Podcast: What BPD Can Teach You About Managing Emotions
In this episode, Lois W. Choi-Kain, MEd, MD, provides tips on managing emotions that she has learned from treating patients with borderline personality disorder (BPD)—including ways to manage crises through emotional regulation.
Dr. Lois Choi-Kain is the director of the Gunderson Personality Disorders Institute at McLean Hospital. The Gunderson Institute provides intensive, specialized programs to train clinicians in evidence-based treatment methods, including mentalization-based treatment (MBT), dialectical behavior therapy (DBT), and DBT for post-traumatic stress disorder (DBT-PTSD).
Jenn: Hey everyone, welcome to Mindful Things.
The Mindful Things podcast is brought to you by the Deconstructing Stigma team at McLean Hospital. You can help us change attitudes about mental health by visiting deconstructingstigma.org. Now on to the show.
Alright, hello everybody. We are just about ready to get started. First of all, thank you so much for joining us today. And we hope that wherever you are that you are doing well and are staying safe and healthy.
I’d like to introduce myself. I’m Jenn Kearney. I’m the digital communications manager here at McLean Hospital, and I’m personally really excited about this webinar today.
So, over the next 45 minutes, Dr. Choi-Kain will walk us through lessons learned from borderline personality disorder treatment, which will help us manage heightened emotions, embrace key components of our personalities, and overall just become more comfortable with uncertainty. She’s also going to share techniques to be collaborative in high-stress situations, how to regulate our emotions and get back on track
Last but not least, for those of you who are unfamiliar with Lois, Dr. Choi-Kain is the director here at McLean’s Gunderson Personality Disorders Institute. So, without further ado, Lois, I will pass it over to you.
Lois: Okay. Good afternoon. I want to start by thanking you for this opportunity to speak to you about how we can manage these difficult times and the many emotions at hand by thinking about our personality functioning. The unsettling combination of massive chaos and pervasive isolation of COVID-19 reproduces for all of us the tensions between urgency and disconnection that individuals with borderline personality disorder contend with every day.
What I hope to do today is share some distilled lessons that I’ve learned from providing evidence-based treatments for borderline personality disorder. And this experience of working with patients and families in these treatments have enriched my life to enable me to stay steady in the face of tumultuous times. What I aim to do here is to provide some pearls of wisdom from these treatments, rather than be exhaustive about the complex techniques or the elaborative content so that these kernels of what hopefully will seem like common sense to you will be more immediately useful when simplicity is key.
And hopefully they will help you manage your own intensities, isolation, disorientation, and challenges throughout these times of COVID-19, whether you’re a person that’s struggling with these problems, a family member or caretaker of somebody who struggles, or a clinician. For those of you who are clinicians out there, this boiled-down cheat sheet does not require intensive protocol to administer, but might be a useful source of pragmatic focus for your work with patients.
Just to start with, I want to talk to you about what personality involves. We all have personalities and we’re all prone to having ups and down in how well our personalities work for us in any given situation. Unfortunately, there is a great deal of stigma surrounding personality disorders, which closes down our ability to think and talk about personality dysfunction openly and productively.
As the director of the Gunderson Personality Disorders Institute, I spend a lot of my time educating professionals to more openly disclose the diagnosis of personality disorder to their patients, with the aim to empower and collaborate with their patients on an effective treatment plan that gets both the clinician and the patient their goal. But at the same time, it’s also true that patients and their families have mixed reactions to being told about the diagnosis of a personality disorder. I can remember many times when patients have responded to my disclosure of a diagnosis by saying something like, “Are you saying there’s something wrong with my personality?” And my response is simply honest. Yes, I am saying that the way that your personality works is not helping you cope or relate to others in a way that’s reliable or satisfactory.
In fact, the way that our personality functions determines how vulnerable we all are to injury, illness, and instability. Personality functioning encompasses how we understand and manage our reactions, how we behave, how we relate to others, how others see us, and how we see ourselves. If we can improve our personality functioning, we can become more resilient to the stress in our lives. Really, borderline personality disorder represents a general way in which personality can become dysfunctional in the most strained and deprived of times, with features of emotional instability, behavioral dyscontrol, self-destructive tendencies, interpersonal turmoil, and damaged self-esteem. And these are all tendencies we encounter to some degree in tough times.
We can think about personality as an envelope in which we contain our psychologies that holds together what happens in our minds while we’re navigating the journey to various destinations. The intensity and volume of what’s inside gets to be too much at times and challenges the integrity of the envelope. Equally, the environment outside, the conditions in which that envelope has to travel, also can stress and disturb the envelope to cause it to break down. And when that envelope doesn’t cohere, its contents spill out and get lost. And when it’s too rigid, it might not move easily along the way to its destination. So, if you think about personality in this way, there’s this balance between being coherent and also flexible.
Most treatments that work for BPD really do emphasize some form of this kind of moderation and balance between extremes so that we can hold ourselves in a steady center rather than seesaw with the ups and downs of life. It facilitates reflexive action and provides clear division that guides action.
Okay. So, when we get to extremes, we can all experience some black-and-white thinking, seeing things as good or bad, rescues or threats, for us or against us. And this gives life a set of very clear handles on what we can do, how we are to think, and how we are to act. However, there’s a cost to this form of thinking. Despite its clarity, it creates polarized options in terms of what we can do about any given situation. It really destabilizes relationships and gives us a very narrow channel in which we can manage our self-esteem.
So, that really challenges our personality functioning when we get to black-and-white. It challenges our psychological envelope to maintain coherence and hold it together when there are extremes inside of us guiding our behaviors, our feelings, and our relationships with others. So, this coherence in how we’re carrying ourselves through our personality functioning is crucial for us to understand for ourselves so that we can operate in a way that we can manage reliably and that other people can predictably interact with, okay?
So, towards the end of describing some key concepts we can use to stabilize our personality functioning, I’m going to share with you a top 10 list of lessons learned from evidence-based treatments for borderline personality disorder. Another title for it could be, “Everything I needed to learn, I learned from the treatment of borderline personality disorder.” So, I’m going to go through these top tips and I want you to think about them as guideposts in your process rather than things you might actually say along the way, especially if you’re a clinician. It can come across a little bit like you’re a Magic 8-Ball if you’re just kind of revolving through these sayings. They’re not exactly meant to be responses, but they’re meant to be ideas that you can use to guide your responses to either other people in your lives or to the stress you’re facing in your own situation.
The first lesson learned from evidence-based treatments for borderline personality disorder that I’d like to share is that emotion dysregulation is a snowball. And the opposite is also true, that emotion regulation is a snowball. Now, the title of this talk today was about controlling our emotions, and Jennifer and I had a conversation about this. On the one hand, I think we all seek to control our lives and our emotions. It gives us a sense of confidence. It relieves us of anxiety. It gives us a plan to feel like we know what will happen and we’ll know what we can do about it. And yet, control is hard to sustain, especially at times like this when there’s a vast degree of uncertainty about what’s going to happen from week to week and a lack of control over what we can all do about it. So, the treatments for borderline personality disorder often focus on what we call regulation, just managing what happens in our emotional experience rather than aiming to control it outright.
So, I’m going to start with the problem of emotion dysregulation. Everyone experiences emotion dysregulation when emotions are running high and times are full of stress. When I say emotion dysregulation is like a snowball, it’s something that starts with negative emotion that challenges us all to react in a way that’s effective. And when we encounter these emotional bumps in the road, it’s easy to react sub-optimally. And when we make these missteps in our management of emotional problems, what can happen is that we have an emotional event, we don’t react in a productive way, that creates more problems that then we’re more challenged to address effectively, and then that may make us more sensitive to everything and more reactive in a way that further builds steam in causing us to react in a way without thinking, planning, or seeing the big picture around us in terms of the problem.
So, when we are all in a state of emotional dysregulation, it’s hard to reverse it because it has a certain degree of momentum and it’s already accumulated some emotional steam so that the first order of business is just trying to achieve some stillness. So, to stop the freight train of emotional regulation, we have to somehow get ourselves to not react as a first step. And stopping our reaction allows us to start by thinking, thinking about what’s going on, thinking about what you’re limited in doing. That actually helps situate yourself and allows you to start planning your next move forward.
A lot of treatments for BPD really instruct us to do nothing, whether you’re a patient or a family member or a clinician, that we can feed into emotional dysregulation by reacting too quickly. So, stopping, taking stock of the situation, understanding it more clearly, understanding better what you can and cannot do and what your aims are may be the first step. And a lot of energy has to go into just tolerating and accepting what happens before you can actually productively cope with it.
Now, the good news of this is that emotion regulation is also like a snowball and it can start to build on itself. It’s important to have realistic expectations about our ability to cope with our emotions. We have to start somewhere and start with something that’s achievable. On a basic level, emotion regulation is helped by taking care of ourselves. And this is something that has been much-emphasized in the age of COVID-19, just basic self-care: sleeping enough, eating in a healthy way, moderating your use of substances and medications, taking care of physical illness, having positive events, feeling a sense of mastery and control. These are ways in which we can all actually reel back into the basic elements of self-care so that we can decrease the scope of control we’re trying to achieve in an arena that we do have some level of leverage.
So, starting with self-care, it’s really important to not neglect the basics. And this is oftentimes easy to dismiss or sweep under the rug, but it is really a fundamental bedrock to emotional stability and managing our level of emotional vulnerability. So, as you accumulate more practices of steady self-care, that allows you to actually contend with the negative emotions at hand with more clarity, directness, and confidence. And it really does take that level of stillness and steadiness to be able to contend with some of the emotions at hand. I would encourage patients, in order for people to be able to do this, and when you’re a clinician working with a patient, it takes time. And validating how hard it can be is really important to help encourage that patient to know that what they’re doing is useful and effective and worth doing, even if the results are not immediately evident.
So, emotion dysregulation is a snowball. It can kind of gain steam and get really out of control. And emotion regulation is a snowball which can gain momentum and just build over time so that you’re more and more resilient to the stressful events that come your way and you’re more able to stay on track and stay ahead of these problems in terms of their management if you’re consistent with these practices.
Now, relatedly, borderline personality disorder has been also conceptualized as a problem of interpersonal sensitivity. So, interpersonal dysregulation is also like a snowball. It’s something that can happen under times of stress when people are in close quarters and having intense interactions that are dysregulated, unstructured, and unpredictable. And once you start having negative interactions with other people, these can snowball so that you become highly sensitized to these interactions, expecting the worst and unable to appreciate the best aspects of them. And when you’re in this space, it can be incredibly threatening and incredibly isolating.
So, doing some work to recognize that you’re rolling down the hill of gaining steam with your interpersonal sensitivities, and dysregulation is really important as well. It’s not just about emotions. It’s about how those strong emotions will challenge fulfilling interpersonal interactions. So, the opposite is also true. If you start relating to people in a way that’s more direct, more clear, and more accurate to how you feel and what you want, the likelihood of getting the same in return is higher.
So, what I would encourage here is really working on your communication about where you are, first of all with yourself. Where are you with things? How are you feeling? What does it cause you to want to do? And what do those actions mean in the scope of what you hope to achieve? It takes time to think about these things. And having time and space for yourself so that you can regulate how sensitized you are and how extended or stretched you are by relationships allows you to take on as much as you can handle.
And your psychology will often tell you when you’ve taken on too much. You may become irritable. You may become depressed and withdrawn. And those are signals within yourself that you may need to do something different. And it’s okay in this time of this pandemic to feel that way. I really want to be careful to not convey that you should feel a certain way about any given aspect of this unprecedented experience. But what I am saying is that you can best manage and regulate both your emotions and your relationships by giving yourself time and space to think.
Some of this could be achieved easily by just having structure in your day. I know we have all had to reinvent the way we organize our time each day. For me, it’s been a daily revision. And this has undermined years of working towards a schedule that helps me flow through the demands and responsibilities and goals I have in a manageable way. So, we’re all reinventing that wheel. And what we can do in terms of regulating our emotions and interpersonal interactions is that we create a time and space for things to the best of our ability; so, a time and space for your relationships, a time and space for other pursuits, including time and space to think. So, whether this is achieved by getting in your car or taking a walk or putting on headphones and going to a space that’s slightly removed from others, whatever it may be, having space for yourself to process, to acknowledge, and then cope with your emotions and your experiences so that you can actually enhance the way you interact with others is well worth the effort.
So, that’s the first lesson learned, and it might be one of those more broad lessons. The second lesson learned is that acceptance of painful realities is the road to surviving pain with less suffering. This is a lesson that is hard to employ. And by that I mean that reality has been a very difficult presence in our lives right now, both because it’s unfamiliar, it’s chaotic, it’s threatening to lives, it’s threatening to our financial stability, it’s threatening to our relationships, and it’s threatening to our identities. Many aspects of how we understand ourselves have been reduced or taken away because of the needs to physically distance ourselves, not go into our places of work, not interact with people that we generally interact with, and that is a very hard thing to cope with. The reality at hand has undermined a lot of what holds us up and defines us.
So, there’s nothing that we can do to avoid the pain of the situation that doesn’t cause more problems. So, while it’s normal to want to reduce the pain of this current reality, the first order of business is accepting it. If you accept that this is a situation in which you lack control, you feel helpless, you have losses, you have to redefine yourself, you have to reinvent the way you do things, while it brings a lot of pain, what it does is clear the way for processing your emotions about all of it and then more effectively coping through gaining clarity about the problems to be solved and the problems to be accepted.
Now, when people avoid acceptance of reality for various reasons that are completely normal and completely sane, they undermine their own ability to resolve their emotional experiences and create effective plans of actions, and this happens really innocently. If you have a loved one who has a problem and you don’t want it to be the case and you dwell in a space of saying, “It shouldn’t be so,” it makes it harder for you to take care of the emotions you do feel about the current status of your loved one’s situation. And as those emotions remain unprocessed, the really build up and become distorted. In the moment, you may feel sad about something; that’s completely understandable. But if you don’t process that, it builds up with a lot of other emotions that occur along the way and it’s extremely difficult to locate the sources of those emotions and the solutions to the problems that have generated those emotions.
So, acceptance of painful realities provides a foundation or an anchor on which we can start accepting our emotions, resolving them, communicating them in effective ways to gain the support we need, and problem-solving to the extent that is possible. And when we don’t accept painful realities, it actually produces more suffering by undermining our abilities to take care of ourselves and others.
The third lesson learned from treatments for borderline personality disorder is that uncertainty is both uncomfortable and essential. Now, we live in a time of massive uncertainty, I think, unprecedented uncertainty, and we all like to have answers. I can recall in the early days, I think there was a profound urgency, an intense pressure to get answers about things. And for a long time, pre-COVID, we had the luxury of more certainty, more stability, more predictability in a way that we don’t now. But starting with this uncertainty, it allows us to actually ask questions and embrace a not-knowing position so that we can actually observe something new. This is an unprecedented time. Nobody has a manual or a handbook to manage this. And we would benefit from taking stock of what’s actually going on around us before we make determinations about what it is and what it is we need to do.
Now, the urgency to know and act is really normal in the face of all these threats. But again, embracing uncertainty so that we can be more flexible about the avenues in which we can cope with both our internal and external problems is essential to being present and engaged with our current realities.
The fourth lesson of evidence-based treatments for borderline personality disorder is that extremity is reactive and clarity is achieved. I said in the introduction to this talk that black-and-white thinking is a common element of personality dysfunction. We all get to a place of that degree of polarization. And there’s a way in which our minds work sensibly to divide things into good and bad so that we can take a rapid course of action. However, that rapid course of action tends to be urgent, intense, and specific in a way that doesn’t allow flexibility or a change in course to an ever-evolving problem and our ever-evolving understandings of those problems.
So, taking time to assess the ups and the downs, the pros and the cons, the many sides of a situation allows us to incorporate all of those elements into a more coherent picture of what’s at hand so that we can figure out how we will also coherently cope with it; that is, how do you manage what happens in terms of your emotional reactions? How do you cope with the behaviors that you’re prone to use that are either ineffective or self-defeating? How do you organize a more effective plan of action so that you can meet your goals and feel sense of competence and self-esteem? And how do you interact with others so that you feel understood and you can broker collaboration in your goals rather than conflict and opposition?
So, extremity does breed rigidity, intensity, and polarization so that collaboration can be rather difficult. But when you start from the middle ground, pulling in all the separate pieces of the picture, whether good or bad, you center yourself so that you have a broader view. You see the forest through the trees. And you can be clear about the elements of the problems and how they fit into big picture.
The fifth lesson learned from evidence-based treatments for borderline personality disorder can help with this aim to be more clear, and that is by being more descriptive rather than judgmental. What I’m not telling you to do is refrain from having judgments because we all have judgments. It’s the way that our minds integrate how we feel with our interpretations of reality and what we want to do about it. However, they’re very shorthanded. They’re not very informative. And like I just said, extremity is reactive. Judgments are reactive. They inform us about our feelings and our immediate point of view, but they’re not the same as reality.
So, when you actually pay attention, and this is kind of the goal of mindfulness, when you pay attention to the reality at hand, you can be descriptive about what you see, what you feel, what you sense, and this is all observational. And what it can do is get you on the same page with the people who are there around you. It’s harder to coordinate judgments, because those are deeply personal, than it is to get onboard with each other’s observations. Because they happen from different vantage points, they’re not laden with the emotional investments that judgments are. Being descriptive gives you more entry points with which you can intervene on problems too, that the more information you provide yourselves and others about a problem at hand, the more possibilities you have for tolerating the situation together or problem-solving it in a organized and collaborative way.
The sixth lesson of evidence-based treatments for borderline personality disorder is to aim to be effective rather than right. Everybody enjoys being right some of the time; I know I do. And it gives us a sense of comfort, it gives us a sense of stability, and it gives us a sense of confidence in the face of challenges. However, it can be blinding in the sense that being right can overpower our efforts to be effective.
So, when I talk about being effective, I’m talking about achieving your aims. If your aim is to find a solution to a problem and you’re stuck in feeling like your way is the right way, it can really interfere with getting to a solution, because sometimes you’ll need to rely on other people in order to broker solutions to a problem. And getting more flexible and being joined in your goals allows you to be effective together rather than this win/lose proposition about being right or wrong.
So, when you observe that when you’re in a dialogue with someone that you’re trying to work with in coping with a stressful situation, figuring out what your goals are, trying to observe them and describe them in a way that you can collaborate with the other person, and then aim to be effective and negotiate with that person rather than being fixed on one way of doing things or your way being acknowledged as the right thing to do can help you feel more empowered and more effective at the end of the day and it can help you feel more satisfied with the outcome.
The next lesson learned from evidence-based treatments for borderline personality disorder is that curiosity opens conversations, trust, and learning. Now, I admit that it’s very difficult to be curious during times of stress. I think it’s a natural reaction when confusing realities are at hand to say, “Why me? Why is this happening?” And that actually is not as much driven by curiosity as it is driven by sometimes the need for answers to relieve anxiety, and that’s okay.
At the same time, curiosity is a little bit different. It really embodies an attitude of asking questions rather than finding answers so that you can open up conversations and learn. Sometimes, we all get fixated in trying to achieve certain outcomes, especially when it comes to relationships. So, if you’re one of those parents who are struggling at home with trying to balance the demands of work, whether they’re work demands of managing your household or work demands in a professional setting, while at the same time managing your children and the expectations they have with homeschooling or other endeavors that they’re involved in, it’s easy to really interact with others in a way that aims towards getting exactly what you want. You want your child to do a certain thing. But that can actually close down your curiosity and the openness in your dialogue with whoever you’re working with.
So, when you actually start a conversation with emotive listening, wanting to know, not knowing, it allows the other person to say what’s on their mind, and people will talk to you when they think you’re willing to listen. And this is where trust starts is that when you feel like another person is listening and is curious rather than fixed on getting a certain outcome, it really facilitates the trust that person has in interacting with you, that the path that you provide in the relationship is not so narrow and not so much in conflict with theirs.
And this is where people can learn together is in an environment where uncertainty can be tolerated and curiosity can be at the leading edge. People can learn more creative ways to manage a new situation or make a situation that’s familiar a new experience. And it’s with the opportunity for openness, curiosity, and trust that social learning can begin. And what we’ve learned from the world of personality disorders treatment is that oftentimes with personality disorders don’t feel understood by others and don’t feel that others really want to know what their experience is, what drives their behavior, why they do what they do, what it is they want, and this makes it harder for them to feel open to interacting and also learning from that person. It makes it feel like what that person has to offer isn’t relevant to them.
So, this tip is really about making social learning possible. When you’re interacting with a child, you want to open up their receptivity to learning from your interactions rather than clamping down on trying to get them to do a specific thing. The same thing is true in treatment relationships, that if you can actually hold your goals in mind but also be curious about where your patient is with a given problem and let them communicate openly about it, then you can use what you’ve shared with them to try to learn how to get to collaborating in your goals and finding a path forward from the problem at hand.
And this is also true in peer relationships, friendships, romantic relationships, that being more open as you approach a stressful situation, starting with a desire to learn before you make decisions or set agendas, and then facilitating trust will lead to more satisfying outcomes in general. And that’s a really important message that those with BPD teach us about how to manage relationships more stably.
Related to that is the eighth point that we learn from evidence-based treatments for borderline personality disorder; that is that it’s easier and less costly to control yourself than to control others. As I said a few minutes ago, the desire to be in control is not problematic. That is a normal attribute that everybody wants in order to manage the uncertainties and anxieties of everyday living. However, when we get too controlling, it’s at the expense of flexibly responding and relating.
So, when there are high emotions, what can often happen is an individual who’s especially distressed and also deprived in terms of various resources or adequate support, those people can actually resort to controlling themselves and controlling their emotions rather than understanding and processing and resolving their emotions. Same goes true in relationships, that those efforts to control oneself through behavioral responses like using substances or self-harm or eating disorder behaviors, they actually communicate to others that something’s wrong, but in a very difficult-to-understand way. And it oftentimes elicits reactions from others that get them too to be controlling because it gets so difficult to understand what’s going on behind the scenes for that person.
So, then, what happens is that one person is trying to control themselves in the absence of being able to cope, understand, or resolve their situations effectively, and that sets off the chain reactions of others acting in controlling ways, such that they’re not being supported by others but rather in this controlling interaction that goes back in forth. The person tries to control themselves. Others try to take over because they don’t agree with what’s happening or that controlling behavior is causing such distress in that other person that they want to eliminate that source of stress. That can cause more difficulty than it solves.
So, when it is opportune for you to kind of take a step back and think about, “How can I manage my own reactions to this situation at hand so that it’s sensible to me and my behavioral reactions are actually effective,” that will enable me to communicate and interact with others in a way so that those others can be supportive and not obstructionistic to my aims and goals.
So, oftentimes we get very focused on what other people do around us because they affect us, they influence us. And it’s really normal in this age of the pandemic to get very irritated with what other people are doing or what they’re not doing. That’s okay. But I think that these treatments tell us that what is more accessible to you, what you’re more capable of doing is managing your own reactions and how it is that you are to cope about it, okay?
The ninth lesson from treatments for borderline personality disorder is that happiness is a fleeting state, but goals and values last longer. I think there is always a lot of pressure to achieve happiness, like that’s a kind of stable position to hold in life. And yet, we all know that happiness is an emotion that comes and goes. It lasts for moments at a time and it can’t be sustained easily. And when we get too bound up in seeking happiness, it’s hard to organize ourselves around having that coherent life that organizes our envelope or gives us a stable sense of self and relating to others.
That’s where goals and values come in. We use our goals and values to organize who we are, what we want, what we do, how we interact with the world, what we communicate to others, and that builds this coherent envelope so that you can travel the world flexibly and keep moving forward in a linear way that you can maintain and that other people can understand. So, while happiness is really important, especially at a time like this where there’s so much stress abounding, it is something that we achieve in fits and spurts. And if you can stay focused on your goals and values, that gives you a more consistent, steady sense of direction and that will fuel your sense of self.
And the last tip that I have, which is going to sound cliché because I think it’s oftentimes said, but I think it’s only overused because it’s true. We are doing the best we can and we can always do better. This is a dialectic that is so important when times are tough. These current circumstances of the COVID pandemic make it hard for us all to do what’s ideal. And what we can do in the face of that helplessness is really focus on doing the best we can with what we do have and keep thinking about how we can do better rather than dwelling on the regrets, the missteps, the mistakes, the causes of what has come to be. That has its own role I think we can learn from the regrets we have about the past.
But in order to maintain control of our emotions and ourselves, our forward-moving directions, we can think about what we’re doing, why we’re doing it. That’s the value and the purpose that my colleague, Chris Palmer, talked about last week, and then we can keep trying to refine it so that it works better over time. And that is really how we manage our personality functioning. We take time to reduce ineffective patterns of responding. We take time to process the many emotions that we naturally have during stressful times.
Those emotions give us information about ourselves and what we need to do moving forward and it communicates to others the ways in which we may need support. And we need to take time to build effective and satisfactory collaborations with others so that we feel that others are just as helpful and beneficial as they are demanding and difficult. There are two sides to relationships, and having demanding and difficult aspects to those relationships doesn’t mean they’re terrible relationships.
And managing your self-esteem lastly is a final component of organizing your personality functioning. Doing things that make you feel like you’re achieving your goals or moving towards your goals or acting consistently with your values can give you a sense of purpose when you can’t always control the outcome.
So, those are just some tools that I wanted to share. They’re boiled-down pearls of wisdom from the evidence-based treatments that we use for borderline personality disorder. And I want to end by saying that I feel very grateful for the time I’ve spent learning about what it’s like to have borderline personality disorder. Because at a time like this of major upheaval and major uncertainty, it’s really helped me to be more clear about how the world around me is affecting me and how I can possibly navigate it in a way that’s consistent with who I am. So, I hope that can be helpful to you. I know there’s a few questions, and I’m happy to take them.
Jenn: Alright. Well, first of all, Lois, thank you so much for all of your insight and advice. I think this has been super helpful. I obviously don’t want to speak for all the attendees on here, but I think this was incredibly invaluable, so thank you so much.
So the first question is, “I feel like my mood’s been really quick to change because I’m feeling really heavily influenced by others, whether it’s by what they’re sharing online, how they’ve been interacting with me at work, or even if people aren’t following the rules in a supermarket. So, how can I keep myself from getting angry, anxious, or upset really easily?”
Lois: I think this is a really common experience. With the collapse of the many structures we use to organize our personality functioning, the contents within the envelope of ourselves like our mood is becoming really dysregulated and disorganized so that our moods spill out. And it can make us feel uncomfortable because we’re not holding ourselves together, we feel out of control, and we’re acting in ways that we don’t approve of.
So, I think that this question is driven by a very common experience that lots of people are plagued with right now. And what I think would really help and require some creative thinking is the kind of act of creating more structure around how we interact with others, how we connect with others, and how we make sense of how others affect us.
So, while we may not have the daily schedule that we are accustomed to having, having a time and place to be online, and that may be a time where you’re less vulnerable and more focused on a particular aim or goal that you have when you go online, what is it that you hope to achieve, what is it that you hope to do, and let that guide how you interact. And allow those emotions to come in and out.
What is happening to everyone online is really intense, so it’s no surprise that you’re going to build up a lot of emotional reactions to what people are saying online; similarly, how you’re interacting at work with the collapse of usual structures that organize your relationship. And think through ways in which you want to focus in those interactions, what you want to get out of them, and then try to let everything else go.
So, when you’re at the supermarket, I think this is a common thing where there’s all sorts of confusion about (laughing) where to go and when, and this for example is something that you can think about, “How can I focus on getting my shopping done so that I can get out of this stressful environment and get back to something that’s less irritating?” So, you can acknowledge your emotions, focus on a goal, notice the things that people are doing and how they affect you. You can maintain some curiosity, like, “Why are they doing that,” and then just move back to what it is that’s guiding your path.
Jenn: Awesome, thank you. Second question is a bit more BPD-focused. “What’s the best way to handle emotional cycling if you are somebody’s caregiver?” And we had people ask whether it was somebody they were caring for with BPD, and just in general, it seems like there’s been a hard time with keeping your own emotion in check, and a lot of people have expressed frustration that it seems like they can’t actually reach the people that they’re caring for.
Lois: Mm-hmm. That’s a common experience, especially in this day and age where the availability of other support systems has been really reduced. So, the burden to caregivers is enormous right now. People who are caregivers oftentimes experience a lot of compassion fatigue; that is, in their efforts to be helpful and take care of someone else, they often burn out because there’s nobody taking care of them. The serious and significant pressures of the responsibility to make sure somebody else is okay is increasingly hard to sustain when you’re not okay.
I work a lot with family members of those who have borderline personality disorder, and what I often say to them is that when you’re taking care of someone who has a lot of instability, it’s almost guaranteed that you’re going to develop some of your own over time without proper self-care. And this is where I oftentimes tell families and clinicians that you really need to put your own oxygen mask on first when you’re headed into some crisis because your loved one, whoever you’re taking care of, is not going to be helped by you if you’re not steady yourself. Oftentimes, people feel like they’re being selfish by focusing on themselves and their needs, but it’s really out of this overall goal and value to be helpful to that other person that you’re doing this, to be more reliable, more steady, and nonetheless you may be more limited than you want to be, and that takes some acceptance.
Jenn: I think that’s a very valuable lesson of putting on your own oxygen mask first. That tends to be something that a lot of people forget about, especially when we have so many balls in the air at any given time. And that actually brings me into the last question that most people asked was, “Any suggestions on how to not over-interpret how other people are feeling and how they’re emoting? Everybody’s stressed, everybody’s anxious, but how do you maintain your own and not take on other people’s feelings?”
Lois: This is where the lesson of uncertainty comes in handy and really being more comfortable with a not-knowing position. I think we’re all, as human beings, wanting to know things with greater certainty so that we have something that we can work with. And not having a ground to stand on in terms of how you’re going to react or respond to someone is very uncomfortable. However, if you can maintain a stance of not knowing, it takes off the pressure to jump to conclusions.
So, when you’re hearing a lot of contradictory information from someone or extreme information from them and you can’t make sense of it, it may be a little load off of you to think to yourself, “Well, maybe this doesn’t make sense yet. Maybe the person has so many things going on in their envelope that it hasn’t been possible for them to be more coherent.” So, this kind of premature certainty about where they are when they’re not even really sorted out is a tall order and it causes us to get down really elaborated pathways that only cause us to be more upset and cause more misunderstandings in the interactions that we have with that other person.
Jenn: Awesome. Let me just say once more, thank you, Lois, so much for all of your invaluable insight today. And to all of the attendees, thank you so much for joining us today. This actually concludes the next webinar in our series.
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Don’t forget, mental health is everyone’s responsibility. If you or a loved one are in crisis, the Samaritans are available 24 hours a day at 877.870.4673. Again, that’s 877.870.4673.
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The McLean Hospital podcast Mindful Things is intended to educate about, encourage compassion around, and reduce the stigma related to mental health and wellness. This podcast is not an attempt to practice medicine or to provide specific medical advice.
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