Understanding Borderline Personality Disorder in Family Law Cases
Understanding Borderline Personality Disorder in Family Law Cases ©2018 Bill Eddy, LCSW, Esq. The diagnostic manual of mental disorders (DSM-5) tells us that up to 5.9% of adults in the United States has borderline personality disorder (BPD).[1] When someone with this disorder is involved in a family law case, especially involving decisions about child custody and access, there is often a great deal of emotion, frequent professional conflict and numerous decision-making procedures that each barely resolve the conflicts (negotiation, mediation, court hearings, evaluations, counseling, etc.). It helps to understand BPD, in order to manage these cases better. What Is BPD? Borderline personality disorder is a mental health disorder with many of these types of symptoms: Fear of abandonment, unstable relationships, unstable self-image, impulsiveness, self-harming, wide mood swings, feeling empty, sudden and intense anger, and paranoid thoughts. However, personality disorders (there are ten in the manual) are typically not obvious at first until someone is in a close relationship or involved in a conflict. Often, in romantic relationships with someone with BPD, there is an intense and exciting romance, followed by making fast commitments, then a turn for the worse as conflicts and chaos take over both people’s lives. There is lots of blame, yelling, sometimes hitting and other forms of domestic abuse. All of this is often interspersed with periods of friendly and caring (and sexual) behavior. It can feel like a roller coaster and can be very confusing for both people. In many cases, only one person has this disorder and the other person doesn’t have this disorder (or another disorder), and is caught by surprise at the suddenly extreme behavior. In reality, the BPD sufferer has a “dual persona.” It’s all part of the same personality, but there is the public persona, which seems really great, and the private persona that may be involved in abusive verbal and/or physical behavior. Sometimes it takes up to a year to realize that a partner has this problem, because they can be very charming, exciting and loving at first. Therefore, people are encouraged to wait at least a year before making major commitments, such as getting married, having children or buying property together. Why Do People Have BPD? No one chooses to have BPD. There are three basic potential causes: Heredity: People are born with a temperament and genetic tendencies. This may be the biggest factor. They may have ancestors who were intensely adversarial in order to survive during wartimes and other adversities. Fearing abandonment may have been a very good motivator for survival, such that holding tightly onto mates and children would have been good for the family’s survival. Fierce jealousy, clinging behavior, anger at a partner’s and child’s independence may have been helpful to keep the family together through thick and thin. (In her new book, The BIG Book of Borderline Personality Disorder, Shehrina Rooney says she believes she was born with BPD, so she may have this genetic history somewhere in her background.) Early childhood trauma: The first five years of life are when personality development mostly occurs. Insecure attachments between parent and child can often be identified in the development of borderline personality disorder. A secure attachment is necessary to learn emotional self-control (self-regulation); gain a sense of confidence in oneself and trust in others; recognize differences between people and what others are feeling; learn to tolerate stress; learn give and take in relationships; and to learn how one affects other people in order to adapt and change one’s own behavior for greater social success. With an insecure or abusive parent, these essential lessons are often not learned, and unsuccessful or abusive behaviors are learned instead. Cultural influences: Our modern entertainment cultural relies heavily on images of dysfunctional relationships in movies, in TV shows, on the news, on social media, etc. These include lots of relationship manipulation, violence, impulsive acting out, yelling, throwing things, storming out of rooms, etc. It’s as if our culture is intentionally teaching borderline personality disorder behaviors. But it grabs our attention and gets us to watch, so it sells advertising and it won’t be changing anytime soon. For someone with genetic tendencies to have BPD traits, or who grew up in a very inconsistent household, these behaviors may be seen as the way to have normal relationships. (She shows her love and commitment to me by keeping track of my every move. He shows his love and protection for me by slapping me when he thinks I’m getting out of line. Isn’t this what everyone does?) Is There Treatment for BPD? Yes! Over the past thirty years, treatment methods have been developed that teach daily living and self-management skills and have been having a lot of success with people who are willing to commit to a few years of therapy. The most well-known and wide-spread method is Dialectical Behavior Therapy (DBT). There are therapists in most big cities and some smaller communities who have been trained in this skills-building approach. Whatever method is used, it’s important to have a therapist who is personally secure and can be emotionally stable in the face of the chaos and anger that those with BPD bring to therapy. Therapists trained in more standard psychodynamic therapy can be good with BPD if they are also good at staying calm and teaching some type of self-help skills. Just supportive therapy can actually make things worse, if they reinforce blaming comments, say their behavior is normal or justified, and join in focusing on the behavior of other people in their lives. Unfortunately, many therapists inexperienced at treating BPD often believe their clients and reinforce their problematic behavior, rather than helping improve it. Handling a Family Law Case involving BPD Given the dynamics of borderline personality disorder explained above, there are many mistakes that family law professionals commonly make. Here is a list of 10 Do’s and Don’ts: 1. Don’t try to give someone with BPD insight into themselves and their dysfunctional behavior. This just reinforces their defensiveness, triggers their
Improving Conflict Management Skills Will Strengthen Sobriety
©2018 L. Georgi DiStefano, LCSW In my new book, Paradigm Change: The Collective Wisdom of Recovery, I discuss the importance of improving our conflict management skills in order to strengthen and enhance quality sobriety. Self-regulation is a key step in the recovery process. Individuals who focus on utilizing self-regulation strategies and techniques will create new coping mechanisms for managing their daily lives. I frequently encourage my clients who are new in recovery, to learn the EAR™ techniques and to practice EAR Statements™ in their interactions with others. This approach is a valuable tool for individuals in recovery and an effective method of communication with anyone. My frequent co-author and esteemed colleague, Bill Eddy, conceptualized the EAR Statement and it is currently being taught in a host of settings including corporate workplaces. For those in recovery this technique is particularly valuable. The E stands for empathy. By demonstrating empathy for the other person, you are seeing a situation from their perspective and appreciating the problems or issues associated with their situation. Active alcohol and drug abuse often promote a self-absorbed set of responses to others. In early recovery, individuals need to learn to truly hear others and respond with empathy when appropriate. In the A.A. program members often make “Amends” as part of their healing process. It is virtually impossible to make amends to someone if you cannot deeply understand the injury you have created. It is the growth of empathy that fosters the ability to make true amends. The A stands for attention. By demonstrating attention, you are giving the person your full concentration, which will help to increase your thorough comprehension of the issues. People who have engaged in chronic alcohol and drug abuse are often reactive. They frequently respond with anger or heightened emotions without having all the facts or appreciating the nuances of a situation. By focusing on active listening the individual is much more likely to have a better understanding of a situation. Many people in recovery will tell you that it is often a great challenge to manage responses differently. Paying attention by actively listening to others is an important component of recovery. The R stands for respect. By demonstrating respect for the other person in a communication, you are supporting their self-esteem, acknowledging their value, and facilitating a positive connection with them. People who have engaged in alcohol and drug abuse, often are focused in obtaining what they want with little regard for the feelings of others. Respectful interaction is an essential ingredient to a healthy recovery process. Individuals who participate in the SMART Recovery Program, a self-help organization, are provided many opportunities to engage in respectful interactions. An important element of EAR is that you do not have to agree with content. Nevertheless, by learning to respond with empathy, attention, and respect, situations frequently de-escalate. Perhaps more importantly, as I point out in my Paradigm Change book, the EAR method provides the recovering person a standard of communication designed to keep emotions managed and responses appropriate. Many of my clients have adopted EAR as a recovery routine, in that it becomes their go-to process in communications with others. Many clients have commented to me that it is also an easy technique to remember when emotions begin to escalate. In our book, It’s All Your Fault At Work, and in our New Ways For Work Coaching Manual, Bill Eddy and I present a cognitive-behavioral method designed to help individuals reduce their conflict at work or at home and improve their overall self-regulation. We focus on four skill areas of self-regulation that are exceptionally useful and appropriate for individuals to work on in early recovery. The first skill area is “Flexible Thinking.” One of the biggest barriers to successful problem solving is all or nothing thinking. Individuals with all or nothing thinking tend to view situations in the extremes. There are few gray areas, only black and white. This type of thinking impairs effective problem solving. Such extremes in thinking frequently lead to heightened and often upset emotions. Individuals in early sobriety are very susceptible to rigid and extreme thinking. A.A. has many expressions designed to help individuals manage their thinking and emotional responses such as “easy does it,” “one day at a time,” or “It’s progress, not perfection.” A number of my clients have adopted the process of asking themselves “what options do I have using my flexible thinking?” Over time, they recognize when they are being reactive and learn to self-correct and challenge their thinking and initial responses. Another important skill area of self-regulation is “Managed Emotions.” Being unable to manage our negative emotions can distract us from achieving our goals and often will create new and worse problems for us. Learning to manage our emotions can make a big difference in being able to remain clean and sober. As I discuss in my book Paradigm Change: The Collective Wisdom of Recovery, if emotions escalate it often leads to extreme behaviors that frequently are regrettable. In early sobriety, individuals often spend a lot of time trying to fix the damage caused by their extreme emotional outbursts. Utilizing strategies and techniques such as EAR and Flexible Thinking options will go a long way in helping an individual gain mastery over their emotional responses. A third skill area very essential to successful recovery is learning to “Moderate Behavior.” An individual can manage their emotions more easily once thinking becomes flexible. This helps create behavior that is moderate and not extreme. Moderate behavior can lead to collaboration, compromise, and other positive outcomes. Extreme behavior often results in heightened conflict, name-calling, bullying, regrettable decision-making, and frequently, relapse. A key factor in facilitating a process of flexible thinking, managed emotions, and moderate behavior is the final skill “Checking Yourself.” This last piece of the New Ways method is designed to encourage individuals to reflect on their emotional responses, and recognize where they have been successful and what needs to be improved. This is a valuable tool for self-regulation.
Vicarious Trauma: 3 Tips and Review of the book “Second-Hand Shock”
©2018 Bill Eddy, LCSW, Esq. Our High Conflict Institute speakers give seminars around the world to helping professionals (lawyers, judges, counselors, mediators, human resource managers, administrators, etc.) and others experiencing the stress of high-conflict situations. We often get asked about how to manage the stress or “vicarious trauma” of dealing with high-conflict personalities day-in and day-out. I usually give them my three favorite tips: 1. Practice these self-encouraging statements: It’s not about me! I’m not responsible for their outcome! It’s their dilemma! It’s always up to them! With high-conflict people: The issue’s not the issue; the personality is the issue! Just do my job—my standard of care! I call this “putting on my armor” and repeat these over and over again before I head into a high conflict mediation, meeting or individual session. These statements help me stay focused on the process of working with high-conflict clients, while not becoming responsible for their outcomes. They also help me remember the predictable behaviors of high-conflict personalities and the responses that I can use that generally help. Since the behavior of high-conflict people is more predictable than that of ordinary people, years of practice have helped me not be surprised much anymore. 2. Have a great support system: I am fortunate to have two work environments with great colleagues. Where I do my meditations (National Conflict Resolution Center in San Diego) I can talk to our staff and colleagues down the hall right after a difficult session. They understand because they have also dealt with the same clients as staff or similar cases as mediators. With a dozen speakers for High Conflict Institute, I can call or email my colleagues and quickly find someone to share my stress and many similar stories. It really helps to work with people who understand high-conflict behavior and don’t get hooked by the drama. My colleagues have so much empathy for each other and our clients that it makes most of this work enjoyable rather than feeling traumatized by it. 3. Get out of town every so often: I really enjoy hiking and skiing and driving cross-country. It really helps clear my mind to be able to see forests and trees and wide-open spaces. Part of this is getting away from daily television and endless talk about current events. I get energy from seeing the grandeur of our national parks and awesome views that have lasted for centuries. So those are my quick tips. Now, we have two experts, Ellie Izzo and Vicki Carpel-Miller, who have updated their book on this subject: Second-Hand Shock, Surviving and Overcoming Vicarious Trauma, 2nd Edition. I remember when their first edition came out in 2008. Since then, the public events of the economic crisis in 2008, the increased political polarization and 24/7 crises in the news media, there is even more vicarious trauma for professionals and lay persons alike. Trauma seems in the air now! We all need this book! Izzo and Carpel-Miller are both therapists with decades of experience on which to base their theory and practice. Their passion for this subject is amazing. While this is a huge subject, they focus on helpers, and they estimate there are about one hundred million helping professionals worldwide. In many cases, they are professionals who “mostly suffer in silence as the onset of Vicarious Trauma is slow, subtle and covert.” I found it compelling to read about the personal effects on your brain of vicarious trauma, as well as the wider societal implications of this problem. Here’s an example of their passion for addressing this problem at all levels: When we are first indirectly exposed to trauma, our brain begins to paint a picture for us by the activation of mirror neurons in the visual cortex. We see the event as if it were happening to us. A series of bio-physiological events then occur which results in the spilling out of chemicals into our bloodstream and throughout our body. This ultimately concludes in the over-production of cortisol that contributes to the onset of many serious physical illnesses. We believe people are currently being treated for the symptoms of Second-Hand Shock Syndrome, which can be confused as other illnesses. We think Second-Hand Shock Syndrome needs to be addressed and treated as its own illness. Folks are treated for arthritis, cancer, heart disease, obesity, anxiety and depression who likely began their downhill descent with some form of Second-Hand Shock Syndrome. We think it needs to become a recognized diagnosis and we believe that if people began to recognize the chronic intrusion of trauma content in their lives that their physical health would improve. It would also save our ailing healthcare system billions of dollars. I also found it helpful to read their comparison of various phrases that are commonly used for similar experiences. They go deeper and, hopefully, their book will help refine and promote awareness of this problem as one larger subject we can (and must) get a handle on. Vicarious Trauma is NOT compassion fatigue. It is NOT secondary traumatic stress nor is it burn out. Secondary stress, burnout and compassion fatigue are all possible symptoms within the realm of Vicarious Trauma. The defining concept for the diagnosis of Vicarious Trauma is the prerequisite expectation for the professional to control their empathic response while listening to the trauma content of others. This is the crucial differentiating factor. The repetitive ramping up and down of brain and body chemicals in order to control the empathic response is the key component for people suffering with Vicarious Trauma. With charts, many examples, practical tips and a helpful Workbook Section in the last part of the book, the authors offer a real wealth of information for any professional who wants to survive and overcome vicarious trauma in this second edition of their powerful book. BILL EDDY, LCSW, ESQ. is the co-founder and Chief Innovation Officer of the High Conflict Institute in San Diego, California. He pioneered the High Conflict Personality Theory (HCP) and is viewed