Speaker 1 (00:05):
Welcome to, it's All Your Fault On True Story fm, the one and only podcast dedicated to helping you identify and deal with the most challenging human interactions, those with someone who may have patterns of high conflict behavior. I'm Megan Hunter and I'm here with my co-host, bill Eddie. Hi everybody. We are the co-founders of the High Conflict Institute in San Diego, California where we focus on training, consulting, coaching, and educational programs and methods, all to do with eye conflict. In today's episode, we are going to talk about borderline personality disorder with our very special guest and friend and colleague Amanda Smith, who in the past had one of our most downloaded episodes, so are so happy to have her back. But first, a couple of notes send your high conflict related questions to podcast@highconflictinstitute.com or on our website@highconflictinstitute.com slash podcast where you'll also find all the show notes and links.
Speaker 1 (01:14):
So we're very happy again to welcome Amanda Smith of Hope for BPD to our podcast. She has a magnificent background of helping so many people across this whole world of BPD, which is the acronym for Borderline Personality Disorder, and we wanted to have her this month as part of our Bring It to Life series number one. She's one of the biggest experts in the world on this. She's probably blushing right now, but it's true and she really truly understands the perspectives of those involved who struggle with this in many ways. And this month of May is borderline personality disorder awareness month, and it's also mental health awareness. It's either month or week. So it seemed like a pretty good topic to have and to talk about. So thank you for joining us, Amanda, and we'd love to hear, and I'm sure our listeners would love to hear a little bit more about what you do.
Speaker 2 (02:17):
Well, thank you so much. I have now been working with individuals with a diagnosis of BPD and their family members now for almost 20 years. So it's been a really long time and I started out in 2007. I started a nonprofit organization in Florida called Florida Borderline Personality Disorder Association. So I'm no longer living in Florida. I now live in Texas, but I'm so thankful that this organization is still in existence and still doing good work. Today I live in Waco, Texas. I have a private practice where I have the most amazing clients. I love my work. I love working with individuals with BPD and their family members, and I see a lot of success. I see a lot of success.
Speaker 1 (03:16):
That's fantastic. What's interesting is to my knowledge, I guess BPD is one of the few or only mental health diagnoses that you can work your way out of. Is that true or am I a little off there?
Speaker 2 (03:32):
My perspective is that there are a lot of diagnoses that people can work their way out of. BPD is absolutely one of those diagnoses, but I also think that when we think about depression or we think about people with anxiety or OCD, I want people to have a lot of hope that they can see improvement, they can experience healing, they can experience recovery. So I'm on team. No, I think lots of people can get better at improve.
Speaker 3 (04:12):
Let me just jump in and clarify. I think what you may be thinking of, Megan, is I've often said that of the personality disorders of the 10 personality disorders, that BPD seems to be the one that's had the most success at treatment. So for example, antisocial personality seems to be one that we may not actually have a treatment for, although there's some debate about that. But I think most of what used to be axis one diagnoses like depression, anxiety, et cetera, very much treatable. And so if someone has a mental illness diagnosis, most of them are treatable with therapy or medications or both. Personality disorders aren't treatable by medication, but therapies such as BPD have seen phenomenal success. I just want to insert that clarification
Speaker 1 (05:12):
And I'm glad you did. I would not want to be misleading on that, and I think in my mind, it's kind of interesting that my mind just sticks on BPD is that one that is, there's so much hope, exactly what your organization is called, hope for BPD, and if I think of the disorders that used to be on the other axis I guess, that are treated with medication, it seems that those are harder to fully recover from and may need medication treatment forever. However, I'm not a mental health expert or clinician, so this is just Megan, so thank you for clarifying. But it is wonderful that there is hope for this and that as Marsha Lenahan like to say, and I think everyone or most people in the BPD world that they let's create a life that's worth living. I want to also mention right here at the start that Amanda's written a couple of books.
Speaker 1 (06:09):
I've been fortunate enough to publish 'em through my publishing book, company Unhooked books, and one is a book for the person who struggles with BPD, and it's called Dialectical Behavior Therapy of Wellness Planner. And then there's a second one called the Borderline Personality Disorder Wellness Planner or Families. So one for those who struggle and one for those who are family members of those maybe with a diagnosis or who struggle. So let's start there. Let's bring this to life. There's a lot of people who probably don't have the diagnosis, don't even understand why they're struggling or suffering or those who do. What's the common experience if there is one of someone with DPD Amanda, there
Speaker 2 (06:55):
Probably isn't a common experience for a lot of people or universal experience. However, we can just start with the Diagnostic and Statistical manual as a way of beginning to understand some of these things that come up for a lot of people. So we think about the experience of sometimes having really big emotions or having a lot of volatile emotions. Some impulsive behaviors may be coming up for people. I think about the experience of emptiness for a lot of individuals with a diagnosis of BPD. Some people with BPD also engage in self-harming behaviors or self-destructive behaviors, self sabotaging behaviors. And sometimes people with a diagnosis of BPD sometimes feel suicidal, so they may talk about suicide, they may spend a lot of time thinking about suicide and they also may make suicide attempts.
Speaker 1 (08:03):
Are there other things that come out? Because what I've heard from others and kind of observed is a lack of order in their lives. It's just really hard to get things together. Is that common?
Speaker 2 (08:16):
Oh, I think that is pretty common for a lot of people, especially before treatment or early on in treatment. The idea of organization can be very, very challenging. Having that order keeping even a bedroom clean or a car clean can be challenging for a lot of people. So that can be something that's not a part of when we are diagnosing someone we would necessarily ask about. But I think that is absolutely something that's pretty common for a lot of people who are suffering from this diagnosis.
Speaker 1 (08:59):
And what about taking sort of a victim stance in life? Is that common? Something we hear about from a lot that, oh, this person just think they're a victim in every situation and it's looked on so negatively?
Speaker 2 (09:14):
I think that can be a part of a diagnosis of BPD. Many of my clients when they first come to treatment, either they've failed in treatment or they haven't done as well as someone else may have hoped they would do in treatment. And sometimes there is this attitude or this belief I can't help myself or I can't get better or I can't improve things that I want to improve. Sometimes people have this idea that life will always be difficult or will always be challenging, or that other people are getting in their way and they can't recover or they can't make these important changes they want to make in their lives until other people change first. I would say that kind of belief is fairly common for a lot of people who are suffering from the disorder, but definitely we sometimes see people who believe that other people are to blame for their unhappiness or their misery or their inability to move forward in life in a way that feels healthy and productive and meaningful.
Speaker 3 (10:38):
Now let me jump in here with kind of a question about that. I run into clients I have as consultation clients because I'm not doing therapy anymore, although I used to do it and I did have some with BPD, but in legal disputes and consultations about legal disputes, I find that there's some people with some self-awareness, but they don't change their behavior or that that's a step in the process of behavior change, where you have someone who has an insight and they share it with their partner. Then they separate maybe work on getting a divorce and the partner says, well, she says she has up and down moods and sometimes she feels like killing me and there's this kind of range of emotions, but I'm worried about her and the kids because she hasn't actually changed her behavior. She just had these occasional insights. So I guess it's two questions. One is the path to recovery from this and the other is what should somebody do? How would somebody change who has those insights but isn't changing their behavior and may actually have people around them that are in conflict with them? What can be done?
Speaker 2 (11:58):
Marshall Han, who is the creator, the developer of Dialectical Behavior Therapy. I think we'd say that people don't necessarily need insight or awareness to change. They need a blueprint, they need a roadmap. They need to maybe be taught skills or to be thinking and we think about new ways of understanding common problems. That may be something that's important, but we don't necessarily want to wait around for people to have awareness or insight that they might be part of the problem or that there is something that they can do to change or to create change in their relationships. Sometimes we want to lead with, again, a skill or an idea or an assignment. Helping someone to take that first step instead of again, waiting around and hoping that someone will have an epiphany, that they'll have that awareness and then change will spring forth from that point, which I don't think happens all that often.
Speaker 3 (13:13):
It's interesting that you say that because one of the things we teach is what we call the four. Forget about us with high conflict people. The first is forget about giving people insight into themselves because they're just not going to agree with you or go there. They're going to resent it. Of course, try not to open up emotions if you're the lawyer or mediator or judge or human resources, whereas you can work on emotions to not get stuck focusing on the past and to not tell people they have a personality disorder. These are the four things for conflict resolvers, but I think in your position, some of this you can talk about because you have an ongoing relationship and there is some willingness to work on their part. Would you say that's true?
Speaker 2 (14:05):
I believe that's true, absolutely. And I think also awareness and insight sometimes unfold slowly over a long period of time. So I wouldn't expect someone to come into an initial session owning all there is to own in their own lives or in their relationships. But when we think about progress and how that happens, then we think about maybe over time the person gains a little more awareness and that can be something that's beneficial to them again at that time.
Speaker 1 (14:43):
And that's such a tough thing for those around the person to understand and be patient about, right, because we have expectations of our loved ones and all my other kids are doing fine. Why is this one not? Why is this one messy? Why is this one not getting their life together? Why is this, why, why? So I think we have to adjust our expectations, but I think it's tricky for people to understand if they're a family member, how hard to push if someone's resistant to treatment or even if they finally get into treatment and it's the right treatment, dialectical behavior therapy amongst others. Do you hold them accountable to continuing their treatment or do you say, Hey, it's up to you.
Speaker 2 (15:33):
I'm more in favor of holding people accountable, encouraging people to go to treatment, supporting people in treatment, helping to motivate people, a family member to go in treatment, go into treatment, but also stay in treatment because that's problematic too. Sometimes we can get people in the door, but this idea of coming back week after week can be pretty challenging for a lot of people, treatment is really hard work. It's really tough. So sometimes it's not even about getting someone in the door for an assessment or an initial appointment, but it's how do we keep this person motivated to stay in treatment when treatment becomes really tough and uncomfortable and difficult and challenging. So sometimes I think that's more of the challenge than, okay, how do we get this person into treatment or to help?
Speaker 1 (16:42):
How would you hold someone accountable? What do you say?
Speaker 2 (16:46):
Well, it's tough. I think that that's
Speaker 1 (16:49):
The million dollar magic wand question.
Speaker 2 (16:51):
It's so hard. It's going to be different depending on the relationship and on the family. It's going to be different. I don't think it's necessarily beneficial to emphasize a diagnosis of borderline personality disorder, especially in the beginning, but we can talk about getting some help for some of the symptoms that we see related to borderline personality disorder. So if a family member is very depressed, we want to encourage them to get treatment for their depression. So the same thing is true if the person has anxiety or the person has some symptoms related to OCD or A DHD. The good news is that there are lots of adaptations of dialectical behavior therapy for all these different symptoms. So if we can get someone pointed in the right direction and we have an evidence-based therapy and we have a provider who knows that therapy or that treatment that can get things going.
Speaker 3 (18:04):
Let me ask a question about treatment. Do you have a group therapy that supplements your individual therapy and is that recommended? Is that the standard? Where does that come in and what role does that play?
Speaker 2 (18:20):
I love group. Group is absolutely a part of dialectical behavior therapy. I have an idea that all the magic happens in group because people are able to learn from each other, they're able to hear different stories. I think group alleviates a lot of loneliness for people, a lot of shame, a lot of emptiness. All of those things seem to consistently go down when people are involved in a group of people like them learning new skills, learning ways to cope, learning ways to handle their emotions. So I am a really big fan of skills groups and having people come together and learning from each other I think makes such a difference. It's one thing for me to say something to a client, but it's another thing when they're hearing something similar from someone in their peer group, someone they sit with week after week, someone they get along with someone they admire. When that person says that thing, I think it's far more powerful than if I say it.
Speaker 1 (19:46):
Well, let's take a short break and we'll come right back.
Speaker 3 (19:59):
So I have another question. Now it's is going to get uncomfortable, but in family court stealing with custody disputes, there's often a question of whether one of the parties has a borderline personality disorder, their sudden intense anger, this could be mom or could be dad, sudden intense anger, wide mood swings, questions about their ability to be stable for the child. And I've been one to, I do trainings for judges and I mentioned there's these five personalities tend towards high conflict and borderline is one of them. And I'm hearing now of some judges saying, I want an assessment and if this person has borderline personality disorder, I want to order them to go through a BPD therapy. I'm wondering if you've ever had that, what your thoughts are about that and whether that can work when it's court ordered. Can someone make progress and own it if they feel they're a victim of a court who made them do something they never volunteered for?
Speaker 2 (21:11):
Some of my favorite success stories when I think about all of my clients over the last decade or so have been clients who were court ordered to treatment. So they were involved with a CPS case or someone said someone, an attorney or a judge said, Hey, as part of what's going on, I want for you to be getting the support you need. I want for you to be getting treatment. I see a lot of success when that happens. So I'm a huge fan of mandated work. I think the idea is, well, oh, it can't work if someone's telling you to go to treatment, but I think it absolutely can.
Speaker 3 (21:59):
That's great because we've always known that about substance abuse, drunk driving programs work in their court order, stuff like that. Let me just add a follow up and then I'll pass it back to Megan. I know of cases where someone's been told to get BPD therapy and they've just gone to an individual therapist. There's no group and the therapist, it is questionable to me whether they're really trained to treat BPD because there's too supportive only. And what they say is, my therapist agrees with me and they don't work on behavior change, and then after six months they say, I want to stop this. It's not helping and I don't need it. And their spouse or partner often getting a divorce in a custody dispute says, Hey, he or she has never changed. This isn't working. Well, they did DBT therapy, so I guess that failed. What do you say about people who don't seem to change from just individual therapy,
Speaker 2 (23:10):
Individual therapy and group work, those so beautifully together. So I think that's important to recognize that this isn't just about sitting in front of a therapist week after week and just having the therapist listen and provide a lot of support or a lot of validation. Marshall Linehan says that DBT is not just about validation, but also about change. What do we want to work on or what do we want to change? That's an important part of this as well. I know that there are a lot of therapists out in the world who sometimes say that they do DBT, but they haven't necessarily received the training that Marshall Linehan created when she dreamed up this evidence-based treatment that works so well for so many people. It's absolutely true that maybe the therapy isn't for everyone, but my first question would be is the therapist really trained to provide the evidence-based treatment that individuals with a diagnosis of BPD really need?
Speaker 2 (24:28):
So they're not just checking off a box saying, I went to a training once, and we want people not just to have training, but to have supervision, to have ongoing education, to be part of a consultation team with other therapists. We want people to really be committed to working with this population and be thinking about all that. That looks like this is not always an easy population to work with. So we don't want to just assume that we sit down in a therapist's office and we find some kind of quick success or quick change. I don't know that it works that way for most people,
Speaker 1 (25:13):
Which is not that dissimilar from cancer treatment and recovery. These are hard things. They're not fun, they're not pleasant. The professional can't always give you the best news even if they have your best interests at heart. But I think about that often for families who are struggling with this or even the person themselves thinking that it's not fair and it's not. This is really hard to handle as the person or as the family member. If I may, Amanda, I'd like to ask you to explain as if you're on an airplane and someone said, I don't know what BPD is, and I don't know what the person who has it is feeling. I know that's a really big question, but is that something you could answer?
Speaker 2 (26:09):
I would want someone to consider that the individual with the diagnosis is in a tremendous amount of emotional pain at any given moment, and then we think about the manifestation of that pain. How is that pain being processed? Is it being recognized? And that's when we think about people who sometimes take out that emotional pain on others or we see it when there's a lot of anger that comes up for people, a lot of blame. Or we can think about the person with BPD, who again has a tremendous amount of emotional pain, and sometimes they take out that pain on themselves. So again, they might engage in self-harming behaviors, or they may be thinking about suicide or planning a suicide attempt, or they may be individuals who frequently are getting in their own way when they have a choice and seem to consistently make that decision. That is not a wise decision. It's not a responsible decision. It's a decision that affects other people in a way that's confusing, in a way that can be hurtful.
Speaker 1 (27:37):
And all the while they're trying to just keep their head above water and survive. And even when they put a smile on their face, which seemed like the outsiders, that they're doing fine, right? Oh, they're doing great. They're doing better. And then you see some massive setback and Oh, that failed. But I think if family members could understand they're just doing the best they can trying to get through from day to day, right?
Speaker 2 (28:05):
Absolutely. Absolutely. That's one of the primary assumptions when we talk about dialectical behavior therapy, that all people at any given point in time are doing the best that they can. We think about how that definitely applies to the individual with the diagnosis, but I also think about how that tenant also applies to family members, to friends, to even to therapists. Therapists are doing the best that they can, right? Therapists are not perfect family members, moms and dads, spouses and partners are not perfect. So this is, again, something that we talk about in DBT, this idea of doing the best that we can, giving other people a lot of grace and helping people to understand that this is really part of the human condition.
Speaker 1 (29:08):
And interestingly, I'm seeing more of an openness or maybe awareness in media. For example, there's a Netflix special out right now. It's trending at number one called Baby Reindeer. The terminology borderline personality disorder or any personality disorder is never mentioned, but we see themes of self-harm. We see maybe some stalking. We see a lot of trauma, and for those who understand this world a little bit, we recognize those things in a series like this, and it seems like it's becoming maybe a little bit more mainstream for the world to recognize that, hey, this is a part of society. This is a part of life. This is part of the human condition, and so let's accept that it is and see what we can all do to help and not demonize someone who is sometimes very challenging to live with or handle in a relationship or handle a relationship with. I wanted to ask you about dissociation, and I think this may be new terminology to some, but as it relates to BPD dissociation and reports by someone with BPD of things happening that you're like, that didn't happen. Maybe someone knocking on the door in the middle of the night or people yelling at them or just something always happening, so dissociation and then whatever this other thing is, is this related to BPD at all or can it be?
Speaker 2 (30:45):
It can be, yes. It's part of the diagnostic criteria for BPD, although we don't see it in all individuals with the diagnosis, but we think about how when the person is experiencing an acutely stressful moment where there's an episode where a lot of things are happening and the person is feeling overwhelmed, that's when dissociation may come up for that individual. So it might look like the person is there, but they're not really present. It may be tempting to think that the person is kind of ignoring what's happening in the relationship or what's happening in the moment, but it might be true that the person, again, is experiencing something that is actually meant to be protective in the moment. But this is another thing that's fairly misunderstood when we think about this diagnosis.
Speaker 1 (31:50):
Fascinating, complex for sure. It
Speaker 2 (31:53):
Is.
Speaker 1 (31:54):
It looks like we have a lot more to talk about regarding BPD and family members, so we hope that if you're listening to this, it's been helpful. I'm positive it will be in many ways. Next week, we'll continue talking with Amanda, specifically focused on BPD, and how family members can best support their family member with BPD and also take care of themselves. Send you questions to podcasts@highconflictinstitute.com or submit them to high conflict institute com slash podcast. We'd love it if you tell your friends and colleagues about us, and we'd be grateful if you'd leave us a review. Until next time, keep learning and practicing skills. Be kind to yourself and others while we all try to be the conflict. It's All Your Fault is a production of True Story FM Engineering by Andy Nelson. Music, by Wolf Samuel's, John Coggins and Ziv Moran. Find the show notes and transcripts at True story fm or high conflict institute.com/podcast. If your podcast app allows ratings and reviews, please consider doing that for our show.