Latest / It’s All Your Fault: High Conflict People / Part 2: Borderline Personality Disorder for Family Members
Transcript
- Megan Hunter: Welcome to It's All Your Fault, on TruStory FM, the one and only podcast dedicated to helping you identify and deal with the most challenging human interactions, those with someone who may have a high conflict personality, I'm Megan Hunter, and I'm here with my co-host, Bill Eddy. Bill Eddy: Hi everybody. Megan Hunter: We're the co-founders of the High Conflict Institute in San Diego, California. In this episode, we're joined for part two by a special guest, Amanda Smith, who will discuss her specialty borderline personality disorder. In part one, we focused on helping the person who may be struggling with BPD, or thinks they may have BPD. So it's really good information there. In this episode we'll focus on how family members can best help their loved one who struggles with BPD, and how they can help themselves, which is very, very important. So you'll want to listen to this episode if you have a family member who may struggle with BPD. But first, a couple of notes. If you have a question about high conflict situations, or about BPD, send them to podcast@highconflictinstitute.com, or submit them on our website at highconflictinstitute.com/podcast, where you'll also find the show notes and links for today episode. Please give us a rate, a review and tell your friends, colleagues, or family about us, especially if they're dealing with a high conflict situation. We are very grateful. Now let's talk borderline personality disorder for family members. So welcome Amanda. We're here to just learn all we can from you. So I guess I'll start it off with, what is the primary reaction of people, family members with someone who gets a diagnosis? Amanda Smith: I think there's often a lot of fear, worry. I think that for parents there's sometimes some blame. Parents often blame themselves, or sometimes parents blame the other parent and say, well, this came from this side of the family, not my side of the family, but this side of the family. That's a pretty common reaction in some families I've worked with. But yeah, I think people often feel worried, often think, okay, well, what's going to happen now? And what's going to happen in the future? What will this mean for this individual and for our family as a whole? Bill Eddy: Well, I guess one of the things I want to talk about is when they're not diagnosed, but you see this pattern of behavior and family members are very frustrated, because they're being blamed for things that, explosive rage because you forgot to mention and you forgot to tell me to pick that up at the store, and here I'm back at the store and you're just outraged that I didn't pick up that thing that you didn't make clear you wanted. How should family members deal with someone with this kind of blaming, rageful, disproportionate response to things? Amanda Smith: I think one of the most important things for family members to remember is that they're not the cause of their loved one's suffering, their loved one's emotional pain. Even if there's a genetic component, I would hate for any family member to blame themselves and to say, oh, well, this is my fault, or this is how I failed my child, or this is how I've failed my spouse or my partner. I think that it's pretty common for all of us when someone, again, is lashing out at us, we take the behavior pretty personally. And that may either mean that we get really defensive, or sometimes we take on all of the blame, all of the responsibility and say, well, I must have done something. So now I have to figure out what I need to avoid doing in the future so that we avoid these outbursts, or these problems. And I don't know necessarily that either approach is necessarily helpful. It's one thing to think, okay, well I said this in a particular way and I can see where this anger comes from, but it's not necessarily helpful when we think about creating healthier relationships. So I just want to, when I'm working with families, I just want them to pay attention to those patterns that, again, play out in all of our relationships and thinking, okay, am I taking this all on in this moment? Am I imagining that I'm fully responsible for what's happening? Or am I that person in the family who gets really defensive and argues back, fights back, or even shuts down? So I think even just beginning to be aware of those patterns and the things that we do in our relationships is a first step to potentially making some really positive and helpful changes in our lives. Bill Eddy: Now, one thing that happens for family members is they reach a saturation point and one of set limits, let's say with an older adolescent, or a young adult, and they wonder, should I just kick them out, or what do I do when they're just, there's all this rage, et cetera, that's so inappropriate? And we know that they have a problem, but they don't agree that they have a problem. How do you help people with that? Amanda Smith: I think it's important for family members to think about safety, and that doesn't mean just physical safety, but I think about emotional safety, feeling safe in the relationship. If the other person is not accepting help that's available to them, and the relationship feels untenable and unsafe, I sometimes think it's absolutely appropriate to think about creating, I think Marshall Lenahan would talk about creating a family vacation. We're taking a vacation apart from each other for a specific period of time, or until something changes, something's different. That's not the same as abandonment, or throwing up our hands and saying nothing's ever going to be different. So we're just giving up on this relationship. But I think it can sometimes be very healthy for family members to say, we need to separate at least temporarily, again, especially when relationships feel potentially dangerous and unsustainable. Bill Eddy: Yeah. Megan Hunter: What's that look like in a marital relationship, the family vacation? Amanda Smith: I've worked with families where, again, and it's so helpful when people are on the same page, and boy, is that hard to do. So I just want to recognize that. But many years ago I worked with a wonderful, wonderful couple and the husband was in treatment with me. He was doing really well in DBT, and yet things at home were still really challenging, really challenging. And so we had a very honest discussion about a temporary separation, and I think the separation lasted, I think it was just about 90 days, and it's actually something that proved to be a reset for the entire family. And they still met every single day for dinner, but it was a brief 90 minute, two hour interaction. And the husband was getting lots of really good support and encouragement and also was working with someone when it came to getting some additional parenting skills and parenting training. But I think this can absolutely work for couples and families. But again, it starts with an honest conversation about what's working and what's not working? And then the willingness to try something different, to say, okay, well, what would it look like if, again, it's not a separation that takes place indefinitely, but what if we took a 30 day break, or a 60 day break, and just to do an assessment and see, again, what's working and what's not can be helpful. Bill Eddy: Great idea. Now sometimes I'll have someone I consult with and they'll explain pattern that sounds like borderline personality disorder to me. And they'll say, I'm trying to decide whether to get divorced, or try to make it work. And I often recommend, well, try to get the person to go to couples counseling with you. But then they go to couples counseling and the counselor agrees with the person with borderline traits that it's all the other person's fault after all, because they're very blaming. It's what I call a persuasive blamer. And the person calls me back and say, well, that didn't work because now it's all my fault. And that's the problem. It's not all my fault. Any thoughts of what I should tell people, or what you would tell people about couples counseling? Amanda Smith: I think couples counseling is wonderful and at the same time, yes, what you've just described happens pretty frequently. Sometimes I think it's beneficial for couples to have separate therapists, and then someone working with a couple together, but each spouse or each partner has that separate therapist. I think that, that can be sometimes really helpful for couples. And again, having those honest conversations, because this is pretty common in couples work, where one therapist, the couple goes and they agree, okay, we're going to try to work this out together. And it feels like the therapist may be taking sides, or one partner just, again, walks away feeling blamed or feeling like, oh, I'm showing up, I'm trying. And it's just not coming together. I know it's a really pretty common dynamic when it comes to couples' work. So it's a risk, unfortunately. Bill Eddy: Let me add to that. So let's say a family realizes that someone has borderline traits, but the person's angry resistant, et cetera. Is there starting to be interventions like there are with substance abuse treatment? Is there starting to be interventions for borderline treatment, like getting people into DBT, maybe even into a hospital DBT program for severe borderline behavior? Amanda Smith: Oh, I don't know of anything. Although, I find the idea to be really interesting. I think about for most people, and I think this is true for individuals with a diagnosis of borderline personality disorder, and again, also narcissism. There's usually a tremendous amount of shame that, that person has been experiencing for a very long time. So I think interventions can feel often very threatening. Those ultimatums aren't necessarily effective for most people. But yes, I think there's definitely room to, again, have those honest conversations about what is not working in relationships, or in families, and to, then to come to a place where maybe we say, you know what? If things don't change, then here's what we're going to do next. Not that these are ever decisions that we make lightly, but to think about that follow through, instead of thinking, okay, well, now the person has said no, so maybe now we give this another three months or six months or five years, and then we just continue the patterns, which is really heartbreaking to see. I don't want to see any families break up forever and ever, and yet sometimes we know that, that, again, what I'll call a vacation, can help people decide, no, I do want to go into treatment, or I do want to get help, or I want to figure out how to make this relationship work. And if that's the result then, wow, maybe that's okay. Megan Hunter: So, would it be helpful if a family member said to their loved one, you have borderline personality disorder, I'm pretty sure you do. Is that a good idea? Amanda Smith: Probably not. Although there are exceptions, there are exceptions. I definitely worked with clients who were genuinely curious about their own emotional health and why? They were really confused about why it was hard to get along with other people and why there were all of these misunderstandings and broken relationships. And then sometimes there's an opportunity for a family member to say, I've been reading about this thing called borderline personality disorder. And then if we can give the other person some information that, again, is non-stigmatizing, nonjudgmental, supportive, encouraging. It's not impossible to imagine that someone might say, oh, okay, this actually does describe me. I'm glad you gave me this information. That's actually have been the story for many, many of my clients. And I want to also caution families that, that may also be met with defensiveness and hurt feelings and some broken trust as well. Megan Hunter: So maybe if a family member could approach it with a lot of validation, a lot of empathy and no judgment, no shame, no blame. It's probably the best way in. And something I've seen work also is to say, look, I struggle with my own emotions. I may struggle, have these different things that I deal with. And I want to get help with them too, or I have gotten help with them, and you've seen that change. Do you think that's a good way to do it, to put yourself along beside them? Amanda Smith: Oh, absolutely. Absolutely. And I've seen so many times where family members are stronger when they learn the skills together and make that commitment. So it's not, hey, you need help. I'm okay. It's hey, both of us need help, or we need help as a family, can be a great way to role model emotional health and healthy seeking help. I think is really important. So yeah, so absolutely yes to normalizing, we all need help at some point in our lives, even if it's for a brief period in our lives, it's okay to need help. And if that message is coming from a family member, or a friend, I think that's terrific. Megan Hunter: Yeah. I think a lot of families get it backwards where they just say, oh, this person's the problem. This is the black sheep. And they need help, but it's really a whole family system that needs to get help together. Amanda Smith: Oh, I think it is. Absolutely. I agree. Bill Eddy: One of the dynamics, and I keep coming at this from the perspective of high conflict divorce cases, because there seem to be so many people with borderline personalities or traits involve, but one of the issues is alienation, or resistance, or refusal to see the other parent in a separation or divorce, which often seems to be associated with a parent with borderline personality traits. And it seems to me pretty clear from studying this for 40 years, is that the emotion dysregulation just passes through lack of emotional boundaries, really passes to the child. The child absorbs one parent, whether it's mom or dad's anger towards the other parent, their hurt, their sadness, all of that. And can't emotionally tolerate it. And so they go, okay, calm down, mom, or calm down, dad. I'll totally agree with you. And this isn't even a conscious process, but often happens between about nine and 13. And to resolve this in family core takes pointing out all those bad behaviors, which sadly builds resistance to change. And I just didn't know if this is an area that you have any thoughts on, how to help people be more aware of how they impact the children without having to be so blaming and angry and court focused to get something to happen. Amanda Smith: That absolutely makes sense. And my hope is that when people begin to identify coping skills that help them, that tendency to blame and criticize and judge and attack really, really does diminish. We have a really big issue in making assumptions that people know what to do. People know how to take care of themselves. People know how to sue themselves. People know how to talk to themselves in a validating kind, generous way. So instead of, again, you're right. It's so tempting to say, well, just stop doing that, stop doing that. Bill Eddy: Yep. Right. Amanda Smith: And yet I think that recognizing that problem really does start with helping the person help themselves so that they can then tolerate it when someone says, hey, you're really, really attacking this person. And again, remember when we talked about everyone's doing the best that they can, and getting back to that, that's a really hard message when someone's been in the habit of blaming others and attacking others for a very long time, even imagining that another person is doing the best that they can, can be incredibly painful. But I think if we have that foundation of self-care, coping skills, mindful awareness, my hope is said that, that helps reduce those attacks and that defensiveness and that meanness. That's my hope. Bill Eddy: What I hear you saying is family members and even professionals may need to set limits, but do it with kindness, empathy. Well, we like to say empathy, attention and respect to ear statements that, that's fair to do. And also maybe more motivating for change than harsh criticism. Amanda Smith: Absolutely. And the reality is that there are still consequences to our behaviors. Bill Eddy: Yeah. Amanda Smith: Whether we have coping skills or we don't have coping skills, there are still consequences to our behaviors, real world consequences. So I think that's also part of having, or beginning to have that discussion in treatment is like, yeah. You know, sometimes we say or do things we regret and we're still responsible for those outcomes, those consequences, even in that moment. I think when we have really good coping skills and we're taking extra good care of ourselves, we have a lot less to apologize for. At the end of the day, or a lot fewer messes to clean up when it comes to our relationships. So again, it's yes, we want people to do their very best and not expect people to do things they cannot do. Also, again, the reality of we're still responsible for our own behavior at the end of the day. Bill Eddy: Excellent. Thank you. Megan Hunter: Indeed. Does medication help? I guess if I were a family member, particularly in connection with mental illness, people think that it's just an automatic assumption that they need a pill. So do you want to give a quick one, two on the medication front for BPD? Amanda Smith: I think that medication can be helpful in managing some symptoms, sometimes related to depression or anxiety. There is no medication to treat borderline personality disorder. I really caution my clients and their family members from imagining that a particular medication, or a combination of medications is going to help them to manage every unwanted emotion, or thought. I have not found that, that's true, but sometimes my clients think, well, yeah, if I find just the right medication at just the right dose, I'm going to like myself and I'm going to like other people, and I'm going to be able to work and go to school. And again, I haven't found that, that's true. I think medication can be beneficial, but boy, I wouldn't want anyone to think medication is it. Megan Hunter: Maybe it's best for the short term and not a long term of this pill's going to fix it and they just stay on it forever. It's really that, everything you've been talking about, the learning skills and emotion regulation and the things that you'll learn in treatment, or your loved one would. So let's talk about your book, The Borderline Personality Disorder Wellness Planner for Families. We talked about The Dialectical Behavior Therapy Wellness Planner, which is for the person struggling with BPD, but this one is specifically for families. It's a little bit of a different structure, where the DBT planner is daily, and this planner is weekly? Amanda Smith: Correct. Yes. So this is, like you said, a weekly planner with a very short meditation to read some ideas on recovery and wellness and getting better. And then on a separate page, there's checklist of ways in which family members can think about self-care, think about how they are honoring their values. Think about setting limitations, following through with limitations in their lives. I believe with this, with all my heart, I want family members to take care of themselves. I think that is so incredibly important. So many times I see family members neglect their own emotional health, or their own physical health, their own spiritual health. I want for family members to give themselves permission to prioritize their health. And my hope is that this wellness planner for families helps people give themselves some structure around that self-care. Megan Hunter: I love it. And it's just so helpful and necessary. And like the other book in the last episode, I went and looked through the Amazon reviews to see what people are saying, and it's all very positive. And this one stood out to me. Someone said, "This planner is invaluable if you have a family member or close loved one with BPD. From the self-care assessment to the weekly reflection, along with the checklist, to be sure you are caring for yourself emotionally and physically, this planner can only enhance one's life and help to understand your loved one's journey with BPD. This planner gives you hope and understanding." And I think it's, really that was your heart in writing this book, because you've worked with many families and their loved one. And so you understand what everyone needs are through this journey. So I'm grateful that you've written it, and I know that those who have used it are also grateful. And if you have a family member with BPD, or friend, it could be anyone in your life, in a close relationship. It's just a good idea to take care of yourself. And this wellness planner really helps you do that. So I encourage you to get it. I just want to thank you, Amanda, so much for being with us on these two episodes. I think the three of us can talk about BPD for days on end, and it's just such a fascinating subject. And I love that you bring this message of hope to it, because it can be a very dark and seemingly ugly situation to deal with. But there is a lot of hope. There's tons of evidence showing that people get better, that they can get out of the diagnosis if they stick with the treatments and do the things they're supposed to do and families can heal. They don't need to be divided or ruptured forever. There's probably a big space for forgiveness and moving forward, instead of really staying stuck in the past, and some of the behaviors that might have come out in the past, which can be very, very extreme. So it's a good idea, I think, to remind yourself as a family member, to separate the behaviors from the past, any of those behaviors from the person, because this isn't a bad person, this is a person who just needs a little help maybe from a therapist and from those around them. Just a little love, kindness and compassion, and I can go a long way, and setting limits Amanda Smith: And setting limits. Exactly. Yes, it's both. It's both. Lots of love, lots of validation. And we also set limits when we need to set limits. That's okay. Megan Hunter: Yes. Very good. Well again, thank you Amanda, for being with us. If you would like to visit Amanda's site, it is hopeforBPD.com. And her books are The Borderline Personality Disorder Wellness Planner for Families, and The Dialectical Behavior Wellness Planner for the person that struggles with this and is improving. These books will help you. All those links will be in the show notes and we have a couple of articles in there as well. And I know you can contact Amanda through her website. And as a family member, I know Amanda has a great course for family members, and I think she just started a new one very recently, but check her website for those, and you'll be able to find the next time you can sign up. So we appreciate you listening. And if you have any questions about BPD, or anything to do with high conflict, send them to podcast@highconflictinstitute.com, or submit them to our website. Just we'd love if you tell your friends about us and we'd be very grateful if you'd leave a review wherever you listen to our podcast. If you are dealing with a high conflict situation at work or at home, keep calm, use your skills, set your limits, and eventually you'll find the missing peace, P-E-A-C-E. It's All Your Fault is a production of TruStory FM. Engineering by Andy Nelson, music by Wolf Samuels, John Coggins, and Ziv Moran. Find the show, show notes and transcripts at trustory.fm, or highconflictinstitute.com/podcast. If your podcast app allows ratings and reviews, please consider doing that for our show.