1. “Those Borderlines:” Removing Stigma and Facilitating Recovery Reneé Kopache Hamilton County Mental Health and Recovery Services Board

2. Agenda Recovering and Facilitating Recovery Hope Empowerment Self-Responsibility Meaningful Role Issues to Contend With Stigma Co-dependency Substance abuse Trauma Self-Injury and suicidal actions

3. Recovering & Facilitating Recovery from BPD

4. Stages of Recovery*  HOPE  Empowerment  Self-Responsibility  Meaningful Role ---------------------------  Recovered * Village Integrated Services, Inc.

5. Hope Becoming rational thinkers: Hope is basically an attitude (influenced by thought). Those of us with BPD struggle a great deal with irrational thought patterns, which hinders our sense of hope. To obtain and maintain a sense of hope, we have to change (control) our thoughts… …we have to become rational thinkers!

6. The Role of the Provider - Hope  Engagement Trust Dialogue  Don’t hide the diagnosis from the consumer  Education Help the consumer understand why they do what they do and think the way that they think  Separate the illness from the individual Avoid Stigma Teach rational thinking…instill a sense of Hope!!!

7. Hope Con’t  Helpful Coping Skills/Techniques: Support from a trusted, third party observer Journaling mood logs Positive self-talk and/or affirmations medications  Barriers: Stigma & discrimination from having a mental illness  “We’re difficult, manipulative, and nobody wants to work with us because we’re so bad off - - how can we have hope when the system has no hope for us?” Fears (change, abandonment, emotions, etc.)

8. Empowerment  Become Knowledgeable know your illness & yourself  learn to distinguish between symptoms and you  warning signs  Triggers  rights  Utilize Support Professional Peer Friends/family  Become active in your treatment Medications alone will not improve your life Your treatment providers cannot fix you

9. The Role of the Provider - Empowerment  Educate Support the process of gaining self-awareness Homework assignments  Boundaries Consistency Avoid getting trapped  Support Begin to assist the consumer with the process of developing a healthy support system

10. Empowerment Con’t  Helpful Coping Skills/Techniques: Continue using skills from previous stage Read, read, read Self-Assessment  strengths, weaknesses, needs, wants, goals, etc. Let people help Exercise….pursue hobbies  Barriers: Stigma Triangulation Fear of abandonment Trust

11. Self-Responsibility  Changing Behaviors/Regulating Emotions Advanced recovery  critical stage where we shift from an external to internal locus of control  taking responsibility for our lives…being willing to do whatever it takes to get better for some, progress in recovery stops here Anger is not the only emotion we have  taking on responsibility for our well-being opens the door to feeling the positive emotions Creating a positive lifestyle  change, change, change  risks, risks, risks

12. The Role of the Provider Self Responsibility  Support the efforts to change Provide tools and techniques Cheerleader Sounding Board Expect failure and be ready to deal with it  Help the consumer improve self-esteem and sense of self  Help the consumer deal with co-dependency issues

13. Self-Responsibility Con’t  Helpful Coping Skills/Techniques: Continue previous skills as appropriate Identify the problems as well as reasonable solutions…then, develop a plan to implement the solutions (Impulse Control Logs)  Physical  Thought/Emotional  Relationships  Barriers: Self-sabotage (fear of success) Fear of failure Low self-esteem & poor social skills

14. Meaningful Role  Integrated life in the community Life extends beyond mental illness and the mental health system Valued Role in the community  Employment/volunteering  Faith community  Family  Friendships/relationships  Community organizations  Giving back Pursuit of interests/hobbies (outside of MH)

15. The Role of the Provider Meaningful Role  You’re job is just about done! Encourage activities in the community  Help the person connect to natural supports Help the individual transition out of services  Be prepared for self-sabotage

16. Meaningful Role Con’t  Helpful Coping Skills/Techniques: Keep doing what’s worked Try new things Give back  Barriers: Old habits are hard to break returning to the comfort zone Self

17. Issues to Contend With  Stigma  Co-dependency  Substance Abuse  Trauma  Self-Injury and suicidal actions

18. Overcoming Stigma  Stigma from others (external) Mental Health System  Providers  Peers Community (family, friends, neighbors, etc.)  Self-stigma (internal) Serenity Prayer Self-Esteem Empowerment

19. Co-dependence & BPD "Codependence is about giving away power over our self-esteem.” (Burney, Robert) It is this lack of a "self" that leads the person with BPD to continually set and re-set themselves up as victims. (Mahari, A.J., 2000). Robert Burney From his Column "Codependence vs Interdependence”-- In an article by A.J. Mahari (2000) titled: “Co-dependence: Where Borderlines and Non-Borderlines Often Meet.” www.borderlinepersonality.ca/bordercodepdance.htm

20. Codependence Cont’  Recovery from co-dependence is about knowing that you want and deserve healthier relational reality…It’s about meeting your own needs! “you NEED to learn to validate yourself from the inside out and you must stop seeking others to define you and or to meet your needs for you” (Mahari, A.J., 2000).  Recovery from BPD involves overcoming co-dependence and becoming an emotionally healthy adult by taking responsibility for oneself, and building a sense of self (identity), self- esteem and self-worth.

21. Substance Abuse  54% of those with BPD have a problem with substance abuse (bpdcentral.com).  Individuals with BPD who abuse substances… are at greatly higher risk for suicide and for death or injury from accidents. often abuse substances in an impulsive fashion contributing to a lower threshold for other self- destructive behavior.

22. Trauma  Research suggests that between 40% and 70% of individuals with BPD are victims of trauma (NIMH website).  Approximately 25% of individuals with BPD are also diagnosed with PTSD (NIMH website).  Challenges to treatment due to trauma Threat to therapeutic alliance Issues with transference Traumatic memories Splitting

23. Self-Injury and Suicidal Actions  Approximately 70-75% of patients with BPD have a history of at least one deliberate act of self-harm.  According to Linehan et al, the mean estimated rate of completed suicides is 9%.  Self-mutilation is distinct from suicidal behaviors, but such behaviors double the risk of actual suicide Purpose: most often those with BPD self-mutilate to punish themselves, but some are seeking relief of dysphoric states http://www.afsp.org/education/gund_ridolfi.htm

24. Self-injury and suicidal actions  Managing Suicidality Split treatment (multiple providers)  Identify the Primary Clinician Contracting for safety Responsibility for reporting feelings/thoughts falls on the consumer When the crisis has passed, process it  how you felt about it  how the consumer felt about it  plan to respond differently in the future http://www.afsp.org/education/gund_ridolfi.htm

25. Resources: Books  I Hate You, Don’t Leave Me Kreisman, Jerold  Managing Intense Emotions and Overcoming Self- Destructive Habits: A Self-Help Manual Bell, Lorraine  The Angry Heart: Overcoming Borderline and Addictive Disorders : An Interactive Self-Help Guide Santoro and Cohen  Life at the Border: Understanding and Recovering from the Borderline Personality Disorder Heller, Leland M.D.

26. Books Con’t  Skills Training Manual for Treating Borderline Personality Disorder. Linehan, Marsha M.  Eclipses: Behind the Borderline Personality Disorder Ford Thornton, Melissa  The Feeling Good Handbook Burns, David M.D.  Pathways to Recovery: A Strengths Recovery Self-Help Workbook Ridgway, Priscilla; McDiarmid, Diane; Davidson, Lori; Bayes, Julie and Ratzlaff, Sarah

27. Resources: Websites  Borderline Personality Disorder http://www.bpdcentral.com http://www.bpdresourcecenter.org/ http://www.laurapaxton.com/ http://www.biologicalunhappiness.com/ http://borderlinepersonalitydisorder.com  General Recovery Websites http://www.mhrecovery.com http://power2u.org

28. Q&A and Contact Info. Renee Kopache reneek@hamilton.mhrsb.state.oh.us www.mhrecovery.com Angela Ostholthoff aostholthoff@gcbhs.com www.recoverycenterhc.org