Transcript Recovery: On the Move
“Those Borderlines:”
Removing Stigma and Facilitating Recovery
Reneé Kopache Hamilton County Mental Health and Recovery Services Board
Agenda
Recovering and Facilitating Recovery
Hope
Empowerment
Self-Responsibility
Meaningful Role Issues to Contend With
Stigma
Co-dependency
Substance abuse
Trauma
Self-Injury and suicidal actions
Recovering & Facilitating Recovery from BPD
Stages of Recovery*
HOPE
Empowerment
Self-Responsibility
Meaningful Role
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Recovered
* Village Integrated Services, Inc.
Hope
Becoming rational thinkers: Hope is basically an attitude (influenced by thought).
Those of us with BPD struggle a great deal with irrational thought patterns, which hinders our sense of hope.
To obtain and maintain a sense of hope, we have to change (control) our thoughts… …we have to become rational thinkers!
The Role of the Provider - Hope
Engagement
Trust
Dialogue
Don’t hide the diagnosis from the consumer
Education
Help the consumer understand why they do what they do and think the way that they think
Separate the illness from the individual
Avoid Stigma
Teach rational thinking…instill a sense of Hope!!!
Hope Con’t
Helpful Coping Skills/Techniques:
Support from a trusted, third party observer
Journaling
mood logs
Positive self-talk and/or affirmations
medications
Barriers:
Stigma & discrimination from having a mental illness
“We’re difficult, manipulative, and nobody wants to work with us because we’re so bad off - - how can we have hope when the system has no hope for us?”
Fears (change, abandonment, emotions, etc.)
Empowerment
Become Knowledgeable
know your illness & yourself
learn to distinguish between symptoms and you
warning signs
Triggers
rights
Become active in your treatment
Medications alone will not improve your life
Your treatment providers cannot fix you
Utilize Support
Professional Peer Friends/family
The Role of the Provider Empowerment
Educate Support the process of gaining self-awareness Homework assignments
Boundaries Consistency
Avoid getting trapped
Support Begin to assist the consumer with the process of developing a healthy support system
Empowerment Con’t
Helpful Coping Skills/Techniques:
Continue using skills from previous stage
Read, read, read
Self-Assessment
strengths, weaknesses, needs, wants, goals, etc.
Let people help Exercise….pursue hobbies
Barriers:
Stigma
Triangulation
Fear of abandonment
Trust
Self-Responsibility
Changing Behaviors/Regulating Emotions
Advanced recovery
critical stage where we shift from an external to internal locus of control taking responsibility for our lives…being willing to do whatever it takes to get better
for some, progress in recovery stops here
Anger is not the only emotion we have
taking on responsibility for our well-being opens the door to feeling the positive emotions
Creating a positive lifestyle
change, change, change
risks, risks, risks
The Role of the Provider Self Responsibility
Support the efforts to change
Provide tools and techniques
Cheerleader
Sounding Board
Expect failure and be ready to deal with it
Help the consumer improve self-esteem and sense of self
Help the consumer deal with co-dependency issues
Self-Responsibility Con’t
Helpful Coping Skills/Techniques:
Continue previous skills as appropriate
Identify the problems as well as reasonable solutions…then, develop a plan to implement the solutions (Impulse Control Logs)
Physical
Thought/Emotional
Relationships
Barriers:
Self-sabotage (fear of success)
Fear of failure
Low self-esteem & poor social skills
Meaningful Role
Integrated life in the community
Life extends beyond mental illness and the mental health system
Valued Role in the community
Employment/volunteering
Faith community
Family
Friendships/relationships
Community organizations
Giving back
Pursuit of interests/hobbies (outside of MH)
The Role of the Provider Meaningful Role
You’re job is just about done!
Encourage activities in the community
Help the person connect to natural supports
Help the individual transition out of services
Be prepared for self-sabotage
Meaningful Role Con’t
Helpful Coping Skills/Techniques:
Keep doing what’s worked
Try new things
Give back
Barriers:
Old habits are hard to break
returning to the comfort zone
Self
Issues to Contend With
Stigma Co-dependency Substance Abuse Trauma Self-Injury and suicidal actions
Overcoming Stigma
Stigma from others (external)
Mental Health System
Providers
Peers
Community (family, friends, neighbors, etc.)
Self-stigma (internal)
Serenity Prayer
Self-Esteem
Empowerment
Co-dependence & BPD
"Codependence is about giving away power over our self-esteem.” (Burney, Robert) It is this lack of a "self" that leads the person with BPD to continually set and re-set themselves up as victims. (Mahari, A.J., 2000).
Robert Burney From his Column "Codependence vs Interdependence”-- In an article by A.J. Mahari (2000) titled:
“Co-dependence: Where Borderlines and Non-Borderlines Often Meet.”
www.borderlinepersonality.ca/bordercodepdance.htm
Codependence Cont’
Recovery from co-dependence
is about knowing that you want and deserve healthier relational reality…It’s about meeting your own needs!
“you NEED to learn to validate yourself from the inside out and you must stop seeking others to define you and or to meet your needs for you”
(Mahari, A.J., 2000).
Recovery from BPD
involves overcoming co-dependence and becoming an emotionally healthy adult by taking responsibility for oneself, and building a sense of self (identity), self esteem and self-worth.
Substance Abuse
54% of those with BPD have a problem with substance abuse (bpdcentral.com).
Individuals with BPD who abuse substances… are at greatly higher risk for suicide and for death or injury from accidents.
often abuse substances in an impulsive fashion contributing to a lower threshold for other self destructive behavior.
Trauma
Research suggests that between 40% and 70% of individuals with BPD are victims of trauma (NIMH website).
Approximately 25% of individuals with BPD are also diagnosed with PTSD
(NIMH website).
Challenges to treatment due to trauma
Threat to therapeutic alliance
Issues with transference
Traumatic memories
Splitting
Self-Injury and Suicidal Actions
Approximately 70-75% of patients with BPD have a history of at least one deliberate act of self-harm.
According to Linehan et al, the mean estimated rate of completed suicides is 9%.
Self-mutilation is distinct from suicidal behaviors, but such behaviors double the risk of actual suicide
Purpose: most often those with BPD self-mutilate to punish themselves, but some are seeking relief of dysphoric states http://www.afsp.org/education/gund_ridolfi.htm
Self-injury and suicidal actions
Managing Suicidality
Split treatment (multiple providers)
Identify the Primary Clinician
Contracting for safety
Responsibility for reporting feelings/thoughts falls on the consumer
When the crisis has passed, process it
how you felt about it how the consumer felt about it plan to respond differently in the future
http://www.afsp.org/education/gund_ridolfi.htm
Resources: Books
I Hate You, Don’t Leave Me Kreisman, Jerold Managing Intense Emotions and Overcoming Self Destructive Habits: A Self-Help Manual Bell, Lorraine The Angry Heart: Overcoming Borderline and Addictive Disorders : An Interactive Self-Help Guide Santoro and Cohen Life at the Border: Understanding and Recovering from the Borderline Personality Disorder Heller, Leland M.D.
Books Con’t
Skills Training Manual for Treating Borderline Personality Disorder.
Linehan, Marsha M. Eclipses: Behind the Borderline Personality Disorder Ford Thornton, Melissa The Feeling Good Handbook Burns, David M.D.
Pathways to Recovery: A Strengths Recovery Self-Help Workbook Ridgway, Priscilla; McDiarmid, Diane; Davidson, Lori; Bayes, Julie and Ratzlaff, Sarah
Resources: Websites
Borderline Personality Disorder
http://www.bpdcentral.com
http://www.bpdresourcecenter.org/ http://www.laurapaxton.com/ http://www.biologicalunhappiness.com/ http://borderlinepersonalitydisorder.com
General Recovery Websites
http://www.mhrecovery.com
http://power2u.org
Q&A and Contact Info.
Renee Kopache [email protected]
www.mhrecovery.com
Angela Ostholthoff [email protected]
www.recoverycenterhc.org