Sunday, May 23, 2010

May 23rd - 30th, 2010

I hope everyone enjoyed our mid-week post, I look forward to expanding that aspect of our peer support, I would love to hear from you guys on what you thought of it.

So last Sunday we looked over our checklist for when to ask for something from another person and when not to. When to say "no" and when to say "yes". That sums up what we can do about indecision. Recall that we are going through factors that can reduce your effectiveness; 1- lack of skill, 2- worry thoughts, 3- indecision and finally 4- environment. Let's discuss our environment.

Our environment has a lot to do with how effective we can be. As I eluded to at the end of last weeks post, our partners have a major impact on our environment. What does one do if their partner seems to be making it exceedingly difficult to be effective? Can we truly train them? Can we change them?

Who wouldn't want to change something your mate does? Or perhaps a support person could do something differently that would produce a much more effective environment for you to blossom in your recovery. Wouldn't it be wonderful if we could make some of these changes for the person? It is important to note, I am not in any way implying that the behavior of others will make or break your recovery, because that simply is not possible. You make or break your own recovery.

The reality though is that actions on the part of your support persons, whether they be your mate, immediate family or whomever, can make it slow going at times. In fact, for some of us, someone we would not consider to be a support person can deeply impact your recovery. Sadly, sometimes that person is a mate. I refer mainly to the role of a partner because that is the most difficult to overcome, in that you are living with the person and you have a committed relationship that you both made; a verbal or non-verbal agreement to love and support one another through anything. When that mate behaves in a way that isn't necessarily defined as abusive or neglectful in the typical sense, yet their actions are damaging, it can be very confusing and frustrating. A deep sense of betrayal starts to seep in. Now, if this person cannot be relied upon to be a support person because of these behaviors the situation becomes even more desperate for the mate with the mental illness. Doubt is a strong, strong enemy of recovery. Since we do understand that although we may not be able to make the changes for our mate, we can affect that change in them. Which, in the end, can be more satisfying than doing the changing for them.

I would like to take a moment to briefly validate the nightmare that exists for those of us out there that are in a situation I mentioned about mates who cannot be relied upon for support. There is a lot of work that you are responsible for doing on your own anyway, and it is devastating to come to the realization that your mate cannot be relied on for support I strongly recommend something more. If you are not already doing so, I would encourage you to seek professional help to deal with that situation. Plain and simple, if your mate is not supporting you, then it will be exceedingly difficult for you to take the approach of the “in the same boat” because in effect your mate is not in your boat at all. Something to understand though, and this is why I encourage professional help, is that just because your mate cannot be considered a support person, do not conclude that he/she does not love you, or that your partnership must be terminated. This often times is not the case. When a mate can make that commitment to you, yet is unable to support you, odds are that they are dealing with something much deeper than what appears to be on the surface. Your mate may very likely be dealing with other forms of mental illness and is unaware of the depths of it because it is overshadowed by your own. This is not all that odd of an idea when you consider the human tendency to gravitate toward persons with like dispositions. The old adage is at work here, misery loves company. Not in the traditional sense, perhaps you didn't consciously seek out someone with mental challenges, but it wouldn't be surprising if you did it subconsciously.

If mental illness is not at play in your mate, maybe he/she is scared senseless, or if suicidal tendencies are present in your behavior, your mate may feel betrayed as well. They may be taking it personally, as you trying to get away from them. Maybe, they are afraid every time they come home as to whether or not they will have to call an ambulance, these are very real and validating possibilities that may be preventing them from showing empathy for you. So once, again, I would deeply encourage you to get more help on board to cope with this hurdle.

Moving onto affecting change in your mates behavior. This will start with some education, I will devote this week to information that if at all possible you can share with your mate. Use last weeks 'checklist' to determine whether this is a request that you should or should not make of your mate, at this time. If it is not a good time, please read it yourself, get acquainted with it, and maybe do a little homework on what parts you think you and your mate could benefit from. Then when it becomes a time you can request your mate to read it, you will be more prepared to discuss its material. For this weeks post we will be using 'she' for the person with the mental illness, not because it does not occur in men, but rather because the majority of BPD sufferers are female. Also, we will be basing our discussion on BPD, not because other mental illnesses are less problematic, rather because the majority of persons seeking DBT skills are in fact persons with BPD. For those reasons we will say that 'she has borderline personality disorder' even though we do recognize that this can easily be a male suffering and it is his mate that can benefit from some of this information, as well as we recognize that any one of the many mental illnesses that people suffer from can benefit from this too.

Dear Support Mates:

Some of the challenges you face when your mate suffers from BPD, and she feels (whether real or imagined) that your behavior makes it more challenging for her to progress are distrust, betrayal, frustration, and extreme confusion. For her, her wise mind tells her that you are doing the best that you can, that you love her and want her to be handled with care. That you do in fact have empathy for what she is going through, and that you would give your left leg to 'make' things better for her. However, the darker evil side lurking in the depths of her mind, which can attack from either her logic or her emotion mind, tells her that you cannot possibly love her, if only she were better then you would be better towards her, that she must not deserve for someone to love her unconditionally, the list is endless. . .

Another killer is, self doubt. She'll question herself; 'Is this experience real or is it imagined? Is he really behaving in a way that is making it harder for me, or am I charging him with it because I am not accepting something? Would his behavior be better if my behavior were better? If I didn't have these 'problems', then he wouldn't have any cause for behaving the way he does.' Again, the list is never ending. These types of questions will plague her continuously.

The reality? A reality that she won't often be capable of seeing is this: You are not her ineffective behavior just as she is not your ineffective behavior. Another reality that may be more difficult for you to grasp than for her: Whether your behavior is real or imagined to her, both of you will still benefit from it being addressed and changed, to some degree. She deserves you to give her as much empathy as you can and even more, as unfair as that may sound. Reflect on what empathy means.

A good friend of mine said, "Empathy is your pain in my heart".

This would be a good time for me to point out the damage the terms “fair” and “unfair” can produce. We must eliminate them entirely from our vocabulary, they are invalidating and undermine the efforts on both of your parts. Something important to note, assuming that you do not have a mental illness of your own, you bear a larger responsibility when your conflicts escalate to an all out blow out. I know that sounds harsh, and I am not saying you are at fault for it. What I am saying is that life with a person with BPD is hard.

Take a look at some of the symptoms below and just imagine feeling them. For example, can you imagine in your heart, how terrifying it would be to live life daily with the fear of being abandoned lurking around every corner? Maybe to you when someone walks out of the room while you are having a conflict with them is slightly agitating or it may make you  mad, but to her you have left her. Not the literal sense of packing your bags and leaving, that can be dealt with. No, rather she feels it deep inside, a basic need that is being met in everyone around her, yet for her it isn't, she is being rejected, left behind, discarded. Her worth is wrapped up tightly inside of this action of you walking away from her, you may be legitimately creating space for some "cool down" time, but doing so without an exit graceful line, can have dire consequences. You can leave her feeling as though she is worth no more than the mud on the bottom of your shoe that you so easily wipe off and never give a second thought to.  Notice the wording it uses: Frantic Efforts to AVOID. That means she will be capable of outrageous things, not to make your life hard, not to get 'attention', not to 'win' an argument; no, all because she wants to avoid the feeling of being abandoned.

Or, have you given much consideration to what life would be like on a daily basis if your sense of self were unstable? What would life look like for you? Getting out of bed and showering one day would be no problem, but then for no apparent reason,  a trigger way off the monitor has caused you to not be able to take a shower at all, simply for being too disgusted to be alone with yourself naked. Or perhaps, going to the mall is too overwhelming because there are entirely too many mirrors as you walk through the stores and you cannot deal with seeing yourself that many times. Basically you would not like being with, you.

Imagine for yourself a world that when you wake up every morning and you go to bed every night, your mind ruminates over anxiety that you may be feeling, or might feel, or had felt last night. Thoughts of your sickness race through your mind and you wonder who's life did I mess up today? did I say something wrong to someone? will I engage in target behavior today? did I yesterday? can I find something to reduce the suffering without engaging in a target behavior? (granted, these symptoms do drastically reduce with treatment, but these are in fact what your loved goes through when her symptoms are raging)

Going back to the bold statement I made earlier, you bearing a larger responsibility: the difficulties that come along with her BPD are deeply painful and it will require that both of you work as hard as you humanly can AND; when you boil things down, she has a mental illness and you do not (in most cases). This reality means you bear the larger responsibility when things go south. If she had lost her legs in an automobile accident, as her mate would you not be responsible for caring for her needs? Wouldn't the responsibility of organizing the house so that she can maneuver inside the home fall on your shoulders?  If she were having a 'bad day' coping with the loss of her legs, and she became snappy or rude, would you not have compassion and empathy for her loss that would lessen or dull the sting of her words? You better believe it would be her responsibility to learn how not to use unkind words, but wouldn't it be a safe and loving environment if she could go through the steps of grieving the loss if you had extra patience? It is her responsibility to learn how to work through the symptoms of the illness that is paralyzing her, yes. It is also her responsibility to learn skills so that she is not engaging in target behavior or is not maxing out the credit cards, screaming and yelling, etc. AND (here is the dialectic) you can give her more patience. It is exhausting for you, it hurts, and certainly you are valid in feeling overwhelmed because honestly, you do love her, but this no doubt has been going on for years. The two of you have years of  ineffective experiences to pave a very volatile temperature in the home; and yet, she deserves more patience.

So take a look at this list below one more time and make an honest consideration of them, meditate on what that would feel like for you. Perhaps you could write out a list of how you would perceive your life if you reacted that way to your world. Share this list with your mate. Talk about it without judgments.

Thank you for your time with this weeks post, the efforts you go through to assist your mate will go a long way to her recovery and ultimately your happiness too.

Next week we will get back on track about what the person with BPD can do to affect change in their environment, with you working on your stuff and her working on her stuff . . . you'll go far!

Again, I must add. It is very important to say that we are very much aware that men also suffer BPD. These men do have a greater struggle yet, they are being treated in an environment primarily for women. They have a stigma surrounding their mental illness that us women do not have. Mental illness is hard for the general public to accept, let alone accept from the men of our society. Men have an image to uphold, as do women, yet their image does not accept weakness, frailty, let alone mental illness. Add all that with a healthy dose of abandonment? I couldn't even imagine how hard it is for you men out there. Hats off to you who have come forward and have begun to get help, you have tremendous courage.


COMMON SYMPTOMS OF BPD: (as found at: ; personality disorders; borderline personality disorder)

A person with this disorder will also often exhibit impulsive behaviors and have a majority of the following symptoms:

  • Frantic efforts to avoid real or imagined abandonment

  • A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation

  • Identity disturbance: markedly and persistently unstable self-image or sense of self

  • Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating)

  • Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior

  • Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days)

  • Chronic feelings of emptiness

  • Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)

  • Transient, stress-related paranoid ideation or severe dissociative symptoms

Wednesday, May 19, 2010

HumP dAy May 19th, 2010

Welcome to our new addition here at My DBT Life. Granted not all new ideas are good ones, so please bear with us while we get used to this one. I figured that we all work so hard on a daily basis to reach our goals that it would be of particular interest for us to share with one another how we get through the entire week.
Ok, so here is what I came up with. I decided I wanted to touch bases with everyone mid-week. Our Sundays can be something big to take in, we have a lot of reflecting to do from the week previous, we are taking in a lot of new ideas and concepts as it relates to our skills, or perhaps we are getting good reminders of skills that we are learning in our groups or therapy. Either way you look at it, we are working hard everyday towards recovery. So I figured on what many term the day as “hump” day, let's get you through the hump and onto the rest of your week. Give you some fuel to get you on to the next...

If you feel specifically unfortunate as of late, by all means take a gander at this gal:

Seriously, not only are people coming apart at the seams and acting out in ways that are unimaginably faulty, but now they have a cheering squad? Yikes, this is the type of behavior that anyone of our BPD sufferers would consider 'out of control' I think this gal, and her support person could use a little mindfulness. This type of news bit is funny and odd, yes. But also disturbing.

While I was on my hunt for something to share today, I ran across this:

Wow, I laughed so hard I literally cried. It was good therapy, I suggest everyone give it a go.

Finally, I wanted to share a bit I found from a doctor on BPD. Although in general his site was very informational and I seriously do feel there is a lot of honestly good information to be found there, I couldn't help myself and my strong opinions when I read myth #6 of his 7 myths about BPD. Follow along if you will:

On this home page, you can scroll to the end, and he will have a link posted to the myths about BPD, the following is an excerpt from his site, mind you he is telling us this is a myth:

Dialectical Behavior Therapy (DBT) is the Psychotherapy of Choice in Borderline Disorder

This myth appears to be the result of the misinterpretation of very good news for some patients suffering from borderline disorder. DBT is the most systematic and carefully studied form ofpsychotherapy for patients with the disorder.[remember most systematic & carefully studied, it proves noteworthy later on] It has now been shown to be more beneficial for some patients with the disorder than the usual treatments they receive, or even alternative forms of care provided by some experts in the field.20 [italics are mine]Those who have been shown to benefit most from DBT demonstrate suicidal and other self injurious behaviors, and require or request numerous brief hospitalizations, primarily for these actions. [ok, ok, wait a minute here, the myth is that DBT is the therapy of choice for BPD patients, so that must mean that in reality DBT is NOT the therapy of choice, yet, DBT is what? what did his statement moments ago say? read it again 'the most systematic carefully studied' I don't know that sounds like a good reason to be optimistic, that also sounds like good news and I don't think that would be a misrepresentation of that info. however, he also makes a strong link to this therapy being so useful for BPD patients with the list of symptoms there, that are actually BPD symptoms! So what he is saying then, is this form of therapy not only has been studied very systematically specifically for BPD, and it has brought some patients good news (I can only assume he means good results) but it also proves useful for those with BPD that actually have symptoms of BPD but amazingly enough is not the choice of therapy for those with BPD. hmmmm oh yea, and did you catch what else he pointed out?Go back and read it, I italicized it for you]

The beneficial results of DBT are obvious [again, noteworthy]. However, a serious misunderstanding has developed about the implications of the research data related to DBT. It appears that some patients, families and mental health care providers are so eager to determine an effective and prompt treatment for borderline disorder, that they have made the unfounded assumption that DBT is more effective in general than other forms of psychotherapy in the treatment of borderline disorder[ok, hold the phone, first of all, yes, my family and myself were very eager for treatment, but is it really an unfounded assumption? Aren't assumptions based on something that hasn't really been researched thoroughly? Wouldn't that be a direct conflict with his first notable statement? Now, this I really do not get, he claims this is an unfounded assumption that DBT is more effective in general than other forms. Well, let's let that general, haven't we already established that by his own admission that patients displaying some of the most common BPD symptoms have benefited from DBT in fact, once again read the italicized bit in the first has shown to be more beneficial...but now he says, unfounded assumption to be more effective in general. boy, my heads spinning how about yours?] . DBT has not been shown to be more effective3 or less costly21 than other forms of psychotherapy for symptoms of borderline disorder, other than those described above. [when put with the italicized sentence in the first paragraph, this sentence doesn't even make sense.]

This issue is of additional importance as many patients and families search in vain for therapists who are specifically trained in DBT when the treatment may not be indicated, and do not seek help from therapists highly skilled in other forms of therapy who would be of help. [this may be true, some may pass up perfectly good therapy simply because it is not DBT, probably not likely enough to necessitate an entirely convoluted 'myth' section about DBT though]

It is well to remember that in medicine, simple cure-alls for complex disorders are extremely rare.[where in the world did he get the idea that DBT was being billed as a simple cure-all??? Perhaps he doesn't mean it specifically to this, but come on, who out there with a diagnosis of BPD (or any other mental illness for that matter) has some silly notion that there is a cure-all, none-the-less one that is SIMPLE! I want simplicity in my recovery, where do I sign up!] This is equally true in borderline disorder, whether one is referring to medicationspsychotherapy, or any form of treatment.

Ok, so that was fun. He has a book too. . . that could be hours of fun, maybe even days. Seriously though, there is truth in what he is saying here, and if I had to sum up this myth? I would probably label it, "Myth #6 - DBT is the only effective treatment. Understand there are success stories as well as failure stories, in DBT, CBT, other typical psychotherapies etc. Don't get hung up on the latest and greatest, research your options and don't stop until you have come to something that works for YOU!" There, done. P.S. I went to leave a comment for the good ol' doc, until I read his disclaimer for responding to comments, and I figured he would not perceive my comments useful to his site. Therefore I did not leave one.

This is what got me over hump day, what about you? :)


Sunday, May 16, 2010

May 16th – 23rd, 2010

My DBT Life will be making some changes! We will be adding a mid-week post and possibly some other additions, but for now, look for something new by 05-19-10!

Here is the alleged 'checklist' I have been raving about!

Before we begin I feel strongly compelled to give a disclaimer. The material for this checklist is not my own. It is from Marsha Linehan's book Skills Training Manual for Treating Borderline Personality Disorder. Although the format and wording is not the same as what her book has, it is the same concept.

Back to our discussion on factors that are reducing our effectiveness. We have discussed whether we are lacking the skill, whether worry thoughts may be getting in the way, whether our emotions are interfering, and now we are deciding whether indecision might be a factor.

For the first row, when to ask for something and when not to; with each yes answer you increase the level of intensity. If you get all “No's” then you do not ask at all. The key here is that you accept that you will not be asking and you do not mope, pout, or hint about what it is that you would like to ask. Accept that at this time you will not be asking. It does not mean that you will never be asking.

Of course, it stands to reason that if certain answers are 'no', then you may need to regroup, perhaps alter your purpose a little. Do a little more analyzing of your needs. Here is an example:

You want to ask your boss to give you an hour and a half for lunch because you legitimately need extra time to rest so that you can be productive the rest of the day. You are willing to work an extra half hour at the end of the day, or simply only be paid for 7 ½ hours a day. Given your mental health this request is quite reasonable, however  maybe your boss does not have the ability to O.K. a schedule change like this, or perhaps you have in the past already made this request and the answer was no, therefore you would be violating the boss/employee relationship by asking again or the timing is off. Of course that doesn't mean if circumstances where to change that you could not ask again. I think we get the point here, taking these 9 factors into much consideration will help you to reduce indecision, which we have found to be a stumbling block for effectiveness. This same principle applies to knowing when to say “no” to a request as well.

Let's look at each factor:

Ability – The question here really is, is the person able to give me what I am asking? Or, am I able to give what someone is asking of me? We are not asking do you want to, or are you comfortable, rather it is literal. Does your boss have the say-so to change your lunch schedule? No? Well then he/she is the wrong person to be asking. Are you able to pick up your sisters kids from school on Friday? You have a car and no appointments, so yes you are able! That does not mean you have to. Looking over each factor and being prepared to explain to her why you have chosen not to will go a long way in keeping the peace when she hears that your answer is “no”.

Timing – This seems to be a no-brain-er, is it an appropriate time to make the request (or is this an appropriate time to say “no”)? Sometimes this can be more complicated than it seems. You may feel with hot intensity to strike up a conversation with your mate after dinner about a conflict the two of you seem to have often. You may even have a great idea and want to try it out immediately, however – be cautioned. Your mate may have had a long conversation with his mother before dinner and feels exhausted over the things that he should or should not be doing, you do not want to add to that stress, and making your request right then, will only do just that. Equally as poor in timing is, that although you will be working on making time for your mental health throughout the week translates into telling your sister that you will not be picking her children up after softball all week, every week, it may not be  the proper time to do so when she is waiting at the hospital with one of her other children getting stitches. So timing is important, it may not always be the deciding factor, but it does need careful consideration.

Clear – Something that is quite important in skills for life really, is being clear on things. Both sides of the street. Are you clear on what you wish to ask of someone? Can you convey clearly what your request is? Have you got your ducks in a row and are aware of what your request entails? Unclear requests often are disregarded or not taken seriously. Likewise, if you are considering accepting an others request, are you clear on what you are getting yourself into? Do you know what will be expected of you? To give someone justice, you really ought to hear them out and ask them clarifying questions about their request of you so that you truly can determine if this is a time to say “no” or if it is a time you should say “yes”; knowing what all is involved will help with this decision. That door swings the other way, letting the other person know what is all involved in your request of them can help them to determine whether they can grant you that request.

Authority – Honestly this has to be one of the easiest to answer, yet one of the most complicated to apply. Let me explain, your boss is obviously in authority over you, and as it relates to your job performance, you would comply, right? Wrong. Yes, many times over that would apply, but there are times when your boss may be making a request of you with regards to your job performance, but at the same time be undermining your self-respect. (have a peek at January 31st - February 7th, 2010 post for details on this conundrum) Although the door does swing the other way on this one too, there is another little glitch that needs to be addressed here, when you are deciding whether to make a request, you also need to consider if you are in authority over this person, would it be an abuse of that authority by making your request? Some of these principles sort of tie into one another, this concept is touched on a tad in relationship and honor.

Ethical – Simply put, is your request reaching over the law? Moral values of another person? Or is what someone is asking of you doing either one of these things? Being ethical involves much consideration because although you may feel really strongly about something, if you know it will violate someone else's values then it would be unethical for you to ask. Clear and simple, you will have to find another way to get your needs met.

Relationship – What is your relationship with the person with whom you are making the request? (or what is your relationship with the person with whom is making the request of you?) This question weighs heavily on your decision. If you have written out a recovery plan and you have decided for mental health reasons that you need a 'download' time before bed. You have called a few support persons and they have agreed to give you an ear for 5-10 minutes each night. You also have a decent relationship with your boss and have at times sort of sounded off to her, your relationship with your boss however would dictate that it would be inappropriate for you to ask her to hear you out three times a week before bed. Granted as with anything there are always exceptions to the rule, but generally speaking of course this would be a request that doesn't really fit the relationship.

Interchange – The easiest way to dissect this one is this, do you give to others? This person you are making a request of, are you giving to them in value, what you are asking of them? Do you have a friend that gives you rides to all of your appointments, the grocery store, clothes shopping and yet you do not give them gas money or an exchange for their generosity, or you do not give them much time when they call and want to chat about how their day is going,?Chances are they will refuse you if you ask them to be your evening 'download' support person. Or are you in the role being asked to be the support person, this person gives you his time, energy, resources to get you to your appointments, are you giving something in return for his generosity? Or should you grant his request as a way to say “thank you”?

Objective – This one does not get any plainer, will you making this request get you further or closer to your objective in the short term? In the long term? How much and what kind of impact will this have on your progress? Will you saying “no” get you further or closer to from your objective in the short term? In the long term? How much and what kind of impact will this have on your progress?

Honor – Are you the type of person that cries wolf? Is there always some big dramatic issue in your life? Are you regularly calling everyone in your contacts list and fanning the flames of your dramatic existence? You will probably be met with a lot of “no's” yourself and therefore it would do you well to reconsider asking anything of anyone for the time being, you have much to work to do with just yourself. However, most of us are not that way, I use that as an exaggerated example of honor. We need to be honorable with the people around us, so that they know when we ask something of them, we have seriously contemplated the request and it means something to us, we can be taken seriously. Although, I know that each one of you, when you read this example you had a teeny tiny recognition of a person you know! We don't want to be that person. Honor also has another angle, if you have in all most all other areas seen that you should say “yes” to the request being made of you, but it boils down to you knowing that you will have little to no self-respect if you do say “yes”; then it would probably be a good idea to say “no” and then spend some time on evaluating why it is that your self-respect would be hindered in that way. Damaging your self-respect can have drastic consequences and can undo much hard work. The flip-side to that though is we do not want to bail-out of granting a request by flying the 'self-respect' flag either. Get to the bottom of it and find out why your self-respect will be lessened and try and explain it to the person or persons asking, or maybe even work a little on exposure therapy . . . ah, but that is another post entirely!

Clearly now you can see why it is so helpful to consider each one of the factors carefully before saying “no” or before making a request of someone. Just simply breaking down your decision this way can really pull the emotional attachment out and let the decision that needs to be made set naked on a table so that you can look at it from all angles and calmly make a choice.

This is quite a lot to take in. Digest it, read it over, take some recent situation that went well and compare it to the checklist then take a recent situation that did not go well and compare it to the checklist, find out where your strengths are int his department and where your weaknesses are. Get acquainted with them, this education can make all the difference in your next encounter, whether it goes effectively or ineffectively!

Next week we will discuss how the environment weighs in on your effectiveness. Maybe we will do a little partner training too! Something to look forward to, because as we all know, sometimes you cannot change other people, or can you? :)


Sunday, May 9, 2010

May 9th – 16th 2010

So relationships... OK, so many of us find that our symptoms of mental illness truly come out when we are interacting with others. It takes skill to learn how to communicate with others, in general and in conflict. Especially conflict; and it takes that much more skill to do it with the handicap of mental illness. Rest assured though, as many of you are learning, it can be done!

If things are not going well,  it does us well to ask ourselves first and foremost, What is reducing  my effectiveness? Factors that get in the way of effectiveness are:

~You simply lack the skill to get through the moment
~Worry thoughts have overcome you
~Your environment.

First one, you lacking the skill. I am sure all of us have found that there are many areas in which we lack the skill to get us through effectively, but after-all; that is what we are doing here right? Learning. The classes some of you are going through, therapy, DBT programs, or independent research is all about expanding our education on ourselves and our mental illness. (or in the case of the readers out there that are doing this education program for loved ones that are still in a bit of denial, this applies to you too) We are all making progress in that we are learning or practicing new skills! So ask yourself whether you poses the skill, if you do, move on in the list and make an effort to understand why the skill isn't working at the moment. Is it being used properly? Are there some adjustments that need to be made? Maybe just a time-out. If you find that you do not have the skill at all, well then pat yourself on the back for the work you have done so far, commit to doing research on how you can learn the skill, what to do in the moment until you can use the proper skill and carry on.

Back to your assessment, if you have decided you do in fact have the skill, go to the next, are worry thoughts interfering with your progress? Are you terrified of what might happen? Are you worrying yourself sick over how this scenario has played out in the past? This is what they call “time travel”, you are living in the past, in that you are suffering the pain from what has happened in the past; and from that past pain you are living in what you perceive to be in your future, or the outcome of this situation purely based on what has been the case in the past. Some have found that if worry thoughts control your thinking a simple effective way to get a hold on them is to train yourself that there is a time to worry and a time not to. Give yourself a specific worry time and a specific worry place. Let's say you tell yourself that each day at 5:00 pm you will take your list of worries and give them consideration for 15 minutes. After which time you will “shelve them again” until the next day at 5:00 pm. Commit to only worrying in a quiet room, or your back porch, etc. This training is quite effective in learning when it is appropriate to worry and when it is not.

If worrying isn't preventing effectiveness, then consider this: indecision. Is this moment happening because wise mind justified, you need to say “no” to a request, or maybe wise mind justified you need to make a request of someone, and you can't decide whether to say “no” or to ask?

Marie wants to ask that Larry, her husband, gets off  work earlier so that they can have dinner together. The past few months they have grown further and further apart. She has been struggling a lot with her mental illness, getting to know her symptoms and identifying the reality of her illness has taken a large toll. She is tired a lot, nervous, scared and feels that she is making her husbands life a little bit like hell. She wants deeply to do some repair on their relationship, they have had so much conflict and pain. They have built a habit of certain responses that each of them know all too well. Larry has been coming home later and later from work. There is so much tension and stress at home and he is finding it difficult to want to be there. They both have agreed that dinner time will make a nice step in the right direction for a little “repair” to their communication. But it seems that he has not made much of an effort to get home in time. Marie is faced with this, does she ask him to get off of work earlier again and chance an argument, since they have had this discussion in the past and have argued about it. Larry doesn't appreciate the implication that he isn't trying hard enough. Or does Marie not make the request and spend her resources in a different way to help improve the situation? Which one is wise mind justified?

It is amazing to do a little deeper searching and see how often we really do find ourselves in this “indecision” mode. Perhaps we are the type that are always saying “yes, yes, yes and more yeses” and spending most of our time and energy helping out others that we have not had sufficient enough time to spend on our recovery. You are struggling to keep your loved ones close to you, you are spending a lot of time in therapy, classes and personal studying on how to make things better and you are feeling tired and overwhelmed, but at the same time, you are watching your neighbors kids before and after school as a “favor”, driving a friend from here to there because they are in need, running errands for a family member, organizing family recreation for aunts and uncles because, who will do it if you do not? Any one of these things in and of themselves are not wrong or improper, but the point of course is not whether you do these things, but do you do them in place of taking care of your recovery progress? Are you doing them in place of making that effort with Larry and your communication? Are you doing them when it really would be wise mind justified to say, “No”? Are you able to say “No”?

Many persons that have a mental illness already think very little of themselves. Their self worth is already at zero or in the deficit, and in many cases these persons find that if they “do” for others at any cost, somehow they will be more of a valued person. They will “make-up” for all the problems that they cause people around them. Or they may find that they don't make requests of people because they don't want to rock the proverbial boat. They do not want to burden others, or they believe they do not deserve for someone to “do” for them. All these reasons are valid, but they are not wise mind justified. You cannot justify them if you are using your wise mind. Period.

So what do you do, right? How do you know if you should refuse a request or make a request? How do you eliminate some of your indecision? Once again, as with many of the skills we learn in DBT, there is a check list! Yes, as simple as that... a checklist. Of course once you know which to do, say “Yes” or say “No”; ask or do not ask, the actual doing is another skill altogether, but let's get one step closer to that skill!

Check with us next week for that check list...

But here is this weeks writing submission. Thank you for sharing!


Sunday, May 2, 2010

May 2nd - May 9th, 2010

This week I want to spend some time on Distress Tolerance. Have talked extensively on our emotions and the role that they play. Now, when our emotions are rising and we are off baseline, as the above diagram shows;  we need to make a distinct effort to control them, we need to make sure that that effort is well thought out, organized and effective. Obviously we cannot possibly think through our distress tolerance while we are in an elevated emotional state. Therefore, it is our responsibility to design a distress tolerance plan.

I purposely say "our responsibility" because we may have special needs due to mental illness but that does not give us a free pass to inflict ourselves on those around us. Here is one of my favorite dialectics "I am doing the best that I can, AND I need to do better." This means that although I struggle, and it is hard and painful for my loved ones around me, I am working at this 100%, and I look forward to the improvements I will be making along the way. I may not be perfect at this, I may blow up and engage in target behavior, but since I am using my skills, I am being responsible with my own mental illness, taking ownership of it, I can feel confident that I am doing the best that I can.

So, having said that, what works? As with anything else, what works from one may not work for others. Last week I listed some ideas and I asked for submissions of writings from the readers. So this is what I have so far:

Recall what we know about Mindfulness. As a quick re-cap, Mindfulness is the corner stone of DBT. Mindfulness is something that it would do well for each person in the world to get a handle on, mental illness or no. I personally believe that mindfulness should be taught in schools, at home with our children. Perhaps as a requirement for graduation each student would need to take a specific class on this technique. It would help our children get a handle on what is out there in the real world. They will be exposed to a lot, but they would be so much better equipped if they already knew how to manage their own thought process before their exposure. I will step down from my soap box now. Few times will you hear "my opinion"; but if you do, no doubt it will be in advocacy for our children! :)

Mindfulness is the purposeful getting in touch with how our mind and body are functioning together in any given situation. It is of particular usefulness when we are elevated emotionally. But it is something that we should be practicing daily, so that we are able to help keep ourselves closer to baseline, and if we do rise above baseline, then we will be skilled enough with mindfulness that it will be successful.

An example of mindfulness is to sit in a comfortable chair, close your eyes, after a few deep purposeful breaths, start counting the sounds you hear around you. Do not linger on what the sound itself was or could be, rather simply count it and move on to the next sound you hear. Do this for about 3-5 minutes. Afterward open your eyes and discuss with yourself what it is that you noticed about the exercise. Often times you will notice that you are more aware of your surroundings, over time practicing this mindfulness exercise or similar ones, you will also begin to notice your body and how it feels in different environments.

Whether we are skilled at mindfulness or not, we can use the bi-products of it to help with our distress tolerance plan. Knowing our limitations and our strengths can greatly assist in this plan as well.

First, we reduce vulnerabilities where we can. Using what we know of our own body sensations, will help clue us into the coming wave of emotional dysregulation. That as our cue, begin a  systematic elimination of vulnerabilities. Have you had enough sleep? Perhaps you need to tend to a headache or maybe you haven't eaten properly for the day. Once your vulnerabilities have been reduced as far as they can and your emotions are still climbing, this is when your plan comes into action. We will hear from readers on their plans:
The first step in my plan is to take a shower. The water drops on my body help the tension inside my body to ooze out through my toes. I have become trained at this, so now if I am in a situation when I cannot take a shower, splashing water on my face can trigger the body sensation of oozing tension just from the chilly water on my face! Which is nice because not am I in a position to shower whenever I get excitable, but usually there is always a faucet for me to at least splash my face. This buys me time so that I can plot my next move.

I seem to have a hard time reducing my vulnerabilities, but I do know when I get elevated, the first thing I need to do is rub lotion into my feet. Most of the time I can do this anywhere. I just carry lotion where ever I go.

What works best for me is praying about my problem. Almost repetitively. A few phrase that remind me of some of my skills that I am not able to use at that moment, but I know I want to, I just pray. When I stop what I am doing to pray, it almost always forces me to breathe slower. The combination helps me to stay calm until the intense moment has passed.

My notebook and a favorite pen are my best companions. I can jot down the distressing event. It helps me to really get to the meat of the problem, and because I have with me other entries I can draw on what I have written in the past. I use it to remind me that no one moment will last forever and that I have got through things like the current situation in the past.

I like to draw pictures, either abstract or specific things, it is so completely different from what is happening in the moment that I think it sort of pushes a reset button in my head.

My heightened moments seem to almost always involve my husband. It is like we just can't seem to deal with certain topics and we fight about it. With my mental illness when our fights hit a certain level, I go crazy.  So what I have learned to be my first line of defense when I get elevated is start a pros and cons list. Pros of pursuing the conflict vs. cons of pursing it. Or, pros vs. having to bring up a topic I know will cause conflict vs. not discussing it. etc.

These are just a few expressions, I am sure there are so many more good ideas out there. Also, these are just some ideas of the first steps of each of their plans, I purposely did not list all steps because I felt it important for our readers to get ideas so that they can formulate their own plan. Get you thinking about what you personally could use. As I mentioned at the outset, this plan needs to be done in advance of a heightened experience. Be prepared! Make a list of a few things that you know work, and work through them like a check list.

Something that was mentioned was high conflict. This is very common with mental illness, especially with those that suffer BPD. Often times with high conflict relationships it is due to an inability within ourselves of knowing when we can or cannot say "no" to something. Or perhaps we needed to request something of a person, but did not. This can produce for us an imbalance in the environment and if our vulnerabilities are heightened or our body memories of how many times we have fought over a subject we engage in conflict. So, next week, we will talk about Interpersonal Effectiveness in whether or not we try and change a situation or whether we accept the situation as it is and let it go.

Once again, please submit writings, I would like to share some each week for awhile. Until next week!