Hello,
Everybody,
And welcome to the adult chair on rash pixel FM.
I am Michelle Shelfont.
So today we have a very exciting show on borderline personality disorder.
And I have a very special guest Robin Arthur is with us today.
So this is a show you're not going to want to miss.
There's a lot of great material that we are going to be talking about.
Before we begin,
Remember,
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So everybody I want to introduce first Robin Dr.
Robin Arthur.
She's the CEO and Managing Director of transform consulting LLC.
Dr.
Arthur has several decades of experience providing transformative solutions for individuals and organizations in business and healthcare.
She maintains a clinical practice,
Previously having helped found and serving as chief of psychology for the Linder Center of Hope,
One of the world's premier mental health facilities near Cincinnati,
Ohio.
Now in private practice,
Dr.
Arthur also serves as a business consultant,
Trusted advisor and coach to individuals and organizations nationally and internationally.
That's quite the bio Robin.
Welcome,
Robin.
So I'm so happy to have you.
It's nice to be with you.
Thank you for having me.
We throw these terms around very loosely,
Whether it be,
I'm codependent,
I'm narcissist,
Or so and so's a narcissist,
And so and so is borderline all of these things.
But I find that the term is very much overused.
So I would love just to begin with what is this borderline personality disorder?
Sure,
I think you're absolutely right.
It is overused.
It's typically used in a very derogatory manner.
And it does a real disservice to people who truly are suffering with a borderline personality disorder.
So in the mental health field,
When we talk about borderline personality disorder,
It's truly a diagnosis,
It's a label that we give,
So we know how to use the right treatment,
Basically,
Not to use as a weapon or as a derogatory comment.
So,
You know,
All of us have personality traits,
And they become disorders when they interfere with our ability to be in relationships or to hold a job or to be successful in school.
So we all have personalities,
They become a disorder and a person who suffers with borderline personality disorder has an ongoing pattern of varying moods,
Their self image is not very positive,
And it's very difficult for them to function in everyday life effectively.
Can you give us maybe some,
Some good examples of what that might look like?
If you say,
So you said a mood disorder,
Give us some examples of what someone would how they would show up in life with borderline personality disorder.
Sure.
Now,
Some of what we need to think about is it depends on how long someone has had a personality disorder.
So I don't like to diagnose anyone under the age of 18.
And really under the age of 21,
With a full-fledged personality disorder.
But leading up to that diagnosis,
They've had situations in life where they work really hard to keep friendships and relationships because they're so terrified of being abandoned.
So they'll jump into relationships full force right away.
There's no like wading into the waters.
It's like,
Oh my gosh,
You're nice.
You're my friend.
We're best friends all of a sudden.
And as you can imagine,
For the person on the other end,
They're not really sure what to make of that.
Right.
So it's intense.
It's unstable with family,
Friends,
Loved ones at work.
And it's,
It's scary to the person who's suffering as well,
Because inside they're just terrified they're going to be abandoned,
Not liked.
Their self-image is very unstable.
So it's also in severe in the more severe kinds,
People are feeling suicidal,
Their moods are changeable very quickly at times.
And they have a chronic feeling of emptiness.
So is there would you say there's a scale of this,
You know,
Can someone be mildly borderline versus an extreme case?
Like if you were,
Can you scale it?
Or is that not a thing?
You can scale it.
And the way I would look at that is,
You know,
There's about 10 criteria you would need to meet for it to be a full-fledged personality disorder.
And you don't need to meet all 10.
But the more that you meet,
The more severe the illness might be for you.
So early on,
When I see people developing this,
I typically would just say there's traits of this going on,
How are we going to effectively help you deal with those traits,
So it doesn't develop into a full disorder?
Would you be able to go over those 10 signs?
Yeah,
And some of them I've mentioned,
But let me give them to you.
So avoid trying to avoid real or imagined abandonment with relationships is one,
A pattern of intense and unstable relationships,
And what we call idealization or devaluation.
So it's that black and white,
You're all good,
Or you're all bad to this person.
Everything's going great,
You might do one thing wrong,
And all of a sudden,
You're not a good person anymore.
But wait a minute,
When you say that,
You're saying,
If I have borderline,
I feel that way about myself,
Or I'm in turn,
I'm feeling that that way about another person outside of myself.
You feel that way about someone outside of yourself,
And about situations outside of yourself.
And then third would be a distorted or unstable self image or sense of self.
So again,
You don't really know who you are,
Which also then creates another criteria,
Which is that feeling of emptiness inside.
So if someone has borderline personality disorder,
Do they know that they feel empty?
Or are they putting a mask over it?
Or just blocking that?
Are they aware of that internal feeling?
It's typically not as apparent to them.
It's,
You know,
When if I see someone with this disorder,
I will say,
Are you feeling empty,
I kind of have to give them words for it initially.
Now,
That's not to say everyone is like that.
Some people will just say,
I just feel terrible.
There's nothing inside of me.
You know,
So there's really kind of a range with that,
Too.
But once you help them to start understanding that it's like eye opening to them.
So yeah,
Really,
It's really important as a clinician or as a loved one,
To be able to help them start putting words to what's going on with their emotions.
That must feel so validating to someone that has borderline borderline,
Or can we just call it so I don't have to keep saying this BPD.
It's what I feel on the inside,
Which is empty.
Oh,
My gosh,
You had to walk around with that for so long and have somebody mirror that must be it's actually one of the hallmarks of a therapist who truly understands the borderline personality disorder.
Because as you can imagine,
As I'm describing all of these symptoms,
How difficult it would be for an outsider to be dealing with this person.
Yeah.
And then they finally meet someone who understands them.
And you're right.
It's extremely validating.
So yeah,
Wow.
Okay.
Yeah.
So let me give you a few more of the symptoms.
Impulsive or dangerous behaviors like spending sprees,
Unsafe sex,
Substance abuse,
Reckless driving,
Self harming behaviors,
Such as cutting,
Or,
And then suicidal behaviors or threats as a real hallmark as the disorder becomes more severe.
And that's why it's also very difficult to find people to treat this particular disorder.
Because as a clinician,
It's very scary to have someone who's constantly threatening suicide,
But not wanting to make changes initially,
They really have to find a clinician who's highly skilled and trained,
Who can be patient,
And yet still hold accountability with the person and and validate them at the same time.
When you are working with someone that has BPD,
Do you find that the threats of suicide are typically carried out?
Or are they mostly threats?
What do you find as far as suicide goes?
As you can imagine,
We never want to take suicide lightly.
Of course,
We're always treating it as if they might follow through until we get enough treatment under their belt where we can say,
You know,
You don't have to do that.
And,
You know,
In the treatment that I do,
Which is dialectical behavior therapy,
Or DBT,
We actually contract with the person when we start treatment that says,
I need you to stick in here with me for at least six months while we get this treatment going.
We do a lot of contracting for safety.
But initially,
There's a lot of threatening going on with many of these people.
And it's a hard call to make.
Are they serious this time or not?
And as you can imagine,
For them,
Inside of them,
They're not always sure,
Right?
They're just reaching out,
Of course,
And their pain is so great on the inside.
That seems like the only option for them.
Right.
And they're typically labeled as manipulative.
And those of us who really understand the borderline personality disorder,
It's not manipulative,
They are suffering,
These people are truly suffering.
And so they're doing what they know,
Before they start learning better coping skills,
They're doing what they know to get their needs met.
Okay,
Keep going over up to,
I don't remember,
Five or six.
I think there's intense anger sometimes or problems controlling anger.
We talked about the changeable moods,
The feelings of emptiness,
And also there's a real difficulty trusting other people,
Which is a lot of times it's accompanied also by an irrational fear of other people's intentions.
An irrational fear.
An irrational fear.
So you can imagine,
The first thing I said is they don't want to be abandoned.
However,
They're fearful to be in the relationship also.
So that's kind of where that borderline comes in where you're like,
Wow,
Can you imagine what that feels like inside?
I want to be close to you,
But I just don't think I can trust you.
It's such an internal conflict.
Right.
Oh,
My gosh.
Okay.
And then lastly,
In a really severe state,
They might have feelings of being cut off from themselves or what we call dissociation.
So observing oneself,
Like from outside of your body,
Or feelings of unreality.
Another terrifying,
You can imagine how terrifying that is.
Oh,
Yeah.
Oh,
Yes.
What is the cause of BPD?
What causes this?
We now kind of look at it as there's more than one potential cause.
So,
You know,
When we think about psychology,
I always think about the bio psychosocial,
You know,
It's your biology,
It's your environment.
So there's,
If there's a family history of someone in the family who has borderline personality disorder,
You are typically at a higher risk.
And then second,
There's brain studies being done.
So that there are some structural and functional changes in the brain,
Especially in the areas that control your impulses and emotion regulation.
And that that's more of an early studies kind of thing right now.
So we don't have as much knowledge about that.
But there are definitely some brain studies being done and some things that are happening in your brain.
And then thirdly,
What most people think of is those environmental and cultural things,
Such as an early traumatic life event,
Or abuse in childhood,
Or even young adulthood,
Or abandonment,
Invalidating unstable relationships.
And these are not necessarily always in your home,
Sometimes they're in your school setting,
Sometimes they're on a sports team.
But if you're a super sensitive person,
So very sensitive person,
And you're dropped into an invalidating environment,
Those two factors combined would put you at higher risk for developing traits of a borderline personality disorder.
So I find that really interesting.
So if let's say a parent is has has been diagnosed with borderline personality disorder.
I just am wondering,
So they have,
You know,
Numerous of these 10 traits that you just mentioned,
They have numerous traits,
Let's just say they have five or 10 of these traits,
Or eight of these 10 traits.
I would just wonder,
I mean,
This is what children would then learn in their household on how and as far as like how to navigate in the world.
So if we have a parent that is borderline,
What are the chances that we as children growing up in that household would not also develop these same traits?
Well,
There's a couple of factors there.
So you are absolutely correct that if you have a parent who is borderline,
And you're in that home environment,
You're probably experiencing a lot of intense emotions from your parent.
And you're experiencing behaviors that are not consistent.
So your parent might be really positive and vivacious and,
You know,
Bubbly one day and the next day their mood changes.
So as a child,
You don't know what to expect.
And so let's say you're,
Let's say there's two children born into the same family,
And one of the children is a very sensitive person.
So that kind of environment for that particular child is going to put them at higher risk.
Let's say your sibling isn't quite so sensitive,
Things roll off their back,
They're more easygoing,
They may survive that childhood in a whole different way and never develop these traits.
Okay,
That makes sense.
Right.
So you're not predestined just because you have a parent who has the disorder,
But it certainly puts you at higher risk and should be really monitored closely,
Hopefully by the other parent,
Or some other person around them.
Sometimes it's a grandparent who's a protective factor.
They can sort of clear things up for that child,
Right?
Exactly.
And provide that stability,
That nurturing.
And as the child grows up,
They can,
You can start explaining to a child some of what's going on.
So do you find that this is misdiagnosed quite quite a bit?
Or what is your experience with that?
Yeah,
I think what makes it tricky is that you can have borderline personality disorder with other mood disorders.
So when we think about diagnoses,
We look at two areas.
One is what we call axis one.
Okay,
And those are your mood disorders,
Your depression,
Your anxiety,
Substance abuse,
Things like that.
Treat it with therapy,
And sometimes medication or the combination of.
Axis two are all about your personality traits.
So the disorders that may develop in there,
There are,
You know,
Multiple personality disorders you can have.
But you can also have an axis one,
A depression,
Anxiety,
Substance abuse,
And then secondarily,
You have axis two,
Which is your personality disorder.
That makes it complicated.
The other thing that makes it complicated is if you think about these symptoms,
They mimic other disorders like bipolar disorder,
Or a really severe OCD disorder sometimes.
What I tell people is,
It's critical to see a clinician if,
Let's say you're being treated by one person,
And you're just not feeling like things are getting better.
It's never a bad thing to get a second opinion and to look for someone who really specializes in the borderline personality disorder so they can start making a really good history for one thing.
And the other thing is,
Are medications helping or not?
So it's not,
You don't always know in the first session,
Oh,
This person has borderline personality disorder.
And sometimes it takes a little while for you to as a clinician to decide,
We need to really look at this closely.
So,
Yes,
There's a lot of misdiagnoses.
And I would say probably one of the most common ones is the bipolar disorder and borderline personality disorder,
Because they can look a lot alike.
So what is the difference between those those two?
Like,
What is the clear difference between those two diagnoses?
If you have a person who has a bipolar disorder and you start them on a mood stabilizer or other medications that have been found to be helpful,
That will clear the symptoms up.
Or maybe not 100 percent,
But it will help if you have a personality disorder that is treated with psychotherapy.
Medications may help calm some of the symptoms,
But they're not as curative as the psychotherapy.
So if you think about it,
Your personality develops over years and years.
Right.
And your personality is formed by many factors.
So if it takes us,
Let's say,
20 years to develop a personality disorder,
It's going to take us longer in therapy to also solve that problem.
So I've seen people in my practice who,
You know,
They come in,
We diagnose them bipolar disorder.
They start on a good medication.
It works for them and they're good to go.
You know,
Life gets calm for them.
If they're misdiagnosed and they start on a medication and these symptoms are still just really out of control,
Then I would start looking at the personality issues that might be happening.
I mean,
You would say then that it's a difficult disorder to treat.
It is a very difficult disorder to treat if the person is not motivated and if they don't realize they have it.
But one of the hallmarks of a personality disorder is the person comes into treatment and it's all about everyone else.
Everyone else has the problem and they're affecting me.
It's not.
And that's the way a person with a personality disorder sees the world.
They don't realize,
Oh,
I have a personality disorder.
Very rarely will I have someone come into my office and say,
You know what,
I'm here because I have borderline personality disorder.
They typically come in because of an unstable relationship or multiple unstable relationships going on.
And it's usually they're blaming the other people.
You can imagine how carefully you have to tread as a therapist to get them to buy into therapy first.
So there is a lack of awareness then,
Would you say,
With BBT,
BBD,
BPD?
Yes.
And I and I know just in my own experience with this,
I've experienced it's almost been the same kind of thing where they've,
You know,
Maybe hopped from therapist to therapist.
Then they land in my office and there's a lot of blame.
That's characteristic of what I typically see.
There's a lot of blame.
It's not their fault.
And it is.
It seems like to me there's a lack of self-awareness.
And,
You know,
Michelle,
The other thing that makes it tricky is that as as we talked about,
These people are going to see you as black and white.
Right.
If they're getting,
You know,
What they want from you initially and then you start having conversations with them about a potential personality thing that reflects on them.
Oh,
No,
You're not really careful about that.
They're going to decide I'm not going to see you anymore.
And they they flee from therapy.
But it's so interesting to me because there's that internal conflict again,
Because they've bonded with us as therapists or coaches.
And so they don't want to at least in my personal experience,
They don't want to let me go.
But they also don't want to hear what what I believe might be BPD.
So it's this internal conflict,
Like,
I don't want to let you go,
But I hate you.
Yes.
It's both.
It's the same exact time.
So I hate you.
Don't leave me.
Exactly.
That's exactly it.
I hate you.
But don't don't you dare leave.
Leave me.
So don't abandon me.
Right.
Right.
Yeah.
Don't abandon me.
Right.
And that's so tricky.
It is very,
Very tricky.
And that's where,
Again,
That validation piece comes in.
So,
You know,
When we talk about treatment,
Well,
I'll talk to you a little bit more about validation and how important that is,
Because that's really what keeps people in initially.
And it breaks my heart.
The clients that I've had with BPD,
I love like they're beautiful people and they don't they can't see it.
You know,
It's so hard to see this and to be aware of what's really going.
They don't want to go there.
And it really it hurts me.
I want to help them so badly.
Yeah,
It's heartbreaking,
Really.
It's heartbreaking.
Like,
Honestly,
It's heartbreaking.
And I remember I had a client years ago with BPD and there was an ice storm here and I could not leave the house.
And we had had a session in the morning and I had called her and said,
I'm so sorry.
I can't my street is a sheet of ice.
And she was so hurt and took it,
You know,
Like it was a personal hit on her.
And I said,
I'm afraid I'm going to have a car accident if I leave.
And it took her a long time to get over that.
It was like a personal hit on her.
But I honestly couldn't drive down my street.
I couldn't even get out of my own driveway.
So it's tricky.
It's such a tricky thing.
I think the first thing is if we just give them hope,
For one thing,
Because they've been validated by so many people and they're really suffering.
And as you just discussed,
What you did made them feel like you were doing something wrong,
But you weren't having the patience to sit with that as a therapist and us not react to that and just say,
Wow,
I can see how you might feel.
You're not important to me.
And so I can't see you today.
But that's not what's going on here.
Yeah,
Validate what's going on inside of them is I can see you feel that way.
And then you give them the reality on the other side.
I really like that.
So you have to,
You know,
It's about giving them the words.
Yes,
That they're feeling that they're not aware of.
Right.
I love that.
That's,
That's powerful.
Thank you.
I'm glad you shared that.
What do you find?
And I know what you're gonna say.
I love dbt.
But do you find that I should just ask it in this way?
Instead,
Is dbt therapy,
The best therapy for someone with borderline personality disorder?
Yes,
I think so.
Yeah.
I mean,
It's not to say that cognitive behavioral therapy won't work on some level.
But what was I think,
Genius.
Dr.
Marshall Linehan created,
She was a coach.
She is,
To me,
The guru of dbt.
She created it.
She researched it.
She published her book in 1993.
She continues to research it.
And it works.
And I've,
You know,
Before being a dbt trained therapist,
Intensively trained therapist,
I was constantly running into roadblocks with patients with BPD.
And I was like,
What am I doing wrong?
How am I not helping these people?
Dbt gave me a clear methodology that works for me as the treatment provider and works for the patient as well.
So it's a it's a partnership.
And that's exactly how Dr.
Linehan designed it to be a partnership that you're not the expert,
You and the patient are the expert on what's going on with them.
I love that.
So it's a partnership.
I love that.
So it's not there.
So they are not in it alone,
Which is probably what they have felt their whole lives.
They're all alone on the inside.
I like that.
So what do you know about?
Because I was trained in or started the training.
I didn't finish the whole training yet.
But in this,
In this,
Excuse me,
In somatic experiencing.
What about that for BPD?
So this is how we think about BPD.
When you go into treatment,
And Marshall and I hand staged it,
Basically,
The first stage of treatment really has to be about stopping suicidal behaviors and giving the patient the skills they need to then do another kind of therapy.
So I think to jump into the somatic stuff first would not be my preference.
I would do the skills training with the dialectical behavior therapy first.
And that's typically six months to a year.
And then the person's ready to handle the other things.
And I think then they work beautifully together.
So I don't feel that DBT is the only way to treat me.
That's the first line of treatment.
And then let's jump into deeper issues.
So when you look at the stages,
Stage one is stabilizing the patient,
Basically.
Stage two,
You can start looking at trauma or underlying things that are creating somatic experiences.
So you just have to tread very carefully and make sure they have what they need to do that work.
That makes a lot of sense to just to give them the skills.
I like that.
Give them the skills and the tools first,
Then take them deeper into experiencing those emotions that are inside the body.
Makes sense.
Exactly.
Because what the skills are,
They fall into four categories.
The first is mindfulness.
So if you can't be mindful,
You can't learn the other skills.
You can imagine if you're in the midst of all of this emotional suffering,
It's very difficult to be mindful.
So we teach mindfulness.
And then we teach distress tolerance.
What do you do when your emotions go from zero to 110 seconds?
How do you stop them?
Then we teach emotion regulation.
How do you keep your emotions from becoming so intense and lasting so long?
So how do you either stop them from getting intense or calm them down once they are?
And then the fourth thing we teach is interpersonal effectiveness.
So like we talked about,
If you've been totally ineffective at relationships for years and years of your life,
Now we give you a roadmap of exactly how to be interpersonally effective.
And there's a lot of homework and practice and training in groups while learning these four modules.
Typically,
I refer my borderline clients to DBT group therapy.
Is that what you would do?
I think that you lead groups.
Is that true,
Robin?
I can't remember.
Yeah.
But when you say that,
I mean,
I believe that DBT therapy or the group therapy is essential for borderlines.
Would you agree with that?
The group therapy in addition to one-on-one therapy?
Absolutely.
I think there's some research out there that says that initially the group is just as effective as one-on-one.
And I'll tell you my experience with it.
So when I was working at the Lindner Center of Hope as the Chief of Psychology,
We had five groups a week running.
And I was running three of those.
And it's such a rewarding experience because you see the changes in these people from suffering to,
Wow,
I can lead a full life now.
And what happens in the group is it's not a typical psychotherapy group where you sit around and you talk about all of your problems.
You absolutely avoid that.
All you're doing,
It's almost more classroom-like where you're learning the skills.
But what's so rewarding is every week people come in and they did their homework.
And so there's eight or 10 people who say,
Here's how I used this skill.
So you learn from eight or 10 other people a methodology to use the skills.
And that's really,
To me,
Where the significant learning happens is in that group environment where it's safe,
Protected,
And you get eight other ideas about how to use a skill.
So very,
Very effective treatment.
And I think Marsha Linehan,
The way she created DBT is if you're not doing four things,
You're not in DBT.
You're in DBT-informed treatment,
But not full-fledged.
So the four things you have to be doing to be in a full-fledged DBT program is you have to be in individual therapy at least once a week.
You have to be in a group at least once a week.
You have to be able to make coaching phone calls to your therapist.
And your therapist has to be in a consultation group.
That is key that I heard that I typically have not heard from anyone else is that you have to,
As a therapist,
Be supported because we need help.
We need that guidance in helping these people.
So that's important.
I like that.
So I think that you already mentioned this,
But medications,
I don't hear you talking about any sort of medications except for maybe a mood stabilizer.
But I mean,
It sounds like DBT is the way to go.
I think DBT is the way to go sometimes because the person has ended up inpatient multiple times and their mood instability is so great.
We'll use medications to help with the mood swings or the depression initially.
And so while it's not the primary treatment,
It definitely has some benefits.
I've had many,
Many patients who come to me on three or four medications and by the time and they truly need them.
But by the time they finish six months or a year of really good,
Strong DBT work,
They're backed off of most,
If not all of those medications.
Yeah.
So.
Wow.
Okay.
Right.
So I never want to say we don't need medications.
So if someone is diagnosed again with BPD,
What can we expect?
I mean,
I've heard some people have said,
Oh,
It takes 15 years to heal.
It takes two years.
Just on average,
I know that everyone has their own life path.
But do you find that people start transforming this and how long,
Like what do you find with your clients or your groups even?
Sure.
I find it's hard to give an average,
But obviously the younger you are when you start treatment,
The better.
And that's true of any mental health issue.
Sure,
Sure.
And I always want to put that out there because people are hesitant to go into treatment.
But boy,
If you couldn't get in and get it early,
Your treatment length is significantly shorter.
But let's say you didn't get into treatment early and you've been suffering with this a while,
Then I think that first six months of skills training can make a huge difference in people's lives.
And after they,
Now that's assuming they're really putting in the work and they're really using the skills every day in their life and practicing them.
I've had many,
Many patients who come to me after at least one,
Maybe two or three suicidal gestures or attempts.
And within six months,
We have them pretty stable.
And then I would say the second six months,
You do group for six months and then you repeat it for six months.
The second six months is where you really internalize things.
So you know how it is when you're learning something,
You hear it once or twice and you got it.
But when you hear it 10 times,
You really have it.
And when you've practiced it,
You start becoming an expert.
So I think if you can stick in treatment,
The key is to stay in treatment.
And I can't say that enough.
Stay in treatment,
Stay in treatment,
Even when it's difficult.
And that really is just as much on the therapist to keep finessing it with the patient.
But I would say within a year to two years,
You should see significant things changing in your life.
I feel so hopeful right now.
I love hearing you say that because I remember hearing someone say to me,
Oh,
15 to 20 years,
Someone that had a lot of experience with this.
And I thought that doesn't feel right to me.
I don't believe that.
I just,
I didn't believe it.
So I'm hearing you say one to two years.
Of good,
Effective treatment.
So yes,
And,
And,
And effort on the part of the patient.
Yeah.
Make huge changes.
Now,
Let me also say that then you go into maintenance mode.
So I have patients I still see weekly.
I have some I see once a month.
I have some I see every three months.
But their awareness of themselves and when they need to really pull on their skills is important.
So,
I mean,
I think,
You know,
These people and all of us are always going to have our underlying personality traits.
Short of having a brain injury or something that changes us,
Our personality traits remain part of us.
How we deal with our personality traits is what makes our life effective or ineffective.
So,
So you find in working with clients with BPD that eventually they do have raised self awareness and are able to own their reality,
Feel their emotions,
Stop the blame.
Like you really find,
I'm,
I just,
I can't tell you how happy I am to hear that.
Okay.
So I also want to say this,
There's a large part of this population who don't stick in treatment and they don't see the outcomes.
So I don't want it to be that,
You know,
You do six months and you're cured.
Okay,
Right.
But what I find is that you are correct.
Years ago,
Before DBT was really seen across the country as treatment,
A lot of clinicians felt like,
And I could see why,
That borderline personality disorder was not curable.
It was not treatable.
Yes.
And I could see why,
Absolutely.
And what,
What I think Dr.
Linehan did that really changed that was she started researching why are these people leaving treatment?
What,
What are we doing as therapists that's not working for them?
And the big piece that she added in was that validation piece.
So in,
In really traditional CBT,
You pay less attention to the emotional side and you pay a lot of attention to the thoughts and changing behaviors.
CBT really pulled in that psychodynamic Carl Rogers,
Unconditional positive regard for your patient.
Yeah.
And so by having that in the patients and by validating their experience,
The patient stayed.
They were like,
Oh,
You get me.
You understand this.
Yes.
If I have a patient who comes in and says,
You know,
I cut myself yesterday.
And the first thing I say is,
Okay,
I can see why what was happening made you feel so awful.
You felt like that's all you can do.
Whereas maybe a therapist in their past has said,
Well,
You know,
You shouldn't be cutting yourself.
Right.
That didn't validate them.
That just made them feel shameful.
Of course.
I say to them,
I get it.
I get what was happening was so awful that you felt like that's what you needed to do.
So that's the validation piece.
Then I give them the problem solving piece.
What other skills could you have used in that moment?
So you're,
It sounds like you are creating new neural pathways by asking that question.
And number two,
They're getting the validation that they never received as children.
Correct.
Beautiful.
Absolutely beautiful.
I love it.
Answer this quickly,
If you can,
For me,
I know that we're getting close on our time here,
But I have a couple more questions for you,
Robin.
What's border,
You know,
Some people throw,
And I don't think you answered this already,
But some people throw the word borderline,
Not only for,
They confuse it for bipolar,
But also being a narcissist.
They go,
Oh,
You know,
He's a narcissist or she's a narcissist.
I'm like,
I don't think so.
That sounds like borderline to me.
Do you find that as well?
That people get confused about those two terms?
Yes.
Sometimes I've seen that.
And one of the,
One of the ways I can differentiate is it's,
It's more,
Much more difficult in my mind to keep someone who's a narcissist in treatment.
So,
Yeah.
Oh yeah.
Because they will invalidate you in a different,
A little bit different way.
Nobody's smart enough.
Nobody's good enough.
Nobody could possibly make them better.
But they,
They could also have the same mood instability that a person with borderline personality disorder has.
And that's why it's so important for the clinician to be well-trained to be able to make that differentiation.
Okay.
This is a question I know that so many listeners really would like the answer to,
Which is what should family members do if we are realizing that perhaps someone in our family has BPD?
How do we engage with these family members?
How can we help them?
Because we,
I,
I have had many clients that have come to me and I realize,
Wow,
You know,
Your son,
Your daughter,
Your whomever sounds like they may have BPD,
But I don't know them,
But this is what it sounds like to me.
And they don't know what to do.
They love these family members.
They don't know how to engage with them.
So what,
What,
What,
What can you offer us about that?
I think there's a couple of ways they could deal with that.
One is first helping them to understand that if the,
If they do have BPD,
That that person is not acting that way to hurt the family.
Okay.
So it,
And then also validating your patient that this is really stressful to deal with and that it needs to be carefully dealt with.
So,
And then second,
Keeping your person,
The family member in treatment is important.
So I typically recommend that anyone who may have a child or a husband or a wife who has borderline personality disorder,
They be in treatment themselves and get really educated about BPD because sometimes what happens is the relative can unintentionally act in ways that worsen their loved one's symptoms.
So,
And one of the things that happens is they treat them as if they're fragile.
And another thing that Dr.
Linehan said is our patients are not fragile.
We don't fragilize a patient.
We treat them as if they can make changes in their life.
That's one of the assumptions we make about patients is you may not have caused your problems,
But you can change them.
A caregiver or family member may be treating the person as fragile and not making them accountable because they're afraid to make them accountable.
So let's say it's early on and the person's loved one doesn't acknowledge they have BPD.
I would typically try to get them in therapy for something else.
You know,
Why don't you go try some stress management therapy,
Or,
You know,
Maybe you're a little bit depressed.
I would look to get them in therapy for something that's true.
We don't want to make something up,
But really hit it from that perspective,
Not go at them with the,
You know what,
I think you have borderline personality disorder and you should get into treatment.
Oh,
No,
No,
No.
It's not going to work.
It does not ever work.
But the other thing is,
I just want to share this with everyone that is hearing the show is make sure if you're going to recommend that your family member goes to a therapist and if that person is doing the research on the therapist,
That that client that that therapist has experienced with borderline personality disorder,
Because if they don't,
They will miss it.
They will miss all.
I mean,
I hear this all the time.
It's missed all the time.
So make sure that therapist knows something about this and then refer your loved one to that therapist again,
For another reason,
For depression,
For anxiety,
For stress or something mild.
Let me ask you this,
This question,
Because this has come up in my practice.
So if,
If a I'm trying to think of this one client that I had,
This woman was,
I think,
In her late 50s and her daughter was in her 30s.
And she was,
The mother was seeing me,
Said,
I don't know,
I keep doing everything wrong with my daughter and she keeps raging on me,
Et cetera,
Et cetera.
Well,
After,
After having a couple of sessions,
I said,
I really think your daughter might have a borderline personality disorder.
But the mother said,
Well,
How do I stop making her go into rage?
Because her mother honestly wasn't doing anything that I,
That I was aware of that sounded like that it deserved rage.
But what do you recommend to people that are just pushing the buttons because their children are so,
They are,
What's the word I want?
They're triggered so easily.
Okay.
Or whether it's a child and you're an adult child and your parent is triggered so easily.
So how do we,
As family members deal with that when we get so much anger or rage back on us?
What do you,
What would you say to that?
How can you help us?
Yeah,
I think in that situation,
Basically what's happening is the,
Their family member has maladaptive abilities to regulate their emotions.
So that's where the rage comes from.
And so a family member is not going to be able to deal with that easily.
So I say,
Don't engage,
You know,
Just say,
I mean,
You could initially say,
Let's think of some other ways to deal with this issue and then see how receptive the person is.
And then if,
If they are receptive and they've learned a few other things,
Then when the rage starts happening,
You could say,
Remember,
We talked about other skills,
But honestly,
The less you engage the better,
Because engaging with them just escalates the situation.
So are they,
Cause you know,
The first thing that I would say,
If I don't know if they're BPD,
I would say,
Well,
You need to set a boundary.
Let's talk about setting boundaries.
When they try to set a boundary though,
They might get raged on,
Let's say.
So what I think I hear you saying is just don't even engage,
But not to the extreme of cutting them off altogether,
But just maybe walking away or again,
Having the understanding something bigger is going on here.
You know,
It's not just that this person has anger issues,
There's something bigger going on.
So it's just letting it go is what I think I'm hearing you say.
Just let it go and just don't engage.
Let's talk when you calm down,
Or maybe they put it on themselves and say,
You know what?
I need to calm down before I can talk.
It's safe for the other person to say,
Fine,
You you're right.
You should calm down.
Okay,
Fine.
But I think the boundary setting is important.
And that's the other thing about CBT therapy is it does set boundaries with patients.
So it teaches them how to start setting boundaries as well.
So it's just vitally important.
Okay.
But that's,
Again,
That's such a hard one when if someone's so angry or,
You know.
Very difficult.
Well,
You can't do it in the moment.
No,
You cannot do it when they're dysregulated.
It has to be something that's talked about when everyone's calm.
But then again,
Like if you're walking away,
And someone's so angry with you,
They're going to get even more angry.
So it's like,
What do we do if we're in the middle of something like that,
And someone is very angry and yelling at us?
How do we respond to that?
I led a group of all moms of kids who were potentially BPD in the making.
They had traits of BPD.
And so the moms came to me,
And we formed a group where they just learned all the skills.
Oh,
Wow.
And then they started using them with their child,
Adolescent child.
And it blew me away how effective that was.
So can you share with us just like two of the skills that you could pass on to anyone that is hearing the show that needs some help?
Sure.
So the distress tolerance skill that is a real go-to as far as I'm concerned,
Is what we call the TIP skills.
T-I-P.
So TIP,
The T stands for temperature.
So changing your body temperature.
So as long as the person doesn't have a heart condition,
You use ice.
And so if they're emotionally dysregulated,
They're in a crisis,
They can't calm down,
We put ice on your forehead.
So put it in a washcloth or whatever,
Put it on your forehead,
And hold it there for about 30 seconds.
It creates what we call the dive reflex.
And it just pulls that emotion down.
And it is very effective.
So I challenge anyone to try it.
It works for all of us.
Okay.
But so that changes the TIP or the T.
The I is intense exercise.
You don't want to use the ice.
Go run up and down the steps five times.
Do some jumping jacks.
Play basketball for five minutes.
Expend the energy.
That's the intensive exercise.
And then the P is what we call progressive muscle relaxation or paired muscle relaxation with also some cognitive restructuring of your thoughts at the same time.
So,
You know,
That's a whole module we would teach.
But very effective skills.
And then if the person starts becoming dysregulated,
We just say,
Use your TIP skill.
And they know exactly what it is.
And then they use it.
Very effective.
I mean,
When somebody comes into a group,
And then they all go home and practice this skill,
And eight people come back and talk about how it helped them,
You know,
It's working.
And what's the earliest?
This is my last question for you.
But what's the earliest age that you have seen this diagnosis?
I know that you said you won't diagnose until 18 or 21.
But at what age might we start to see some of these characteristics of BPD?
Well,
The thinking now is that you can start seeing a little bit of it in early childhood.
But definitely by about age 11,
12,
13,
It's starting to pronounce itself more.
That's personally why I think DBT skills should be taught in every school in America,
At probably the eighth or ninth grade level.
And there is a curriculum for it.
So yeah,
So it's definitely a passion of mine.
So are there common characteristics that we would see that would start showing up around 11,
12,
13?
Well,
When I teach adolescent DBT,
Or I give presentations about it,
I read all the borderline personality characteristics.
And I say,
So it sounds like just about every adolescent,
You know,
Doesn't it?
That's so true.
Adolescents are kind of borderline,
Right?
Yeah,
They are.
The key to teaching it at a young age is preventative.
Okay.
So if we can teach adolescents who haven't really gone into full-blown borderline personality,
But if we can teach them at a younger age to regulate their emotions,
To distress tolerance,
And to be interpersonally effective,
How much more effective is this whole generation of kids going to be?
If we can get that into all of our schools,
Right?
Love that.
Okay.
Thank you.
And another thing I do want to mention,
Michelle,
Is that DBT has been implemented in 25 countries across six continents.
Wow.
So it's very well developed in research and evidence-based.
Is there anything else that we would use DBT for?
Or is it just BPD?
Oh no,
It was normed originally for BPD,
But boy,
It's used for a variety of things now.
It can be used for things like attention deficit disorder.
It can be used for post-traumatic stress disorder.
It's very effective for substance abuse addictions.
This is what I'm thinking.
I'm like,
Gosh,
I would use this for so many other things.
I just know a little bit about it.
I certainly don't know as much as you.
I absolutely use some of my DBT curriculum with almost every patient I treat.
And it is very effective for bipolar disorder as well.
Even a person with bipolar disorder who doesn't have borderline personality disorder will absolutely benefit from DBT.
So it's not a narrow focus anymore of who we can treat with DBT.
Robin,
This was like a great conversation.
I really,
Really appreciate it.
I mean,
You're a wealth of knowledge.
This has been fabulous.
Thank you.
I mean,
How many years?
You've been doing this for 30 some years?
Did you say that?
Not quite that long.
I started when I was about 10.
I just want to say thank you for all of your work with this.
I mean,
Absolutely.
This is so needed in our world.
And I just really appreciate what you're doing.
It's beautiful.
Okay,
Robin,
Tell us all,
How can people find you?
Well,
First of all,
Do you do phone sessions?
Do you have any upcoming groups if people live in your area?
The best way to find me is my consulting company,
Which is transformconsulting.
Us.
So it's all one word,
Transformconsulting.
Us.
I love the balance I have in my life between clinical work and business consultation.
So I do clinical work in my office.
And I do business consultations over the phone or in person.
So it's two separate companies.
I'm not working under my clinical license when I'm doing business consultations.
So my master's degree is organizational psychology.
So it's a really good mix for me.
I work with hundreds of professionals who aren't in clinical care with me,
But C-level executives,
Boards of directors,
Businesses who have relationships and dysfunction in their organizations.
And so I just go in and help them to become more stable.
Okay,
Or executive coaching.
I do over the phone quite a bit across.
I have clients across the country who I do things like that with.
And then also I cleared my calendar a little bit recently to put together some webinars and some of my own podcasts.
And they will be on my transformconsulting.
Us website.
And they range in scope from women aspiring to leadership,
Executive effectiveness.
I'm really excited about adolescence and social media.
And then some parenting things as well.
So a full range of stuff.
And I'm getting ready to put some more together.
So over the summer,
Especially,
I'll be adding quite a bit to the website.
So again,
Transformconsulting.
Us.
I love that,
Like you,
Michelle,
I love that you can put these things up.
And so you can help so many people by having a podcast or a webinar.
Yes.
Whereas one-to-one,
Face-to-face,
You only can help so few people compared to what you can do now with all of our social media things.
So true.
So true.
Do you also do phone sessions for people?
Yes.
Now,
As a clinical psychologist,
You can't operate across state lines.
So I'm limited to Ohio for clinical work.
But for coaching work,
In my transform consulting,
I do anywhere,
Basically,
In phone sessions.
So people can go to your website,
Which we will,
By the way,
Everybody,
We will put her website in our show notes.
And so if you would like to go there,
You will see exactly.
Tell us one more time what it is,
Robin.
It's transform consulting.
So transform consulting,
All one word dot us.
Perfect.
Perfect.
And I'm excited for these webinars coming up.
That'll be great,
Robin.
Thank you.
Thank you.
It's been great to be with you,
Michelle.
I know.
Thank you.
So everybody,
Robin has given us a wonderful book recommendation for BPD.
And just remember,
Today's podcast is sponsored by Audible.
And you can get this book for free.
I love it.
It's a 30 day free trial at www.
Audibletrial.
Com forward slash the adult chair.
So the book that Robin has recommended for us is called Stop Walking on Eggshells by Paul T.
Mason and Randy Kreger.
Again,
It's called Stop Walking on Eggshells.
And that is available on Audible.
You can go to www.
Audibletrial.
Com forward slash adult chair.
You can get it for free.
So Robin,
Thank you so much again.
This has been fabulous.
I am so excited to put this one out into the world because people really need to understand what this is.
And I again,
I am so grateful to hear you say and excited to hear you say six months to a year or so that just gives I mean,
My own clients that have BPD hope and you've given me a lot of hope.
So thank you.
Thank you.
It's been a pleasure.
Yeah,
It's been amazing.
Okay,
Everybody.
This is Michelle Shelfont and Dr.
Robin Arthur.
And we are signing off and I will see you next week seated firmly right here in the adult chair.
