1. Module 4 Family Environment Skills Family Environment Skills

2. Welcome back Agenda Review home practice Module 4 Radical acceptance – audio

3. Last week’s practice exercises 1.List how many characteristics of a validating environment fit your family. 2.Using the Relationship Mindfulness Skills, pick one interaction and use the “How” skills to help to reduce judgments. 3.During the week go through the Steps of Identifying Emotions when you are experiencing something that is emotional. 4.a) Practice observing increasing anger and interrupting it. b) Look for what emotion you were missing when focusing on anger. 5.Come up with the best strategy for you to decrease your emotional reactivity. 6.What State of Mind do you function in primarily? What particular situations bring you there? 7.Be aware of when you are in Wise Mind. What helps you get there? 8.a) Observe your Relationship Mindfulness with a non family member: observe, describe, and participate - non-judgmentally. b) Practice Relationship Mindfulness at least once during the week with your family member using observe, describe, participate, non-judgmentally, one-mindfully, and effectively. In both exercises, notice your own reactions and describe them. c) Practice noticing when you disagree with another person. d) Note what happens when you let go of judgments and notice your new reaction.

4. Individual and Family well-being What is the relationship between individual functioning and family functioning/well-being? Individual and family well-being are INTERTWINED. Both determine the development of: 1.psychopathology or psychological disorders (e.g., depression, substance abuse, eating disorders, anxiety disorders) 2.family or relationship distress 3.distress in families ↔ individual distress Individual and family functioning/well-being both feed each other. Sometimes it works in one direction or the other.

5. Environments: Family We don’t know very much about family functioning in families with a member who has borderline personality disorder (neither family of origin, nor current family). We can say, from first-hand experience, that it is very difficult to be part of such a family.

6. What makes it difficult for us? 1.Severe individual distress and disorder 2.Judgments (right/wrong; should’s/shouldn’ts) 3.Bad habits, patterns: and forgetting that this is a person you love 4.Anger (it can be toxic in families) 5.Poor/inaccurate self-expression 6.Lack of understanding 7.Poor conflict management skills 8.Lack of acceptance Exercise #1: Using this list, put each factor in the order of relevance for your family. a) Which one(s) of those do you think can change? b) What will it require?

7. Blame Game  Who’s to blame? (F) Your fault (P) Your fault = we all blame each other (F) Your fault (P) My fault = blame on loved one with BPD (F) Our fault (P) Your fault = blame on the family (F) Our fault (P) My fault = everyone suffering

8. Alternative No blame Focus on describing the situation, your goals, emotions, wants, thoughts Understanding the other person’s goals, emotions, wants, thoughts Be sad together when things are different from what you want.

9. In social psychology, reciprocity is a social rule that says we should repay, in kind, what another person has provided us. That is, people give back the kind of treatment they have received from you.

10. Reciprocity in relationships A more validating family environment may be a relief for both the person with BPD and their family members It may also be a useful prevention or early intervention strategy. There is a reciprocity in relationships where the transactions that occur, create or maintain a cycle and pattern of positive feelings, or a pattern of negative feelings.

11. Finding the balance Polarisation: seeing things as opposite, black and white, “if it isn’t this, then it is that” Dialectical: not seeing things as opposite, either/or, ie. both sides can be true and have value Depolarisation: finding commonality, something in common that you both want or would like, allows for resolution.

12. Finding the Balance (or synthesis): Primary polarities or dialectical tensions we seek to find some way to accommodate both sides Acceptance vs. Change Autonomy vs. Closeness One person’s desires/goals vs. another’s Individual behavior vs. relationship behavior Individual dysfunction and psychopathology vs. relationship dysfunction Nurturance vs. limits (“tough love”) Exercise #2: Using the list above, write two sentences on each statement that describes your relationship with your relative.

13. Basic Assumptions (to be effective) People need to interpret things in the most benign way possible (“simply” observe and describe) There is no one nor any absolute truth (depolarisation) Everyone is doing the best they can in this moment (relationship mindfulness: observing, validating difference, vulnerability, and where someone is at) Everyone needs to try harder (eg., do better next time) Exercise #3: Give an example from your life of each of the Basic Assumptions. Exercise #4: Give two examples of where Basic Assumption of there being no absolute truth, could have made a difference in an interaction you had with your relative recently. Exercise #5: Use Benign Interpretation once per day. Note your reactions when you perceive things that way.

14. Acceptance and Change Change occurs in the context of acceptance of life as it is. This is a dialectical concept; Acceptance creates the possibility of change, and change requires, and leads to, acceptance. The most important acceptance skill is ‘Radical Acceptance’ (covered in the last module).

15. There are only 4 possible responses to painful events: 1.We can solve the problem 2.We can try to change how we feel about the problem 3.We can accept the problem 4.We can stay miserable.

16. Radical acceptance “Radical” means that you accept from the depth of your soul, in your heart, and mind, and body; you stop fighting the reality of the trauma. The problem is actually accomplishing the radical acceptance. It’s very hard to explain and it’s an interior process.

17. An equation to remember: Pain + non-acceptance = suffering.

18. Acceptance Acceptance may be the only way out of hell Acceptance is YES to reality and says every event has a cause Acceptance is the only way we can take suffering that feels as if it can’t be tolerated and turn it into pain that can be tolerated The distress tolerance skills in DBT are about tolerating and surviving crises while accepting life as it is in the moment.

19. Acceptance is not easy to do at times.

20. Radical Acceptance: means letting go of fighting reality Having a relative suffer with borderline personality disorder is Hell. Just as your relative did not choose to have the disorder, neither did you choose for your relative to have the disorder. But, we need to accept what is in the moment (it is what it is). Doing this helps us to move from a reactive place to a more responsive place of coping. Remember: your loved one is much more than BPD, and you are much more than a relative of someone with BPD. More on this at the end of the program. Being stuck is Non-Acceptance = No Change

21. Exercise #6 Name one thing you had to radically accept in your life. Describe what the process was like. Exercise #7 Choose one relatively minor situation and practice the skill of Radical Acceptance. Describe what the process was like. Exercise #8 Identify something about your relative that you want to work on to radically accept.

22. Practice exercises this week 1.Using the list of items listed on Page 19, “What Makes It Difficult for Us,” put each factor in the order of relevance for your family. Which one(s) of those do you think can change? What will it require? 2.Using “Finding the Balance: Primary Polarities or Dialectical Tensions” (Page 21), write two (2) sentences on each that describe your relationship with your relative. 3.Give an example from your life of each of the Basic Assumptions (Page 21). 4.Give two examples in which using the Basic Assumption (Page 21), “There is no one or any absolute truth” could have made a difference in an interaction you had with your relative recently. 5.Use Benign Interpretation once per day with one person. Note your reaction(s) when you perceive things that way. 6.Name one thing you had to radically accept in your life. Describe what the process was like for you. How did you do it? 7.Choose one relatively minor situation and practice the skill of Radical Acceptance. Describe what the process was like. 8.Identify something about your relative that you want to work on to radically accept.

23. Good luck with your home practice and see you next week.