior before I started down the path to effectiveness was off-the-charts and was affecting my children’s feelings of safety in our household. Numerous times I felt the only solution to protecting my children was to leave my wife and apply for full custody of our children. When my wife was “acting out” and/or in a rage around the children, I would take the kids to the library or to events around town. I worried that they would associate going to the library (a nice quiet place) with my wife’s raging. However, once I understood the reason for her raging, I also understood that there was a more effective solution to my wife’s behavior. The reason my wife was raging was because she had dysregulated emotional states that were painful for her, yet out-of-line with the evidence of the world around her. Still, these emotional states seemed quite real and justified to her. All of her life she has felt that her very being is under threat from those around her. This situation causes fear in her, but the fear quickly turns to rage and no-holds-barred behavior toward others, even those she supposedly loved. In fact, this dangerous and confusing behavior was worse with the immediate family. The reason is that she felt that her emotional states were not understood, not accepted and judged by those with whom she had the most at stake. If your immediate family doesn’t accept you, who will? This judgment and rejection was seen as a prelude to abandonment, rejection and confirmation of her shame. This situation made her frightened, desperate and angry. The anger then translated into rage from which much of the emotional abuse arises.

Behavior is most often conditioned and based on previous beliefs, reactions and conditions. I found that if you, as a loved one of someone with BPD, change the conditions, the behavior will change. If the emotions are accepted and validated, they don’t typically spiral out of control and trigger dangerous abusive behavior. It is not a question of right and wrong, like many people believe it is. It is a question of effective reactions and behavior on your part versus continuing to react ineffectively and, essentially, throwing gasoline on a raging fire. Better to put out the fire with water, which is a soothing elixir. Punishing a person for their feelings becomes translated into more shame since “all feelings all the time” is how they “are”. Rejection confirms that to the borderline that he/she is a bad person, which, in turn, causes more and more rage. Remember, however, that emotions and behavior are not synonymous. You can validate emotions without condoning the resultant behavior.

What about past abusive behavior? When will my borderline take responsibility for that? Should I let that go?

If I’ve learned anything about borderlines in the past five years, it’s that they generally know what they’ve done “wrong” in life, whether or not they will admit it to you. The shame component causes a “deepest, darkest” reflection about who they really are. When a borderline identifies with a particular role in life – such as being a mother – anything that threatens that identity is usually met with fire. Yet, on the flip-side of the defense of their very being, there’s shame, unworthiness and self-flagellation. It is most likely that your borderline will punish herself for the discretions she has committed. Of course, sometimes, the emotion-fueled behavior is not even remembered. It’s sometimes an emotional vomit session to get all the bad feelings out, to purge the nasty sickness of the painful emotions – of course,  those around them can get spewed on. When I said that it might not be remembered some time ago on the ATSTP list, I got a response from a recovered borderline that went “oh, we remember it. We just can’t run to the toilet when it is occurring. And we almost always see the mess that has been made and feel bad about it afterwards.”

My suggestion about “balance” between validation and protecting the children from emotional abuse boils down to the belief that, if the borderline doesn’t let the emotions run away with them, the abusive behavior will (almost) cease entirely. I still get raging from my wife every once in a while – maybe once every 4-6 months. It used to be once every 2-3 days, then it was 2-3 weeks, then once a month and so on. What I changed was the environment for my wife’s emotional expression. I stopped judging her. I validated her when she felt bad. I built a safe, accepting environment for her emotional life. One that she has never experienced before. It was not my “fault” that she felt that way – it was merely how is actually was in her life. I had to accept the reality of the situation and do what I could do to change it.

Several members of the ATSTP list have reported that once they “turned their mind” (and behavior/reactions) toward what I purpose in WHINE, the raging in their borderlines ceased. The Buddha said of dependent origination: “When this exists, that comes to be. With the arising of this, that arises. When this does not exist, that does not come to be. With the cessation of this, that ceases.” My suggestion to each of you is to cause the “ceasing of this” (the non-accepting, judgmental, invalidating environment) to insure that “that ceases” (the abusive, dysregulated behavior).

NOTE “Ask Bon” is a new category within this blog in which Bon answers burning questions about being a non-BPD from his perspective and with the skills an attitudes with which he was able to rebuild his relationship with his borderline wife. The opinions are Bon’s alone.

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Got BPD? Get This! Great for Everyone Who Needs Validation!, June 16, 2011

I have BPD and I love this book! I no longer walk around feeling like BPD is stamped on my forehead and everything I say or do is a result of my lousy emotional filtering. I can constructively offer suggestions to myself (or others) on how I would rather be treated or spoken to. I can laugh with myself and my partner when something my partner says today about 1 cup of noodles sets off a cascade leading back huge resentment about to 2 tons of dirt and threats of leaving —10 years ago. I am proud of myself as a unique person. I can notice feelings of shame without going down the tubes. My partner bought this book for herself and I love it FOR ME! I don’t feel criticized or judged. I feel validated. I am happy and proud. I’ve been dealing with BPD diagnosis for over 35 years and this book is so fantastic! Give it to your DBT therapist, family members, yourself. This is the only book I have ever written a review for. HIGHLY RECOMMEND.

I’m posting it here for more than just shameless promotion of my book (click here for the post on “Why I Bothered to Write a Book”). I’m posting it to point out that people with BPD generally like my work and approach to BPD. That’s more than can be said of Stop Walking on Eggshells which I know from the borderlines who I know despise SWOE. The reason seems to be that in WHINE, I promote something that one of my list members calls the “Platinum Rule” of interpersonal behavior. The platinum rule states “treat others like they wish to be treated” (as opposed, of course, to the Golden Rule “treat others as you wish to be treated”). People with BPD and other emotionally sensitive people wish to be treated in a particular way. They respond positively to a certain way of treatment. Sometimes I get people comment on my methods as being too “easy” on the borderline, “letting the borderline win”, “giving into the borderline” or “not holding the borderline responsible for their actions”. The reality is that when a person is being treated like they wish to be treated, most of the poor behavior will fall away. When someone feels heard and accepted, there’s no need to scream and yell to be heard and accepted. I heard a borderline daughter once tell her mother “you only listen to me when I’m screaming at you”. That sort of thing goes away when you actually listen and accept the person and understand what they are really saying. I believe that much of the trouble between borderlines and their loved ones is due to a communication problem. Borderlines speak one language, their families speak a completely different language. WHINE really seeks to give you the tools to be fluent in the borderline’s (or any  emotionally sensitive person’s) language. Several people on my list have reported that when they started speaking the borderline’s language, the raging, yelling and abusive behavior ceased – in some cases almost immediately.

I like to sell books as much as any other author. Yet, sales is not the reason I write or continue to write, here and on the ATSTP list. In reality, I continue because I discovered something that worked really well for me and wanted to share it with other people who were in the same predicament I was in a few years ago. And, of course, this review also demonstrates that even borderlines like WHINE, so the dread that you may have experienced when your BPD partner finds SWOE might be mitigated if your BPD partner finds WHINE (and actually reads it).

See larger image When Hope is Not Enough (Kindle Edition) By (author) Bon Dobbs List Price: $7.50 USD Release date June 15, 2008.

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After a period of dealing with a partner’s mental illness, compassion fatigue can set in. Yes, you still love your partner. Yes, you still care that they are not feeling well. But it can become difficult to empathize after a while, and you begin to wonder, “When is this going to end?”

While I can’t give you an answer on when–or if–the illness will abate, what I can tell you is that it is essential that if your partner says they are in pain, believe them. The pain could be emotional or physical, and either way, it is valid.

I could not agree more with that statement. Pain hurts even if he seems to you (the partner) as if it shouldn’t.

I wanted to thank Ms. Theda for sharing my tool with her readers. I’d encourage my readers to read her post. I’d also encourage you to check out the Emotional Validation Spotlight.

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I believe that there is no right or wrong way to approach human emotions – there’s an effective way and an ineffective way and there are shades of grey in between those “polar” opposites. The effective way gets a positive outcome. That positive outcome is typically the return to baseline of the borderline and the establishment of a modicum of trust with others. One of the most important issues with borderlines seems to be the idea that they believe no one understands them (they feel “strange” – I said “broken” in WHINE, but I think that it was [a recovered borderline on the list] who clarified that it’s more like a “not feeling ‘normal’ and ‘fitting in’ feeling”), they can’t trust anyone with their emotions because many people have invalidated their feelings throughout their life and this leads to “silent desperation” and the inability to communicate effectively how they feel. If, through the use of my tools, you are able to gradually establish an environment in which your wife feels that she can safely express her emotions, which will go a long way toward establishing trust.

Secondly, you posted that you feel as through your feelings do not have a forum for airing and validation. Unfortunately for you, your wife sounds like a typical borderline. She is impulsive, she cuts, she abuses substances – especially painkillers. The divorce talk is probably born of either shame (“I will leave you before you leave me”) or of a feeling that she is being judged and/or disrespected (or not appreciated and accepted for whom she feels that she is). That leads to a certain mind-set that essentially makes her believe that, since no one has ever listened to her feelings before, she must dig in and hold on to her feelings as if she is the only person in the world. That is, “if I don’t fight for myself no one will”. This situation makes it difficult for you to express how you feel because she gets the message (even if it is not true): “YOU MADE me feel this way” because she thoroughly believes that about you. The reason she believes that you (and others, not just you) make her feel like she feels is that she is unable to self-regulate and looks to others to regulate her own emotionally states. When [a recovered borderline on the list] said something about her being more worried about what you think of her, she hit the nail on the head, because a borderline (and possibly for biological reasons) has a great deal of internal chaos and the usual strategy (also possibly biological) is to internalize other’s feelings and opinions about her self. It’s odd, yet I think that this dynamic is the one in which all the talk of not respecting boundaries arises. She feels at some level that you are actually a “part” of her, because she requires external validation. When that external validation turns to judgment, she has to cut you out of her mind. Sadly, she will continue to seek others (particularly men) to self-regulate until she can self-regulate.

As for IAAHF (“It’s all about his/her feelings”), one thing that many people read into that is that EVERY interpersonal situation is about her feelings and that she will not EVER be able to empathize with yours. This is neither the intent of IAAHF or the case. Borderlines are really empathetic (really no kidding they can be) but only when they are not on fire internally and emotionally. The intent of IAAHF is to EXPLAIN the “crazy” behavior, not to make a blanket statement about the relationship. When asked “why would she cut herself?” (for example) the answer is IAAHF. She’s in pain and the cutting helps alleviate that pain. Or asked “why is she raging at me over nothing?” (which happened to me the other night, presumably out of the blue). The answer is IAAHF.

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IAAHF

As you can see, I also get lots of searches on “famous people” or “celebrities” with BPD. I only post those types of articles to relate to those with BPD and their families that perhaps they are not alone in their struggles – perhaps (again it’s a maybe because the closest celebrity to actually come out and say he/she has BPD is Megan Fox – who speculated about it).

I’ve written a lot about IAAHF here. I also explain the concept and how it relates to validation skills in the I-AM-MAD communication skill. The concept of IAAHF is extremely important to fully understand if a non-BPD is going to understand what is going on in the emotionally dysregulated moments (EDMs). It takes some time to understand and to truly “get” it. For me, it was one to the most valuable perspectives on BPD and emotional dysregulation.

Sometimes, however, nons have a problem with this concept because they misinterpret it. Here is a brief note from “When Hope is Not Enough” (the second edition, on which I am working) about IAAHF:

I found that many people bristle at the idea that it’s “all about” the borderline’s feelings. Sometimes this formulation makes the Non-BPD’s ask: what about my feelings? (which, in a way, is a reformulation of “what about me?”). The intention of this concept is for you to understand the motivation of behavior, not the entire landscape of the relationship. There will be times in which the context of the relationship is about your feelings. Yet, when the “crazy” behavior takes place, it is most often motivated by dysregulated feelings and emotions. The purpose and intent of the behavior is to quell those feelings, even if it seems as if it’s your fault that those feelings exist. To understand and use this attitude properly, you have to remember that it’s (the behavior) is all about (motivated by) his/her feelings (dysregulated emotions that require calming/quelling of pain).

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Sometimes Love Hurts

I’m currently reading the book ‘The Essential Family Guide to Borderline Personality Disorder’ by Randi Kreger. This is the first book I’ve read on the subject & I’m finding it really helpful.

I started to research other books and found the one I’m ‘reviewing’ on the US Amazon website. There are lots of reviews of the book there and it made me decide to buy it as the reviews are very positive. So, if you want to read reviews before you buy this book, have a look on the American site.

I’ve now read the book! Just this minute finished reading it in fact. I have found it so very very helpful, not just with the tools Bon Dobbs gives you for improving your relationship with your BP loved one, but for improving their experience of life. It’s a book for being a kinder, more understanding, more enlightened person in all relationships I think.

The first book I read by Randi Kreger (mentioned above) was more about looking after yourself when in a relationship with a BP. Bon Dobbs’ book is about looking after them too. He says “a BP’s brain is working against them by upsetting the emotional regulation system. It is impossible for a BP NOT to feel those emotions. The emotions are not right or wrong, they just ARE. It is the behaviours that arise from the emotions that can be changed, and that is where we will focus our attention.”

The book is very practical and very intelligently and insightfully written, based on years of experience of living with 2 family members with BP (wife & young daughter). I am so grateful to the author for so generously sharing his experiences and the ways he’s found to improve life for his wife, daughter, the rest of the family & himself.

I have learned so much about why my own loved one developed BPD in the first place and what I can now do to help alleviate some of the suffering that goes with this condition.

The title ‘When Hope is Not Enough’ sounds a bit bleak, but what the book has given me IS huge hope! I now very clearly understand that my loved one needs validation of their feelings. The author has shown me that validating their feelings in no way compromises my own core value of acting with integrity – rather, it will enhance it.

The reason I find this review interesting is two-fold (beyond the thank-yous and the nice words about me): 1) I believe that the reviewer is correct about the nature of my book – it is for the relationship, not for the non-BP exclusively and 2) The reviewer is also right about the fact that you can enhance the relationship, through validation and other tools, without sacrificing your own value or values.

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See larger image Overcoming Borderline Personality Disorder: A Family Guide for Healing and Change (Paperback) By (author) Valerie Porr List Price: $24.95 USD New From: $15.03 In Stock Used from: $11.49 In Stock

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.

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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.

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The core problem with BPD is poor emotional regulation. That particular problem can cause other symptoms to arise as the person with BPD becomes emotionally dysregulated. This term emotionally dysregulated (or just dysregulated) is used to denote the state in which a person with BPD is overcome with powerful and, at many times, misaligned emotional reactions. Remember that emotions don’t arise on their own; they are based on cues or triggers from the environment and compared by our “emotional immune system” to the meaning of the cue. For a person with BPD, the meaning can be misjudged or, as is more often the case, the sensitivity to emotional cues is greatly heightened.

An example is a heat-sensing system that helps to detect and suppress fires. Sometimes companies will install heat-sensing equipment in addition to smoke detectors so that they can protect assets that need a certain temperature to operate (e.g. computer equipment which might cease working at a high temperature). The setting at which an alarm goes off might be 80 degrees Fahrenheit. In the case of someone with BPD, the setting (or “tolerance” as it is called in the control community) is naturally set much lower, at say, 50 degrees Fahrenheit. That means that the alarm will be raised much more often and lead to a reaction to the alarm. In other words, people with BPD will experience many, many (what you would consider) false alarms. However, these false alarms seem completely real to them, because their tolerance for emotional triggers is set very low. They are constantly running a fire drill. Unfortunately for you, the BP may drag you along unwillingly and unwittingly for the drill. (Pages 32-33 of WHINE)

As you can see, the position I take in WHINE is that emotional regulation is the “core issue” of BPD. This position is in line with the DBT way of thinking, which is why one of the “modules” of DBT is emotional regulation skills.

The question is today: is emotional regulation at the “core” of BPD? Or does it go deeper than that? Is there a “cause” for emotional regulation? What are the triggers and how does a person with BPD’s internal feelings affect this “systems dysregulation”?

In the American Journal of Psychiatry, Drs. Stanley and Siever recently (January 2010) publish an article entitled “The Interpersonal Dimension of Borderline Personality  Disorder: Toward a Neuropeptide Model “ in which they seem to posit (in my interpretation again, since I am a lay person and not a doctor) that this systems dysregulation actually has another cause instead of being a “core cause’ of the disorder. They begin the article like this:

Borderline personality disorder is a complex disorder associated with substantial morbidity, mortality, and public health costs. Prominent symptoms include suicidal behavior, nonsuicidal self-injury, aggressive outbursts, and emotional reactivity, all of which typically manifest in an interpersonal context. For several years, there has been an ongoing discussion about whether impulsive aggression or affective dysregulation is at the core of the disorder. While these factors are important in borderline personality disorder, it is the exquisite interpersonal sensitivity that frequently triggers both dysregulated affect and impulsive behaviors, which suggests that this sensitivity perhaps rests at the core of the disorder and may in turn drive impulsivity and dysregulated affect.

They go on to say this:

It is noteworthy that many symptoms in the interpersonal domain of borderline personality disorder are actually manifestations of intrapersonal difficulties (e.g., difficulty being alone and misperception of the intentions of others as malevolent), and this dimension could perhaps be reconceptualized as “intrapersonal dysfunction.” We suggest that an internal feeling of well-being, stability, and self-regulation in borderline personality disorder is tenuous and may rely heavily on a sense of interpersonal contact and connectedness.

So, what’s afoot here? What are they saying and what does it mean to the nons of the world?

It seems to me that they are saying two very important things about BPD that has previously been “unnoticed” as DBT has reigned the clinical community. These are:

• “…it is the exquisite interpersonal sensitivity that frequently triggers both dysregulated affect and impulsive behaviors, which suggests that this sensitivity perhaps rests at the core of the disorder and may in turn drive impulsivity and dysregulated affect.” Basically, that the interpersonal sensitivity is the “control” of is sensitive to the (emotional) heat.
• “We suggest that an internal feeling of well-being, stability, and self-regulation in borderline personality disorder is tenuous and may rely heavily on a sense of interpersonal contact and connectedness.” That means that the lack of internal well-being makes the person with BPD sensitive to interpersonal cues.

What do those two important factors mean to you – the loved one or family member? In my mind they mean that a person with BPD uses people in close personal relationships to self-regulate. In other words, being unable to self-regulate internally, they look to external people to regulate their emotions, reactions, sense of well-being and behavior.  They believe at some level that you, the loved one, is an extension of their mind, emotions and feelings and assume to you “should know what to do” when they are feeling dysregulated.

What SHOULD you do when this situation occurs? What should you do when they are triggered? What should you avoid?

I believe that the most effective answer is to help them learn to self-regulate and self-validate. This “lack of well-being” is an unpleasant feeling (I would imagine) and probably feels like a HUGE lack of control. I mean, if a person has to rely on other (unpredictable) people to self-regulate, how must that feel? Having compassion for that feeling is definitely a goal. However, before that comes (and it can be cultivated BTW), one can listen, ask, redirect the choice, validate, normalize and cheer lead when appropriate. Don’t defend or minimize. Living a life in which you’re always waiting for the other shoe to drop has got to be unpleasant.

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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.

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1. Validation and DBT
2. An exercise in validation
3. Primary and Secondary Emotions

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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

Related posts:

1. Interesting Article from Time Magazine on BPD
2. Lindsay Lohan and possible BPD (more detail this time)
3. Holiday Discount of Publisher’s version of When Hope is Not Enough

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Are you and your BP on the same team?

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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Emotional validation strategies contrast with approaches that focus on the overreactivity of emotions or the distorted basis of their generation. Thus, they are more like the approach of Greenberg and Safran (1987), who make a distinction between primary or “authentic” emotions and secondary of “learned” emotions. The latter are reactions to primary cognitive appraisals and emotional responses; they are the end products of chains of feelings and thoughts. Dysfunctional and maladaptive emotions, according to Greenberg and Safran, are usually secondary emotions that block the experience and expression of primary emotions. These authors go on to suggest that “all primary affective emotions provides adaptive motivational information to the organism” (1987, p. 176). The important point here is the suggestion that dysfunctional and maladaptive responses to events are often connected or interwoven with “authentic” or valid responses to these events. Finding and amplifying these primary responses constitute the essence of emotional validation. The honesty of the therapist in applying these strategies cannot be overstressed. If emotional validation strategies are used as change strategies – that is, if lip service is given to validation in order to simply to calm the patient down for the “real work” – the therapist can expect the therapy to backfire. Such honesty, in turn, depends on the therapist’s belief that there is a substantial validity to be found, and that searching for it is therapeutically useful.

Cognitive-Behavioral Treatment of Borderline Personality Disorder

This idea is an important one for loved ones of those with BPD because it touches on several points:

• It acknowledges that emotional validation focuses on “normal” emotional reactions, not “the overreactivity of emotions or the distorted basis of their generation.” That is the way of emotional invalidation, i.e. “You’re overreacting to something trivial. Look at what really happened.” I see that expression from Non-BPs all the time.
• It points out the differences between primary and secondary emotions. This distinction is extreme useful for Non-BPs. Why? Because most often the anger and rage are secondary emotions (not always) and that is typically what Nons focus on. If the emotional validation is used for secondary emotions, then I interpret this as not therapeutic, because you are “validating the invalid.”
• Probing (gently and compassionately) for the primary emotions seems to be a more effective strategy and those are the emotions that can be validated effectively.
• One has to approach emotional validation as a tool unto itself – without using it as a “change strategy.” That is, “it is ok to feel that, but you have to change the way you feel to be ‘normal’.” That is, bound to backfire.
• If this distinction of primary and secondary emotions – the first being true and “authentic”, the second being dysfunctional and maladaptive – is applied to the concept of mentalization, then the idea within mentalization to use emotional validation to probe for further feelings begins to make more sense. One has to help the BP locate the primary emotion.

When Hope is Not Enough
Get the Non-BPD book that is designed for
staying and working on the relationship

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Now I have some time to answer these questions and the ones you ask in a later post. Let me start with these.

I disagree with that. I think that if your show appreciation for a commitment to change behavior that makes a BP think that they are being thoughtful and appreciative/appreciated. A person with BPD LIKES (desperately sometimes) to be liked, apprecaited and wanted. If you can navigate that tool without judgment, I suspect your wife will feel relieved that it wasn’t a dreadful statement of “thou shalt” from you to her. Also, I think “negative consequences” is not reinforcement – it is the threat of punishment. There is an implied positive consquence that you will feel better and thus treat her better – when someone is angry and frustrated they are unlikely to treat another person very well. The problem with real reinforcement at that moment is that reinforcement must occur when the desired behavior is performed (as I say in the reinforcement section) and your wife is not performing the behavior, just committing to perform it in the future.

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Tough Love

Not too long ago I wrote an article on why tough love is not the answer for BPD. I still believe that ONLY tough love is not the answer; however, I have come to reconsider tough love and BPD.One of the reasons was that the TIME article said that DBT is a combination of emotional validation and tough love.

One of my list members has moved from the techniques that I provide in “When Hope is Not Enough” – which is basically a non-judgmental attitude plus validation and normalization – to a combination of those techniques plus “tough love.” What is tough love? In my opinion, tough love is the application of PERSONAL boundaries on a relationship. These personal boundaries need to be understood. Often, people don’t understand personal boundaries. Even popular books about BPD for Non-BPs (such as SWOE) get this concept wrong. In fact, even books that are ABOUT boundaries get this concept wrong. The other day I posted a link to a video of a part of the film “The Basketball Diaries” in which Jim Carroll’s mother (Jim Carroll is played by Leonardo DiCaprio BTW and the film is based on the book by Jim Carroll and is true) denies her son money for drugs (he is a heroin addict). She enforces her own boundary (I will not give my son money to buy drugs). She does not enforce a “rule” which is the way that someone tries to control the behavior of another person. Rules and boundaries differ significantly. With a rule, you try and control another person’s behavior – such as telling a child “you have to go to bed at 8:30 PM.” That is a rule, not a boundary, because it has to be enforced. Rules have to be enforced, boundaries do not (except on yourself).

Back to tough love… how does one use tough love with BPD? Well, first of all I have to say you can’t START with tough love, because first emotional trust has to be established. If you start with tough love and use ONLY tough love, that is a recipe for disaster with someone with BPD. The problem is that tough love hurts too much for them. They feel “different” and “broken” and tough love reinforces these feelings. However, tough love can be used once the trust is established. Tough love is something you can use FOR YOU to establish your own boundaries with someone with BPD. But you have to make sure that it’s your boundaries that are being applied and not rules for another person’s behavior.

When Hope is Not Enough
Get the Non-BPD book that is designed for
staying and working on the relationship

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Thursday, Jan. 08, 2009

Minds on The Edge

By John Cloud/Seattle

Doctors used to have poetic names for diseases. A physician would speak of consumption because the illness seemed to eat you from within. Now we just use the name of the bacterium that causes the illness: tuberculosis. Psychology, though, remains a profession practiced partly as science and partly as linguistic art.

Because our knowledge of the mind’s afflictions remains so limited, psychologists–even when writing in academic publications–still deploy metaphors to understand difficult disorders. And possibly the most difficult of all to fathom–and thus one of the most creatively named–is the mysterious-sounding borderline personality disorder (BPD). University of Washington psychologist Marsha Linehan, one of the world’s leading experts on BPD, describes it this way: “Borderline individuals are the psychological equivalent of third-degree-burn patients. They simply have, so to speak, no emotional skin. Even the slightest touch or movement can create immense suffering.”

Borderlines are the patients psychologists fear most. As many as 75% hurt themselves, and approximately 10% commit suicide–an extraordinarily high suicide rate (by comparison, the suicide rate for mood disorders is about 6%). Borderline patients seem to have no internal governor; they are capable of deep love and profound rage almost simultaneously. They are powerfully connected to the people close to them and terrified by the possibility of losing them–yet attack those people so unexpectedly that they often ensure the very abandonment they fear. When they want to hold, they claw instead. Many therapists have no clue how to treat borderlines. And yet diagnosis of the condition appears to be on the rise.

A 2008 study of nearly 35,000 adults in the Journal of Clinical Psychiatry found that 5.9%–which would translate into 18 million Americans–had been given a BPD diagnosis. As recently as 2000, the American Psychiatric Association believed that only 2% had BPD. (In contrast, clinicians diagnose bipolar disorder and schizophrenia in about 1% of the population.) BPD has long been regarded as an illness disproportionately affecting women, but the latest research shows no difference in prevalence rates for men and women. Regardless of gender, people in their 20s are at higher risk for BPD than those older or younger.

What defines borderline personality disorder–and makes it so explosive–is the sufferers’ inability to calibrate their feelings and behavior. When faced with an event that makes them depressed or angry, they often become inconsolable or enraged. Such problems may be exacerbated by impulsive behaviors: overeating or substance abuse; suicide attempts; intentional self-injury. (The methods of self-harm that borderlines choose can be gruesomely creative. One psychologist told me of a woman who used fingernail clippers to pull off slivers of her skin.”

No one knows exactly what causes BPD, but the familiar nature-nurture combination of genetic and environmental misfortune is the likely culprit. Linehan has found that some borderline individuals come from homes where they were abused, some from stifling families in which children were told to go to their room if they had to cry, and some from normal families that buckled under the stress of an economic or health-care crisis and failed to provide kids with adequate validation and emotional coaching. “The child does not learn how to understand, label, regulate or tolerate emotional responses, and instead learns to oscillate between emotional inhibition and extreme emotional lability,” Linehan and her colleagues write in a paper to be published in a leading journal, Psychological Bulletin.

Those with borderline disorder usually appear as criminals in the media. In the past decade, hundreds of stories in major newspapers have recounted violent crimes committed by those said to have the disorder. A typical example from last year was the lurid tale of an Ontario man labeled borderline who used a screwdriver to gouge out his wife’s right eye. (She lived; he got 14 years.”

There are several theories about why the number of borderline diagnoses may be rising. A parsimonious explanation is that because of advances in treating common mood problems like short-term depression, more health-care resources are available to identify difficult disorders like BPD. Another explanation is hopeful: BPD treatment has improved dramatically in the past few years. Until recently, a diagnosis of borderline personality disorder was seen as a “death sentence,” as Dr. Kenneth Silk of the University of Michigan wrote in the April 2008 issue of the American Journal of Psychiatry. Clinicians often avoided naming the illness and instead told patients they had a less stigmatizing disorder.

Therapeutic advances have changed the landscape. Since 1991, as Dr. Joel Paris points out in his 2008 book, Treatment of Borderline Personality Disorder, researchers have conducted at least 17 randomized trials of various psychotherapies for borderline illness, and most have shown encouraging results. According to a big Harvard project called the McLean Study of Adult Development, 88% of those who received a diagnosis of BPD no longer meet the criteria for the disorder a decade after starting treatment. Most show some improvement within a year.

Still, the rise in borderline diagnoses may illustrate something about our particular historical moment. Culturally speaking, every age has its signature crack-up illness. In the 1950s, an era of postwar trauma, nuclear fear and the self-medicating three-martini lunch, it was anxiety. (In 1956, 1 in 50 Americans was regularly taking mood-numbing tranquilizers like Miltown–a chemical blunderbuss compared with today’s sleep aids and antianxiety meds.) During the ’60s and ’70s, an age of suspicion and Watergate, schizophrenics of the One Flew Over the Cuckoo’s Nest sort captured the imagination–mental patients as paranoid heroes. Many mental institutions were emptied at the end of this period. In the ’90s, after serotonin-manipulating drugs were released and so many patients were listening to Prozac, thousands of news stories suggested, incorrectly, that the problem of chronic depression had been finally solved. Whether driven by scary headlines, popular movies or just pharmacological faddishness, the decade and the disorder do tend to find each other.

So, is borderline the illness of our age? When so many of us are clawing to keep homes and paychecks, might we have become more sensitized to other kinds of desperation? In a world so uncertain, maybe it’s natural to lose one’s emotional skin. It’s too soon to tell if that’s the case, but BPD does have at least one thing in common with the recession. As Dr. Allen Frances, a former chair of the Duke psychiatry department, has written, “Everyone talks about [BPD], but it usually seems that no one knows quite what to do about it.”

Inside the Mind

To have coffee with Lily (a pseudonym), you wouldn’t get much sense of how she has suffered. She is 40 but could pass for 30. She has blue eyes and long blond hair that falls across her shoulders in slightly curly tendrils. On the December day we met at a diner outside Seattle, she wore a pink wool cap pulled down tight and an Adidas jumper zipped all the way. She was friendly but not terribly expressive, and she carried an aura of self-protection.

At one point in the late ’90s, Lily was taking five drugs that doctors had prescribed: three antidepressants, an antianxiety medication and a sleeping pill. Borderline patients are often overmedicated–partly because therapists see them as difficult–but for Lily, as for most borderlines, the meds did little. “Drug treatment for BPD is much less impressive than most people think,” Paris writes in Treatment of Borderline Personality Disorder.

As a teenager, Lily felt little self-confidence. “Junior high and high school just sucks, right?” she said, laughing. “But I had a propensity to take it a little more seriously.” With the help of therapy, she made it through high school and college, but in her late 20s, she became dissatisfied with her job selling specialty equipment. One October day, as she headed out for a mountain-biking trip, she looked at the dun sky and had the feeling that something was wrong. Bleakness massed around her quickly, much faster than it had when she was younger. Soon, nothing gave Lily much joy.

She recalled a talk show in which girls had discussed cutting themselves as a release, a way to relieve depression. “I was so numb,” she said. “I just wanted to feel something–anything.” So she took a knife from the kitchen and cut deeply into her left arm.

If Lily had a hard time figuring out what was behind such dark emotions, she was in good company. When a psychoanalyst named Adolph Stern coined the term borderline in the 1930s, borderline patients were said to be those between Freud’s two big clusters: psychosis and neurosis. Borderlines, Stern wrote rather poetically, exhibit “psychic bleeding–paralysis in the face of crises.” Later, in the 1940s, Dr. Helene Deutsch said borderlines experience “inner emptiness, which the patient seeks to remedy by attaching himself or herself to one after another social or religious group.” By 1968, when Basic Books published the groundbreaking monograph The Borderline Syndrome, the No. 1 characteristic of borderline patients was said to be, simply, anger.

Eventually, borderlines became pretty much anything a therapist said they were. Says Dr. Kenneth Duckworth, medical director of the National Alliance on Mental Illness: “If you hated the patient–if the patient was pissing you off–you would bandy this term about: ‘Oh, you’re just a borderline.’ It was a diagnosis that was a wastebasket of hostility.”

It was Linehan who changed all that. In the early 1990s, she became the first researcher to conduct a randomized study on the treatment of borderline personality disorder. The trial–which showed that a treatment she created called “dialectical behavior therapy” significantly reduced borderlines’ tendency to hurt themselves as well as the number of days they spent as inpatients–astonished a field that had come to see borderlines as hopeless.

Dialectical behavior therapy is so named because at its heart lies the requirement that both patients and therapists find synthesis in various contradictions, or dialectics. For instance, therapists must accept patients just as they are (angry, confrontational, hurting) within the context of trying to teach them how to change. Patients must end the borderline propensity for black-and-white thinking, while realizing that some behaviors are right and some are simply wrong. “The patient’s first dilemma,” Linehan wrote in her 558-page masterwork, 1993′s Cognitive-Behavioral Treatment of Borderline Personality Disorder, “has to do with whom to blame for her predicament. Is she evil, the cause of her own troubles? Or, are other people in the environment or fate to blame? … Is the patient really vulnerable and unable to control her own behavior …? Or is she bad, able to control her reactions but unwilling to do so …? What the borderline individual seems unable to do is to hold both of these contradictory positions in mind.”

Linehan’s achievement was to realize that borderlines are, in fact, on the border between various dualities–dualities that they have to learn to accept and reconcile in order to change their lives. That’s easy to say but seems impossible to do–until you see it work.

A Life Redeemed

After she cut herself, Lily was horrified. In a panic, she called her father, who took her to the hospital. When she was released, she and her parents redoubled their efforts to find her good psychiatric treatment. Through a friend at the University of Washington, they heard about Linehan and contacted her Behavioral Research & Therapy Clinics, which are housed in a homey little annex on the UW campus, where you might find little foil-wrapped chocolates next to the coffee and tea.

Linehan, who grew up in Tulsa, Okla., and spent several years as a nun before becoming a psychologist, embodies several dialectical contradictions: a nun who has never lived in a convent; a careful scientist whose most engaging feature is her wry irreverence; a 65-year-old who has a maternal steeliness but was never a mother. It doesn’t pay to underestimate Marsha Linehan. In Cognitive-Behavioral Therapy for Borderline Personality Disorder, she writes, “If the patient says, ‘I am going to kill myself,’ the therapist might reply, ‘I thought you agreed not to drop out of therapy.’”

In one intense session a few years ago, a patient told Linehan that her work stress was going to lead her to suicide. The patient said Linehan could never understand this stress because she was a successful psychologist. Suicidal borderline patients often confront and alienate therapists in this fashion; for many years, this kind of confrontation was seen as a defining characteristic of the disorder. Linehan believes that borderlines are hurting, not manipulating, but that doesn’t mean she indulges them. In this particular confrontation, Linehan responded, “I do understand. I live with a similar amount of stress … You can just imagine how stressful it is for me to have a patient constantly threatening to kill herself. Both of us have to worry about being fired!”

Such in-your-face tactics were highly controversial when Linehan started out. Other mental-health professionals accused her in public meetings of being heartless, even unethical. But her therapy has saved so many lives and worked so well in randomized trials that few criticize her today. For Lily, who calls Linehan’s therapy “Zen philosophy meets tough love,” Linehan was the first therapist to understand that managing Lily’s illness would require Lily to take a new kind of responsibility–a willingness to grow the emotional skin she never had.

In the beginning, Lily resisted Linehan’s assistance. She felt no one could truly understand the depths of her pain. But Linehan was the first therapist who responded to Lily with more than just endless psychoanalysis and pills. Instead, Linehan taught her practical methods of getting by day-to-day. Once, just after she started with Linehan, Lily locked herself in her parents’ bathroom and swallowed six or seven antidepressants in a half-hearted suicide attempt. Her father broke the door down; her mother called the police. Lily never lost consciousness, but the cops said she had to go to the hospital anyway. Linehan advised Lily’s parents not to accompany her. She also told them they needed to get Lily to work the next day. Lily learned that she wouldn’t be cosseted.

Linehan also taught Lily various skills to regulate her emotions. Among the most important is one Linehan calls the “wise mind”–a kind of calm, Zen state that Linehan insists even the most debilitated patients can achieve. “Generally,” she writes, “I have patients follow their breath … and try to let their focus settle into their physical center, at the bottom of their inhalation. That very centered point is wise mind.” Lily remembers this sensation clearly; she came to feel that her dark moods had a physical location in her body–her solar plexus–and when she focused on it, she could deactivate a destructive emotion.

Another skill Linehan taught Lily (and many others, via a popular DVD called Opposite Action) was an anti-anger technique for social situations: “Don’t make the situation worse,” Linehan counsels on the DVD. “And if possible, be a little tiny bit on the kind side. O.K.?”

If some of this sounds like advice you heard in kindergarten, it should. Remember that borderlines have never learned to regulate their emotions. It’s important to note that Linehan doesn’t just practice tough love with her patients; she also tells them she knows they are hurting and doing the best they can. She emphasizes that she believes in them even though many therapists have tossed them aside. “Clients cannot fail,” she says. “But both treatment and a therapist can fail.” Both compassion and irreverence, both validation and tough love–these are the dialectics at the heart of Linehan’s approach.

One criticism of Linehan’s Zen-derived method is that for some patients, it seems too foreign, too removed from Western experience. Linehan knows her therapy works for most people, but that doesn’t mean she’s unwilling to list its faults. “It takes too long. There are too many components. It takes too much training for therapists,” she says.

Such shortcomings have not dissuaded other therapists from learning Linehan’s techniques. Some 10,000 of them have been trained in dialectical behavior therapy, and Linehan, to her dismay, has become something of a cult figure. “Cults in psychology hurt patients,” she says. “People should try whatever works, not my therapy because it has my name on it.”

Lily, for one, is glad that it’s the therapy she did try. One of her favorite films used to be James Mangold’s 1999 adaptation of Girl, Interrupted, in which Winona Ryder plays a real-life borderline author. When Ryder’s character learns she has received a diagnosis of borderline personality disorder, she indignantly asks, “Borderline between what and what?” It’s a question that weighed on Lily for years and one that many of us may start asking if borderline diagnoses continue to increase. But today Lily is able to laugh about the film because she knows, finally, that the answer doesn’t really matter. The key is not defining that uncertain borderline but learning to be happy there.

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Not all interactions are appropriate for cheerleading; in fact, many interactions are not. If you tell someone “you can do it” when they deeply believe that they can’t, this could lead to a mistrust of your opinion of them. In the case of dealing with an emotional person, typically, “positive mental attitude” statements are unhelpful and invalidating. Saying there’s “no need to be sad/scared/angry” for example just serves to invalidate the emotion that the other person is already feeling.

Many people think that effective cheerleading statements involve saying that one person is “proud of” the other, “believes in” the other or “loves” the other. The problem with each of these is that 1) those statements are about how YOU feel and 2) Those statements don’t necessarily foster effective behavior.

At www.dbtselfhelp.com (which is a wonderful resource that I highly recommend) the worksheet on cheerleading states that there are three types of effective cheerleading statements. Mainly, that site is for self-cheerleading, so I will try to adapt these to relationship cheerleading. The types are:

Three types of cheerleading statements:
1. Statements that provide the courage to act effectively
2. Statements that help in preparing for the situation, getting ready to be effective, to focus on what works
3. Statements that counteract myths about interpersonal behavior.

In WHINE, I suggest a tool that can help with #1, which is the tool to “Be Brave.” While a person’s inclination may be to avoid an uncomfortable situation or to behave in a conditioned or ineffective manner (because of lack of courage or self-assurance about the situation), being brave in the face of uncomfortable situations reinforces itself and serves to support type #1.

Some examples of #1 might be:
“You can do hard things.” (which is my favorite and can apply to both #1 and #2)
“Remember the time you did [whatever]. That was so brave of you in that situation.”
“I’m impressed with your courage in the face of that.”
“Yeah, that is really hard. At the same time you have faced something like that before…”

If you combine “Be Brave” with “You can do hard things,” you go a long way to being more effective, because these two concepts help counteract the idea that you are “walking on eggshells” around someone else and that your feeling that avoidance of an emotional situation is the best route to take. I believe taking on an emotional situation head-on is more effective than letting it fester – both for you and for the person with BPD.

In type #2, the focus should be on effective behavior for a future task. #2 is quite important and, in some ways, is the most difficult type to effectively navigate. Because of conditioned ineffective behavior and the sway of negative emotions, a person might be tempted to repeat ineffective behavior, based on the emotions that they are feeling. A work (or school) situation is a good example of this dynamic. If someone is having a problem with their boss, they might, in anger, have the urge to quit the job or lash out at the boss (or the customers). Work situations can be especially frustrating for a highly emotional person. Work that they consider menial or “beneath them,” overbearing bosses, long periods of downtime in which a person can ruminate or become paranoid that others don’t like them, all contribute to frustration at work.

Some examples of #2 might be:
“You have every right to be angry. Still, the last time he said that sort of thing, you reacted positively. I think that worked out pretty well.”
“Bosses can be a real pain. I know when my boss gets on me; I try to do [something effective]. I’ve seen you do that in the past, so you know you’re capable.”
“You had a similar situation when [whatever] happened and you handled that well.”

In type #3, you are debunking deeply-held beliefs about interpersonal behavior. This technique can be tricky, because a person who is overcome with emotion might not be able to see the other side of the coin. In this type, you are basically reiterating that a person has the rights to their feelings and emotions and helps counteract the idea that other people might not like them just because of an emotional situation.

Some examples of #3 are:
“It’s hard when your co-workers are angry at you. I know I don’t like that either. Yet sometimes it’s about their anger more than your behavior.”
“I think you have the right to state your feelings about the situation.”
“You have every right to ask for what you want, even if you think that will annoy them.”
“I think there’s a lot of validity in how you feel, certainly as much as how they feel.”
“Sometimes I think you have to stand up for your rights. I’m impressed when you have done that in the past.”
“Sometimes people get annoyed when you don’t do exactly what they want. However, you have rights and feelings too.”

Related posts:

1. Using DBT Skills to Help the Relationship
2. PUVAS and DBT Skills
3. Boundaries and their effective use

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When Hope is Not Enough
Get the Non-BPD book that is designed for
staying and working on the relationship

Related posts:

1. Validation and DBT
2. Emotional Independence and the Types of Love
3. What Diane Schuler’s story can tell us about emotional honesty and acceptance

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I AM MAD Communication Skill

Last week I wrote an email to someone explaining the value of validation and the stance one “should” adopt when using validation. Emotional validation is valuable when someone is experiencing an “emotionally dysregulated moment” (which in the ATSTP group we call “EDM”). These moments are common when someone has BPD or ERD.

Anyway, I posted an anonymous version of my message to the group and one of my group members (thanks Tides!) edited it into what she called the “I-AM-MAD” communication tool. I will post the content of the tool below and upload the PDF…. Oh, quickly… The formatting came out a little wonky. And “IAAHF” means “it’s all about his/her feelings” which is a concept in WHINE.

I-AM-MAD

1. Identify the emotions.

It’s best to do this with “feeling” words, like “look”, “see”, or “sound”, rather than “know” or “understand”.

Examples: “I see that you are frustrated.”

“You sound aggravated.”

“You look really upset.”

2. Ask a validating question.

This encourages them to share their feelings about whatever triggered them. Do not use “what’s wrong?” If you use “what’s wrong?” they will hear “what’s wrong with YOU?” Also, don’t assume you did anything wrong. Remember, IAAHF (It’s All About His/Her Feelings).

Examples: “What happened?” (most effective because it is open-ended, requires more than yes/no answer)

“Did something go wrong at work [school] today?”

“Want to talk about it?”

3. Make a validating statement about their emotion.

Validate the feelings expressed in step 2. This helps reinforce that it is natural and valid to feel what they are feeling in the situation. Again, remember IAAHF. Don’t defend against blaming or projecting. And don’t apologize at this point, even if you are guilty. (Apologies for things you are actually guilty of can come later… after they have returned to their emotional baseline.)

Examples: “Wow, it must have made you feel awful to have done poorly on that test.”

“Yes, it is frustrating when it seems that someone is taking advantage of you.”

“Yeah, that’s really disappointing.”

4. Make a normalizing statement about their emotion.

By relating the situation as common to all people or “normal” for them, this helps alleviate their stress about feeling judged or unaccepted.

Examples: “I think anyone would feel angry if they had to do that”

“I would feel the same way if that happened to me.”

“I can see why you feel that way.”

5. Analyze the consequences of their behavior.

By examining the consequences of both negative and positive behavior with the person, you help them to separate their emotional reaction from their behavior. The behavior may need to be changed, but the emotions are natural and should not be punished for.

Examples: “When you don’t ask questions about something that confuses you, I don’t realize that you are struggling, so I can’t help you. When you do ask questions though, I can either give you the information you need to solve the problem yourself or we can work together to figure out the best solution to the problem.

“When you yell at me, I feel disrespected and become upset too. However, when you speak calmly to me, I know you have respect for me, so I am able to listen to you better.”

“When you refuse to talk to me, I don’t know what else to do except give you space. When something is bothering you, it’s best to be open and honest with me so I know what’s going on and don’t make the wrong assumptions about what you need.

6. Don’t solve the problem for them.

Solving one’s own problems helps to build self-confidence. Empower the person by getting them to come up with a solution themselves. When given the opportunity in a non-judgmental setting, most people will find that they can come up with solutions to their problems. You can guide them through this process by asking helpful questions to ascertain what they need or want.

Examples: “How would you like to handle this?”

“What would help you make a better choice next time?”

“Is there anything I can do to help?”

(Note: Sometimes you have to go back and forth to help them find the most effective solution. They may say, “I don’t know” or “I don’t care.” This can be tough. Go back to step one to deal with any additional emotions that become apparent.)

I AM MAD PDF Version

Related posts:

1. SET Communication Skills and BPD
2. Cheerleading as an effective relationship skill
3. I-AM-MAD Skill makes it to Partners in Wellness Blog

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Well, my experience has been that marital counseling doesn’t really help
much when a BP is involved, because counselors really don’t understand the
dynamics of BPD.  While their goal is to promote better communication
between partners, they tend to focus on resolving the complaints.
Of course, BPs have LOTS of complaints (which
really are not the problem), so nons just end up feeling attacked… even by
the counselor at times.  When counselors do this, it tends to validate the
BPs feeling that their nons really are the problem.  It sometimes even
leaves the non feeling like he/she really is the problem.

I suspect you may want to continue this “counseling” approach, since it is
SOMETHING your BP has agreed to.  If so, my suggestion would be for you to
be as honest as possible with the counselor about YOUR FEELINGS.  Don’t
waste your time (and money) defending against your BPs accusations and don’t
point fingers back.  (This only makes you look bad to the counselor… like
you never let your BP talk or express himself… ha!, I know!)  Simply ASK
for advice on how to communicate better (since that is the goal of the
counselor to get you communicating with one another.)  Try the suggestion a
few times, and if it doesn’t work, then you can come back the following
session and express your disappointment and confusion about why it isn’t
working.  Eventually, after enough times of doing this, your counselor will
(hopefully) recognize that he/she cannot help you and will refer you to
someone more qualified (like a DBT specialist, if your lucky enough to have
one of those in your area.)

My only comment on this statement – which is wonderful IMO – is the idea that the complaints are “not really the problem.” If those complaints are not really the problem, what is? Well, I believe it is that the BP FEELS bad (negative emotions) and judged (so they judge back). I think if someone who DOES understand the dynamics of BPD works with a couple, the therapist can hopefully deal with the real issue: the painful emotions.

No related posts.

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Rainbow for Hope

In Oct 2007, I was at my wits end and ready to walk away from my raging husband after 4 months of marriage. He had been in therapy for over a year, yet still raging almost daily, beating himself half to death, lying to me about the most ridiculous stuff and destroying our home. All this chaos was causing my 2 teenagers to alienate me out of fear of him. As a Project Manager, I had participated in many classes and seminars on effective communication in the workplace through my job, but it seemed that nothing I tried worked with my husband… most of the time, it only seemed to make things worse. I truly felt helpless. I knew I loved him and I fully understood the complexity of this disorder and how my own (natural) reactions to his behavior contributed to the dynamics of our relationship, but I also realized I didn’t have what it took to provide the healthy and supportive home environment I knew he needed in order to heal from his past.

At the urging of my own therapist (whom I had retained for my own sanity), I decided to join an online support group for loved ones of people who suffered from Borderline Personality Disorder. I found a group called Anything To Stop The Pain (ATSTP). As time went by (with me lurking in the group), I realized that the founder of the group (Ben Dobbs, the author of this book) was promoting a very similar approach with group members that my husband’s therapist was using with him during their sessions. I got more involved with the group and learned how to use this approach, at home, with my husband (and, consequently, with other family members also.)

Ten months later, I’m happy to say that my husband’s raging has reduced to, maybe, once every few months and the intensity is nothing like before — despite the fact that he hasn’t been attending therapy on as regular a basis as I had understood was necessary for improving his emotional health. We are finally enjoying the closeness we both wanted in our marriage. My house feels and looks like a home again (rather than a battlefield) and my kids are back to spending more time with us again. He is slowly changing his maladaptive coping methods to more healthy ones… and working out his past by using this same approach with his own family. It feels good to get genuine apologies (versus “FINE! IT’S ALL MY FAULT!!”) and ‘thank you’s’ (versus daily blaming and projecting) for my patience and understanding.

I have read many books on this disorder. I found ‘Stop Walking on Eggshells’ to be quite validating to my feelings as a loved one (a NON) to a borderline. In that sense, it was very healing for me, personally, but it didn’t help me improve my relationship. ‘I Hate You, Don’t Leave Me’, ‘Sometimes I Act Crazy’ and ‘Get Me Out of Here’ were beneficial to me in that they helped remind me that my husband’s erratic behaviors really were not about me at all. From my personal experience, this book is the next progressive step for those who recognize that they cannot FIX their borderline loved one, yet still have a smidgen of hope that there is a way to find peace and harmony with this person IN their life.

I have read the book and it amazes me how so much valuable information can be condensed into such a quick and easy read. It is written in a style that most anyone can understand and it is filled with useful examples on how to use this approach in everyday situations we all face with highly emotional people. Used correctly, the information provided in this book can help you improve your relationship right now… not next year, not next month, TODAY.

I highly recommend it for anyone who truly wants to learn how to effectively communicate with someone (spouse, parent, child, friend, co-worker or boss) who is struggling with an emotional regulation disorder. You don’t have to give up your rights or go without getting your needs met anymore to stay in this relationship! And the nice thing is, it doesn’t require therapy or counseling to be successful. All you need is an open mind and a desire to try something different… something that works!

WHINE (When Hope is Not Enough) is available at Amazon and other Internet retailers.

Related posts:

1. Why Hope is Not Enough
2. Holy Cow! An Amazon Review for When Hope is Not Enough
3. New Review of When Hope is Not Enough

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I decided to write this post because I have seen many non-BPs frustrated over the fact that when they try to use the tools in certain books with their BP, the tools seem to cause more rage and emotional dysregulation. The two “tools” that I have found that cause the most problems are boundaries and detachment. I’ve already written a LOT about boundaries and where my view of boundaries diverges with some of the other “Non-BP authors.” Today, I’d like to turn to detachment.

“Stop Walking on Eggshells” recommends on page 98, that a Non-BP “detach with love” from a BP and BPD-like behavior. This concept was “borrowed” from Al-Anon as it is made clear in SWOE. I think that “detaching” (whether with or without love) works in some situations and blows up in the Non’s face in others.

What are the differences? In WHINE, I explain that the “engine” of BPD is emotional dysregulation (which is the opposite of regulation). A person with BPD will heat up more quickly and cool down more slowly than someone without the characteristic of emotional dysregulation. One study that I cite in WHINE deals with “neutral” reactions to someone who is dysregulated. The basic evolution of an (as “Tides” calls it on her blog) Emotionally Dysregulated Moment (or EDM) is trigger -> cognition -> emotion -> expression -> behavior. Emotions can spur on other emotions. Anger is IMO the most powerful of the basic emotions and it is easily triggered, especially when a person with BPD is feeling judged. Ok, now back to detachment. On page 39 of WHINE, I explain that:

One of the most interesting findings of a study in which scientists used functional magnetic resonance imagining (fMRI) to measure the emotional reaction (limbic system activation) of patients with BPD is that these people react to neutral faces in the same manner they react to angry faces. In essence, when shown a picture of a person with a neutral expression, people with BPD showed amygdala activation as if the picture was one of a person with an angry expression. These people expect judgment and anger in others towards them and react physically and mentally to neutral situations as if they are threatening. They are likely to find “meaning” that is judgmental or threatening in an event that others would see as meaningless. A member of my list compared this reactivity to neutral faces to neutral feedback on eBay. As a buyer on eBay, you don’t give neutral feedback to a seller when everything about the sale is perfect. You give [neutral] feedback when something is wrong. A person with BPD will interpret a neutral face as “something wrong.”

Emotional detachment from an EDM will trigger more emotional dysregulation within a person with BPD. Instead, an EDM is a time to engage someone with BPD and engage them on an emotional level. Otherwise, if you detach emotionally from the situation, the BP will interpret your “calmness” and detachment as judgment or criticism. Additionally, they will likely consider you untrustworthy to validate their emotional states. What I mean by this is that if they are feeling so much emotional pain that they are dysregulated what they are really trying to do (regardless of the content what they say) is to communicate that pain to you. If they’re “dying in pain” and you’re detaching and calm, they feel they can’t come to you with the problem. On page 95-96 of WHINE, I describe this situation as follows:

The purpose of someone coming to you in an emotionally dysregulated (or close to one) state is to communicate the emotions that she feels. She may have difficulty expressing these emotions and may use other means for expressing them such as blame, sobbing, cutting, raging or other behaviors that are difficult for you to deal with. The underlying point however is one of communication – she is trying to tell you something, but she doesn’t have the language for it. Therefore, if you respond to an emotional communication in either an invalidating fashion (using one of the many, many invalidating phrases above) or in a way that doesn’t match the emotional distress, the BP will feel unable to communicate. She will think “I’m going off the deep end here and you are so calm! You don’t understand anything! You’ll never understand me!”, and not trust you. The tenor of your voice is more effective if you express your emotional identification with emotion in your voice as well, but with slightly less emotion than the BP is feeling. In other words, express distress in the identification, but less emotion than if you are actually in distress yourself.

Related posts:

1. Tools and the Borderline
2. BPD: Emotional Dysregulation and MRI/fMRI

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helping someone with bpd
bpd crazymaking
levels of validation
“self-destructive behavior” friend
how to get bpd to go to psychiatrist
bpd communication
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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
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when she clearly has a personality disorder
bpd google groups
how to deal with a bpd
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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.

Related posts:

1. A Note about BPD and Boundaries And SWOE
2. Why did I bother to write a book?
3. Book Review of WHINE from “Tides of Crazy Love”

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Validation is Walking Along With Someone

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.

When Hope is Not Enough
Get the Non-BPD book that is designed for
staying and working on the relationship

Related posts:

1. Why Hope is Not Enough
2. WHINE and DBT Skills Compared
3. Ask Bon: How do I balance validating somebody’s feelings with protecting myself or my children from emotional abuse?

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Another quick review from my group…

Disclaimer: I just downloaded WHINE. I have not read the entire book.

However, the section on validation is excellent, excellent, excellent!
For some reason, I’m always deeply impressed when someone actually
understands this concept. Not only is validation explained in a
complete way but sample conversations are also given with suggested
validating language.

This section alone needs to be required reading for any loved ones of
persons diagnosed with BPD.

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1. Why did I bother to write a book?
2. Holiday Discount of Publisher’s version of When Hope is Not Enough
3. A new book from Bon

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Holding on to Hope

The author of this book, Bon Dobbs, is the founding leader of my online google support group – ATSPGroup. His wife has been diagnosed with BPD and his daughter struggles with emotional dysregulation similar to that of BPD.

When I found this group, I had just come away from the Welcome To Oz group known as WTO-Staying. I was tremendously discouraged (support-wise), because the folks there just didn’t seem to “get” this disorder… from my perspective as a suffer and as a non to my BPDH. There were a few informed folks who were seriously trying to explain the underlying fears and irrational thoughts behind BPD, but most of the nons couldn’t seem to get past their own hurts, fears and thoughts to learn the type of communication that is most effective with a BP. I knew immediately from reading Bon’s supportive responses to group members that he and I shared many of the same thoughts and opinions about the disorder… and about how non’s tend to become affected negatively by it over time, which inevitably contributes to the further erosion of the relationship.

“When Hope Is Note Enough” (WHINE) explains all this, and goes on to offer excellent and insightful tips on how to support the BP in your life without condoning the inapproprate behavior (projecting, blaming, intense anger, impulsiveness, etc.) or agreeing with the irrational thoughts you oftentimes find yourself subjected to by the BP in your life. It’s a very validating resource, especially for nons, that teaches you how to provide a validating environment in which your BP can finally heal without sacrificing your own values, beliefs and feelings.

I’ve been using the approach in this book (naturally… thanks to my own previous therapy) since the day I found out about hubby’s MH issues. It was challenging at first, as I had to view what I knew from a different perspective, but over the past 8 months, we have really begun to see an improvement in our relationship and in my hubby’s healing process. (I think my life updates in this blog will be a testament to that… once I get them all posted anyway, lol!) I was glad to see Bon write this book. Many times, I had considered doing the same, but unfortunately, I’m not organized enough in my mind to take on such a project… at least not at this point in my life. He did an superb job bringing it all together in a way readers can easily follow and implement! I highly recommend this book, not just to nons of BPs, but to anyone who is caught up in a high conflict relationship with someone they love.

Here is a nice book review I found of my book When Hope is Not Enough. I “know” this reviewer through my email list ATSTP. She is incredibly wise and knowledgeable about BPD and being a Non-BP. She should write her own book IMO.

Thanks! Hope you enjoy and can use the book (of course, sometimes “hope” is not enough – haha).

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1. Why did I bother to write a book?
2. WHINE sells over 100 copies in a month
3. Holy Cow! An Amazon Review for When Hope is Not Enough

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Boundaries… I’ve posted about boundaries many times before. I think boundaries are one of the most misunderstood concepts in the non-BP/BP relationship. While it is difficult to be a parent of anyone (much less someone with BPD) and provide no guidance to your child – I mean, it is natural to want to provide some advice and guidance to children – boundaries in the sense that many people on the Internet understand them are not effective in an emotional situation. Now, WAIT! Actually boundaries ARE effective… OK, how can I say they aren’t effective and are effective at the same time?

The major problem with boundaries is that most of the Nons out there believe that boundaries are something to “control” or “moderate” their BP’s behavior. This concept is absolutely ineffective and untrue. Boundaries created for other people (whether they have BPD or not) are not effective – especially when the other person has a general fear of judgment like those with BPD. Those types of boundaries are not really boundaries at all – they are RULES for the behavior of another person. They will not work in emotional situations.

Boundaries that DO work are those you set for yourself with respect to other people’s behavior. In other words, boundaries that guide your OWN behavior are effective ones. If you say to someone, “I will not go to a restaurant with you if you are drunk” (for example), what you are really doing is setting a boundary that limits/affects your OWN behavior given certain conditions. That type of boundary is effective because you, as a non-BP, have complete control over it. You can choose NOT to do something given a set of conditions.

I would encourage you to examine what you ”boundaries” you have in place and see if they are rules for other people’s behaviors or if they are actual personal boundaries that manage your own behavior and reactions. If they are the former, I expect you will end up being frustrated quickly. If they are the later, then you can find some peace when they are applied to a given situation. This statement isn’t meant to imply that someone with BPD will automatically accept your application of personal boundaries (to yourself). No, they might rage at you or try and convince you to do otherwise (i.e. go to the restaurant even if they are drunk), but you are the master of your own behavior and you can always be firm and say, “No.”

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3. Tough Love is not an effective approach to BPD

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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).

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Today, I’d like to take on the idea of “hoovering.” A full definition of hoovering can be found here (BTW, that is a lousy website for BPD information IMO). You can read the definition and forget it. Hoovering doesn’t exist. As a Non, you might feel that it exists, but in reality it doesn’t exist. I know I’m bound to get angry emails or comments from angry Nons that are convinced that they have been hoovered. “It happened just last night!” I thought I had been hoovered, way back on November 2, 2005. Here’s the text of a message I posted on WTO about my wife’s “hoovering”:

FROM ANOTHER LIST MEMBER: [I have never written before because I was too ashamed to admit that I had allowed myself and my children to fall into such a bizarre and screwed up situation, nor am I sure that anyone would believe what we have actually lived through.]

MY RESPONSE:
Yes, no joke. Really none.

I have felt this way for YEARS. I have refused to open up to anyone. I was embarrassed and sick about the behaviors. It wasn’t until last month at this time – when my wife exhibited “cutting” behavior – that I realized that she’d finally gone and done something I didn’t have an inkling about why. I always understood the depression (it’s in my family in spades) – I always understood the rage (well, sort of, Nons are angry too) – But I never felt the compulsion to cut myself.

That = research. Research = finding out about the real story behind BPD. That = finding WTO. This forum is just about the only thing that keeps me sane. Knowing that I’m not alone, that’s priceless.

You are not alone. Embarrassed, sure. Hiding the secret, yes.

My wife is currently (well, if she wasn’t passed out from taking too many sleep pills) in a BP moment – she just hoovered in the most primal way – trying to push my buttons, but me not allowing them to be pushed. That = rage on her part (and I have said she isn’t a rager – she only rages when I don’t comply). Now I’m 3 rooms away (we have a fairly large house) and I can hear her snoring away as I write this. Point is – embarrassed or not – the nons all feel your pain.

God, I knew nothing about BPD back then. I was so ignorant. I actually said that finding WTO was “finding the real story behind BPD.” Stupid me. I’ve learned so much more about BPD since then and realized that WTO was poisonous toward maintaining a relationship with a BP. I just felt so validated there, because I found other people that had experienced some of the same things I felt I had experienced. I had an explanation and some (virtual) shoulders to cry on. Unfortunately, that is all they do there – bitch about there (usually) “BPxh” (who most likely doesn’t have BPD and is just an a-hole) and cry on each other shoulders. I suppose there’s room in the (virtual) world for that. Must be, considering they have 4000+ members.

Ok, back to hoovering. Why do I say it doesn’t exist? I say it doesn’t exist because a person with BPD has dysregulated emotions. When they feel kind, happy, desperate, anxious, sad, angry, etc. they actually FEEL that way. The feeling is overpowering. It is not a “designed” situation. It is not manipulation – which is exactly what hoovering implies. A person with BPD is too “in the moment” of their dysregulated emotions to plan ahead of time when to hoover. Granted, this action may be born out of a fear of abandonment. However, the feeling is real and not prearranged.

Well, then you might ask me: What does this person (with BPD) actually believe about me? Are they telling the truth when they rage at me and tell me they hate me? Are they telling the truth when they “hoover” me into sex (or something else)? My answer: they are telling the truth in both situations. The truth is what they feel at any given time. It is not about you. It is about their feelings and their inability to self-soothe. I have an acronym for this in my book: IAAHF (It’s all about his/her feelings). Once you understand that, you are moving a long way toward the path of healing.

When Hope is Not Enough
Get the Non-BPD book that is designed for
staying and working on the relationship

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1. The Myth of the High-Functioning Borderline
2. Net BPD Myth Debunking from “Tides…”
3. More on Hoovering

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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 Hope 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.

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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.

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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).

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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

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ABC News Report of Suicide Story

I decided to use this report to point out something important about this story. What her parents have gone through in this case is monstrously painful and I don’t, by any means, take up this tragedy to criticize her mother. I can only imagine the amount of pain and anguish her mother and father must be going through. I know if one of my children did this I’d be beside myself in grief and loss.

The reason I bring it up is because of this quote from her mother about the details of the incident:

Megan was distraught. Tina, angry about the nasty online exchanges, insisted that Megan log off the computer.

“Megan got upset with me and yelled — not yelled, but was crying and said ‘You’re supposed to be my Mom and you’re supposed to be on my side,’ and then took off running upstairs,” said Tina.

Twenty minutes later, Tina went to check on her daughter and made a horrible discovery. “I went upstairs and opened the door and saw her hanging in the closet,” she said. “And I screamed and ran over and tried picking her up.”

The key to this interchange is that Megan was distraught. Her mother could see that plainly. I find it unfortunate that her mother apparently had not be trained in validation and emotional distress skills. If her mother HAD been so trained, I suspect she might have approached Megan differently. When someone is emotionally upset and dysregulated, especially in as much pain as Megan obviously was at the time, the best approach is not criticism, but validation.

Like I said, I don’t think the mother’s (Tina’s) reaction is unusual, nor am I saying that a different response might have prevented her suicide. However, when someone is THAT emotional and “distraught” as her mother indicated, the most effective response is validation of the emotions (which is not agreement with behavior). Based on her response to her mother I see certain things: 1) She did not yell, she cried… that is sadness, not anger in her and 2) She took the mother’s response as judgmental and critical of her, at a time when she was emotionally vulnerable and 3) She felt attacked and without comfort (the “not on my side” comment). Again, before I get angry emails defending her mother, it should be stated that her mother didn’t CAUSE the original problem – that was caused by Megan’s own emotional reactions to the “mean” messages. The messages themselves (since we don’t have the full text of them) could have been vicious and nasty, but, even if they were, Megan’s REACTION to the messages – her emotional reaction – was what was at issue. By not being validating of Megan’s emotional reaction, her mother (inadvertently for certain) invalidated her child’s emotional reaction. Emotional invalidation causes despondency and shame.

I wonder what would have been Megan’s reaction had her mother validated her emotions by saying FIRST: “Wow, Megan you look so sad, what happened?” And then after finding out, she had said, “I can see how these mean messages would make you feel so sad. I think anyone who received these would feel both sad and angry. I can also see why you responded with such anger. Those messages would make me mad too.” Finally, if she’d left the “teaching/scolding” moment about the language in the messages until later – who knows what would have happened?

My point is that it is extremely important that parents, partners and friends of highly emotional people (and in highly emotionally-charged situations) learn some emotional validation skills. Again, I don’t know if it would or could have prevented Megan’s death, but if they come at the right moment, these skills can help cool down the emotions so that a child has the opportunity to make a different (and hopefully, more effective) decision.

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Pay attention
Understand fully
Validate emotions
Assert yourself
Shift responsibility where it belongs

Paying attention to what is being helps us avoid making assumptions.

Understanding what someone is trying to communicate may require seeking clarification so we don’t make assumptions.

Validating the emotional statements of the other person will pave the way for further smooth communications.

Asserting yourself is a form of setting boundaries and is a very important piece of the healthy communication process.

When Hope is Not Enough
Get the Non-BPD book that is designed for
staying and working on the relationship

Basically, it is similiar to a combination of DEAR MAN and the GIVE skills from DBT. DEAR MAN is extremely helpful for have a conversation with someone who is emotional and to prevent from engaging your emotions yourself. DEAR MAN is:

DEAR (what to do):

Describe – describe the situation WITHOUT being judgmental. Just say what happened without making value judgments of the meaning of what happened or the intentions of the other person.

Express – express how you feel about it with an emotional word (such as sad, glad, mad or scared). Do not judge with this statement either.

Assert – assert what you’d like to happen in the future in this situation – what will not trigger the emotion you expressed.

Reinforce – reinforce means to back up the other person’s statement that moves toward what you wish. If the person says, “I’m sorry. I will try and not do that in the future.” You say, “I would really appreciate that. I don’t like feeling [whatever]. That would make me much happier.”

MAN (how to do it):

Mindfully – this is the “pay attention” part. You should be totally in the conversation and listen to the responses. However, you should ignore statements that are not addressing the issue at hand. You can also repeat your points agina until the other person fully understands what you are saying.

Appear Confident – even if you don’t feel confident discussing the point, you should appear confident. This prevents the other person from attacking or playing on your vulnerabilities.

Negiotiate – in cases where a “middle ground” makes sense, being willing to negiotiate is helpful because no one comes out the total “winner” or “loser”.

The GIVE skills are this:

Be Gentle – don’t attack.

Act Interested – listen carefully to what the other person says and the needs expressed.

Validate – use emotionally validation skills to “soften the blow”.

Easy Manner – use an easy manner and do not dominate the conversation.

Related posts:

1. SET Communication Skills and BPD
2. Using DBT Skills to Help the Relationship
3. A Response with DBT Skills

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Validation is not about agreement or winning or losing. Validation is about finding the truth in other people’s FEELINGS, not their decisions or behavior. The other person’s feelings are the key issue at heart here, not the behavior. If you validate properly you can attain a communication level about feelings, without giving into behavior or threats or without losing. Remember: validation does not mean agreement and does not condone behavior. Its function is to connect with another person on an emotional level.

When Hope is Not Enough
Get the Non-BPD book that is designed for
staying and working on the relationship

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1. Validation and DBT
2. Helping someone with BPD
3. More on Validation and DBT

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2. Emotional Tolerance and BPD
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1) GIVE
2) FAST
3) DEAR MAN

GIVE is used to “keep the relationship” and can be used when OTHER people have strong feelings. The GIVE skills are:

Gentle (Be)
Interested (Act)
Validate
Easy Manner (Use an)

FAST is used to keep you self-respect. THe FAST skills are:

Fair (be)
Apologies (no)
Stick to values
Truthful (be)

Last, DEAR MAN is used to get what you want (including change in the other person). They are:

What to do:
Describe
Express
Assert
Reinforce – this is the IMPORTANT part about changing behavior. You will notice in SWOE, this Reinforce, I believe, is replaced with Reiterate (I don’t have a copy of SWOE handy to check).

How to do it (these are left out of SWOE):
Mindfully – stay on point, you can ignore or use “broken record”
Appear Confident
Negotiate (be willing to)

So, you can see here validation is only for one thing – and it is not change. It is for opening the communication lines – to know that you hear and that you’re listening.

http://www.dbtselfhelp.com/html/ie_handout_9.html

Related posts:

1. A Note about BPD and Boundaries And SWOE
2. SET Communication Skills and BPD
3. A Response with DBT Skills

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Actually, these communication methods work with anyone, anytime.
They will work in normal communication and during “OZ” – and I am
trying to always be in this mode. It is difficult and takes a ton of
effort, because it is against my normal way or interacting. At first
it will seem really awkward, but, with practice, it becomes easier
and more natural.

I used every one of the methods with my BP-ish (In other words,
emotionally sensitve and ashamed) pre-teen daughter last night.

Here’s the situation (I’ve compressed it slightly because it was
longer than this):

I come home from work and she’s all smiles. Then, she asks me where
I was late the night before (I was at a training group) and I
say “Uh, um (trying to think of the right words) … I was at a
course that I take…”

She says, “You’re lying.” (Because of the “uhs”).

I say, “Why do you say that?”

She says “Because you said ‘um’…”

So, I say “You seem sad and angry about people lying to you. Do you
think that someone lied to you today?” (Acknowledgement, I
recognized her feelings and identified them, not based on what she
said, but how she said it) See, it was not about me or the current
situation.

She says, “When people lie they say ‘uh’ a lot and people lie to me
all the time.”

I say: “Boy, that must make you feel really angry and sad to feel
that people lie to you. (Validation of her feeling) If I thought my
friends were lying to me, I’d feel pretty angry and sad too. Anyone
would feel angry and sad if they felt they couldn’t trust their
friends (Normalization, meaning, it is normal to feel this way when
you perceive that situation).”

[OK, quick aside - you will notice I didn't try to 1) fix it or 2)
deny how she feels. It could be that her friends are not lying to
her at all. In the past, I might have said - "I don't think their
lying to you, you must be wrong..." (invalidating). But that is
poison, because she actually FEELS like they are lying, whether they
are or not. Also, I can't fix her feelings. So, trying to fix it
("I'll have to talk to these kids and ...") is not the answer -
because it is about her FEELINGS, not about what "really" happened.]

She says, “Yeah, I guess so, but it still makes me really angry.”

I say, “Yes, I can see you’re really angry. Maybe you can think of
something to do when you think people are lying to you.”
(redirection, I put the responsibility for feeling back on her and
suggest she come up with a course of action)

So she says, “I guess I could just ignore them.”

And I say, “I guess you could, are there any other things you could
do?”

So, we got no real conclusion. But what this conversation kicked off
was a very open, sharing conversation with her right before bed in
which she shared with me her shame about being lied to (that is,
that she thinks that other people think she is a bad person and that
is why they lie) and many of her feelings (almost all of them
negative BTW). In that conversation, I continued to use those
techniques to acknowledge what she said and validate, normalize and
redirect.

Usually she will just say “I don’t want to talk about it”. So,
by doing this I got my foot in the trust door. BPs don’t trust you
enough to reveal their feelings. Why? Two reasons: 1) the shame is
too great to tell the whole truth, because they think that you’ll
think they are a “bad” person and 2) You have never listened in
the “right” way before, so they don’t feel heard at all. Has your BP
every said “No one understands me” or “You don’t understand me”?
They don’t feel heard/connected to you (or anyone).

Related posts:

1. Emotional Literacy
2. BPD, lying and the nature of truth
3. Emotional Glasses for Liars and Tantrums

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When borderline personality disorder makes communication difficult, following the SET method may help. SET stands for support, empathy and truth. It was developed by Jerold J. Kreisman, MD and Hal Straus, the authors of I Hate You, Don’t Leave Me and Sometimes I Act Crazy.

Why SET Works

The symptoms of borderline personality disorder (BPD) can result in the BP asking for conflicting things or being unable to recognize that the another person cares for them, especially during times of stress. A person with BP may be unable to experience conflicting feelings at the same time, and tends to see things in black and white with very little shades of gray.

As a result, the BP experiences her current feelings as being her persistent feelings.

SET allows friends and loved ones of people with BP to honestly and address the person’s demands, assertions, or feelings, while still maintaining appropriate boundaries. It is important to do these steps in order, as each step builds upon the other.

Support

Support refers to an initial statement which indicates the loved one supports the person with borderline personality. It is a statement that begins with “I” and demonstrates concern and a desire to help. It can be anything that establishes a foundation for the relationship or interaction: “I want to try to help you feel better,” “I care about you,” or “I am worried about how you are feeling.”

The support statement is meant to reassure the BP that the relationship is a safe one, and that her needs matter even during this difficult moment.

Empathy

Empathy refers to communicating that the loved one understands what the BP is feeling, and focuses on “you.” It is not a conveyance of pity or sympathy, but instead a true awareness and validation of the feelings of the BP: “I see you are angry, and I understand how you can get mad at me,” “How frustrating this must be for you.”

It is important not to tell the BP how she is feeling, but instead put her demonstrated feelings into words. The goal is to convey a clear understanding of the uncomfortable feelings she is having and that they are OK to have, thus validating her feelings. Without such a statement of empathy, the BP may feel that her feelings are not understood. It is important to use feeling words, as in the examples above.

Truth

Truth refers to a realistic and honest assessment of the situation and the BPs role in solving the problem. It is an objective statement that focuses on the “it” — not on the subjective experience of the BP or Non-BP. Often the BP may seem to be asking, or demanding, something impossible, not taking an active role or responsibility in resolving the issue, or even presenting you with a “no-win” situation. The truth statement is meant to clearly and honestly respond to the difficult demand or behavior of the BP, while placing responsibility appropriately: “This is what I can do…,” “This is what will happen…,” “Remember when this happened before and how you felt so bad about it later.”

It is important to use the support and empathy statements first, so that the BP is better able to hearwhat you are saying, otherwise the truth statement may be experienced as little more than another, and expected, rejection creating even more defensiveness or anger.

Validation and Support Are Not Agreement

When first learning about SET, it can seem that you are being asked to agree with the BP. It important to clarify that validating feelings does not mean that you agree with them, only that you recognize that the BP is feeling them. The supportive communication described in the SET model does not mean that you are letting the BP off the hook, instead you are focusing on honest communication and ensuring that you are being heard, not just reacting to and defending against what is being said.

Related posts:

1. Using DBT Skills to Help the Relationship
2. A Response with DBT Skills
3. PUVAS and DBT Skills

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A quote:

“Invalidation is to reject, ignore, mock, tease, judge, or diminish
someone’s feelings. Constant invalidation may be one of the most
significant reasons a person with high innate emotional intelligence
suffers from unmet emotional needs later in life.(1) A sensitive child
who is repeatedly invalidated becomes confused and begins to distrust
his own emotions. He fails to develop confidence in and healthy use of
his emotional brain– one of nature’s most basic survival tools. To
adapt to this unhealthy and dysfunctional environment, the working
relationship between his thoughts and feelings becomes twisted. His
emotional responses, emotional management, and emotional development
will likely be seriously, and perhaps permanently, impaired. The
emotional processes which worked for him as a child may begin to work
against him as an adult. In fact, one defintion of the so-
called “borderline personality disorder” is “the normal response of a
sensitive person to an invalidating environment” (2)  ”

And another quote:

“Telling a person she shouldn’t feel the way she does feel is akin to
telling water it shouldn’t be wet, grass it shouldn’t be green, or
rocks they shouldn’t be hard. Each persons’s feelings are real.
Whether we like or understand someone’s feelings, they are still real.
Rejecting feelings is rejecting reality; it is to fight nature and may
be called a crime against nature, “psychological murder”, or “soul
murder.” Considering that trying to fight feelings, rather than accept
them, is trying to fight all of nature, you can see why it is so
frustrating, draining and futile. A good guideline is:

First accept the feelings, then address the behavior.

One the great leaders in education, Haim Ginott, said this:

Primum non nocere- First do no harm. Do not deny your teenager’s
perception. Do not argue with his experience. Do not disown his
feelings.

We regularly invalidate others because we ourselves were, and are
often invalidated, so it has become habitual. Below are a few of the
many ways we are invalidated:

We are told we shouldn’t feel the way we feel
We are dictated not to feel the way we feel
We are told we are too sensitive, too “dramatic”
We are ignored
We are judged
We are led to believe there is something wrong with us for feeling how
we feel”

Related posts:

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2. Shame and BPD
3. Blast from the Past – BPD, Shame and Self-Image

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When a person confides in you, they are not usually looking for advice
or problem-solving unless they specifically ask for it. Rather, they
are looking for validation. If you are not used to validating, here
are some suggestions. There is no greater way to set a person at ease.

Level One
Overall show interest in the other person (through verbal, nonverbal
cues), show that you are paying attention (nodding, eye contact, etc.)
Ask questions – “What then?” Give prompts – “Tell me more,” “Uh-huh.”

Level Two
Use accurate reflection – “So you’re frustrated because you son hasn’t
picked up his room.”
Summarize what the person is sharing, then ask – “Is that right?”
Take a nonjudgmental stance toward the person, be matter-of-fact, have
an “of course” attitude.
Example: “My therapist doesn’t like me.”
Validation: “You are feeling really certain she hates you.” Note that
you don’t have to actually agree with the person about their
perceptions.

Level Three
Try to “read” a person’s behavior, imagine what they could be feeling,
thinking or wishing for. It feels good when someone takes the time to
think about our life experiences. Remember to check for accuracy. It
is best to not make assumptions.

Level Four
Validate the person’s behavior in terms of causes like past events
present events even when it may be triggered based on dysfunctional
association.
*Validate feelings like, “Since your new boss reminds you of your last
one, I can see why you’d be scared to meet with her,” or “Since you
have had panic attacks on the bus, you’re scared to ride one now.”

Level Five
Communicate that the person’s behavior is reasonable, meaningful,
effective.
*Validate feelings like, “It seems very normal to be nervous before a
job interview – that sure makes sense to me,” or “It sounds like you
were very clear and direct with your doctor.”

Level Six
Treat the person as valid – not patronizing or condescending.
Recognize the person as they are with strengths and limitations.
Give the person equal status, equal respect.
Be genuine with the person about your reactions to them and about
yourself.
Believe in the other person while seeing their struggles and pain.

All of these levels of validation are very important skills for
building and maintaining relationships with others.

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2. More on Validation and DBT
3. Validation versus Agreement

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BPD can be frustrating

UPDATE 10/2008:  This post is quite old… but it still applies. However, if you want to know HOW to do some of the things I mention here, I have recently published the I-AM-MAD communication skill, which distills one of the main skills that I present in my book, When Hope is Not Enough.

Hi all. I have been monitoring the “non” email lists and have found a common idea that I believe is a misconception about borderlines.

A taste of this idea can be seen in this paraphrased comment: ”When will my BP be willing to take responsibility for his/her actions? When will he/she try and fix the harm he/she has done to me and the kids? When will they finally admit they are WRONG?”

This attitude is common among “nons.” What it represents is anger and sadness on the part of the non and a desire for the borderline to behave in a “normal” way.

Unfortunately, the borderline will not behave in a “normal” way until the source of the behaviors are either accepted or changed. This site (and many others about Borderline Personality Disorder) posits that borderlines behave in the way that they do because they are in pain. This pain is deep and emotional and is characterized by shame. They do not feel guilty for what they do. No, they feel shameful about who they are. They believe that they are bad/wrong people. Why do so many kill themselves? To stop the pain.

The anger that the “non” expresses comes off to the borderline as judgment of their feelings. One of the key “causes” of BPD is an invalidating environment. If they are acting in a way the “non” feels is “wrong” the expression of that feeling on the part of the non is a judgment of the BPD’s feelings. In other words, they have internalized that it is wrong to feel that way. The problem is: they feel that way anyway, whether the non believes it is wrong or not. They behave in such as way to stop the painful emotions (mainly shame) and the judgments that come from the invalidating environment.

People in the “non” support groups don’t want to hear this. Why? Because they too are in pain. They are angry and want to be told that none of this is their fault. The disorder is not their fault, but the continuation of the “invalidating environment” is. A quote from an article of DBT Family Skills Training:

Facilitated by DBT’s nonjudgmental framework, DBT-FST offers the possibility of significant emotional and behavioral improvements in the whole family system as well as for the individuals in that system. This is accomplished through:1) presenting the biosocial model to patients and family members in a non-blaming manner similar to the approach employed in psychoeducation models;2) offering support and education to family members in the form of teaching DBT skills; and3) reinforcing skillful behaviors (in particular using rehearsal and feedback) through increasing the levels of empathy and validation in the family.

(emphasis mine)

Note the “non-blaming” manner. This illustrates a new environment that the family members can help create that supports the BPD and eliminates blaming (or judging). The second two points are the ways in which things will change -teaching skills that can be used instead of the old maladaptive behaviors like cutting or starving or raging.

While many nons might be angry at me for pointing out that they need to change also, I feel that these skills provide a sense of control over the situation. The non-judgmental approach applies to the nons too – meaning, we can’t “judge” the actions of the non are “wrong”. Instead, we can see the actions of the non can be painful to the borderline.

That said – many nons don’t want to hear that they have being acting toward their borderlines in painful ways. They too don’t want the blame. But I am not saying these things to “assign blame.” No, I am saying these things to try and help empower the non with skills that help the borderline with his or her feelings. In that way, life can get better for all involved.

Learn about this and how to do it in “When Hope is Not Enough”:

When Hope is Not Enough
Get the Non-BPD book that is designed for
staying and working on the relationship

Related posts:

1. A Note about BPD and Boundaries And SWOE
2. DBT for the Family?
3. Follow the Yellow Click Road

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