Family Connections Welcome to Family Connections!

Family Connections Welcome to Family Connections!
Intro us – our names and roles (carer/worker). Our phone numbers are on whiteboard. More info about us a bit later when everyone will get a chance to introduce themselves. Our 2nd program We are not experts, we are travelling this journey with you. We hope you enjoy the program and not only learn a lot about your loved one, but also the importance of taking care of yourselves, so that you can support your loved ones. Housekeeping Emergency assembly point in Gibson Street side of carpark by tree (see green sign) If we cannot leave by the front door, go out the back door to the room, then out through the building to the rear carpark, and use the key provided to unlock the gate. Do not go out the back door for any other reason as it will set off alarms and result in a call out fee. There is a unisex, disability friendly toilet leading off the main room. Urn and coffee machine, tea, coffee and biscuits in the main room. .

Family Connections: NEABPD Aust: Barb Mullen
We would like to show our respect and acknowledge the traditional custodians of this land, of elders past and present, on which this event takes place. Family Connections: NEABPD Aust: Barb Mullen

Family Connections is a program of 12 weekly sessions
Your family member may or may not have a diagnosis of BPD. The program aims to: Provide information Help you understand certain concepts and learn new skills Look at some approaches to problem management Provide support What is Family Connections? a 6-Module program over 12 weeks for relatives /friends of people with difficulties managing their emotions. was developed under the leadership of Perry D. Hoffman, Ph.D., and Alan E. Fruzzetti, Ph.D. with the addition of materials from FC leaders. We have some articles for you on their work we will to you. Leaders have been trained to lead this course. Leaders include family members /carers because they are “experts” in the way that no professional can be. Also, we, in many instances, have our own personal motivation that is unstoppable. The National Education Alliance for Borderline Personality Disorder (NEA- BPD), is the umbrella under which this program exists, and new information and research is continually arising. A formal diagnosis of BPD may or may not have been given to your loved one. Regardless of what the diagnostic “label” is , Family Connection is a programme designed to provide: Provide education about BPD- the most current information on the disorder Learn new skills that focus on acceptance of what is (ourselves, our loved ones, situations, etc) in any given moment, making life a little less stressful, AND management (change) of ourselves and our relationships more effectively in any given moment or situation. 3.Support each other as you will learn more about the symptoms and behaviours. While you will develop a better understanding about these symptoms and your relative, most importantly, you will learn skills for yourself and your own well-being. For families

Class Values Respect Cooperation Acceptance Homework Punctuality
Attendance Equal talk time As in any group process there are certain guidelines that keep things running effectively. Most importantly our class values centre around: Respect for each others’ differences – our backgrounds, experiences and opinions means having due regard for the feelings, wishes, or rights of others. 2. Cooperation allowing each other space, and time is about working together in partnership, and providing mutual support 3. Acceptance here this means acknowledging that our experiences and views may be different, and valuing what others bring to the discussion 4. Attendance attending each week and being punctual please let us know if you can’t come participating in group discussions being mindful of allowing each person time to speak and contribute Homework thinking about the weekly questions and doing the homework. We cannot stress how important this is to the success of the program for you. Confidentiality is crucial. What is discussed within the group must stay within the group. Participation Confidentiality Family Connections: NEABPD Aust: Barb Mullen

Borderline Personality Disorder (BPD)
Symptoms are difficult to have and difficult to observe in a loved one The symptoms and behaviours can create havoc for many. BPD is difficult to have - and difficult to observe - in a loved one. The symptoms and behaviours can create havoc for many. No one would disagree that the behaviours that go along with the symptoms can be hell for the sufferer and an equal hell for those that love them.

Our goal is to help ourselves
As parents, relatives, and carers - we suffer with our loved ones and then - suffer also for ourselves. We need to know how to best manage ourselves in light of our loved one’s emotional difficulties and behaviours, in addition to our own individual struggles. While we believe that participation in this program may be helpful to our loved ones with BPD, that is not the main goal of the program. Our goal is to help ourselves. As parents, relatives, friends and carers, we suffer with our loved ones and then suffer also for ourselves. Although the symptoms and behaviours can create havoc for many, it doesn’t mean that people don’t get better. Many do but the road, at times, can be bumpy. Family Connections is based upon a Dialectical approach where BPD is viewed an emotion dysregulation disorder. We need to know how to best manage ourselves in light of our loved one’s emotional difficulties and the behaviours that come with that, in addition to our own individual struggles. It’s also important for relatives of those with BPD to maintain a healthy level of support for ourselves and our loved ones.

Weekly format This may vary slightly from week to week but will usually include: Review homework exercises New material Questions and discussion Recap today’s session This week’s exercise. Notes / discussion points / input / ideas for curriculum We will provide you with Student Notes in advance of each session for you to read. Please feel free to make notes including about points you would like to discuss in the class, especially thoughts that arise during the week. We invite you to share ideas and actions that have worked for you, or points you would like to see included in the curriculum. Family Connections: NEABPD Aust: Barb Mullen

Brief introductions Share: your name
your relationship to your loved one their age diagnosis (if available) and treatment history major symptoms Your emotional coping scale 1 to 10 (1=poor, 10 =good). What you would like to get out of the FC program. Your“Emotional coping” scale - Brief Introductions (approx. 5 minutes each) In a few minutes we’ll all briefly introduce ourselves – starting with us leaders. Please tell us who you are, about your situation and your relative, and what you hope to achieve here during our time together. We ask that you also state your own level of emotional coping (1 = poor, 10 = excellent We have a “Pass Rule,” which means it is OK at any time not to share if you do not want to. We do, however, encourage you to talk and share. Remember to observe CONFIDENTIALITY - what is shared in the class, stays in the class. Afterwards…..about our coping skills BPD creates stress for those in the family and for those in a caring role. Part of having the stress comes directly from the very difficult behaviours that accompany BPD and its related symptoms. We need to learn how to manage the stress; otherwise we can become non-functional at times. This not helpful to anyone. Just as we are advised by the airlines to put on our own oxygen mask first, we too need to apply an oxygen mask strategy to be most effective if we want to help our relative. We are not experts but just like you, we have a unique expertise with BPD. We don’t profess to have all the answers, but we hope that together, with the skills we will be sharing and the discussions we will be having, we can decrease some of the stress and worry that comes with being the relative of a person with BPD or BPD-related symptoms. INTRODUCTION EXERCISE (I haven’t checked what this is. We may choose to leave it to the end of each session to introduce?)

“Rights” of relatives We need to:
have a “healthy selfishness” (balance) learn to say “no” have our own emotional support network accept that we cannot solve our relatives problems accept we will lose our “cool” at times. It’s important for relatives and friends of those with BPD to have the right to maintain a healthy level of support for ourselves and our loved ones. So… we need to: have a “healthy selfishness” (to maintain balance in our lives – to look after ourselves - so that we have energy for our loved ones) learn to say “no” have our own emotional support network accept that we cannot solve our relatives problems accept we will lose our “cool” at times. So, why are things so difficult at times? Because this is an extremely complex and difficult disorder.

The Criteria of BPD There are 9 different problem areas; 5 or more need to be present. Fear of being abandoned Intense mood shifts (affective instability) Impulsivity Problems with anger Recurrent suicidal or self-mutilating behavior Pattern of unstable and intense relationships Chronic feelings of emptiness Unstable sense of self, “chameleon-like” (identity disturbance) Stress-related paranoia or dissociative symptoms “Borderline” is an outmoded term. It describes a state on the border between neurosis and psychosis, however, many researchers and professionals today see BPD as a disorder of the emotion regulation system. There have been moves to change the name e.g. to “emotional dysregulation disorder” but to date, the name BPD still stands. According to the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders, there are 9 criteria for BPD; of which 5 or more need to be present. They are in order of frequency: Fear of being abandoned 2. Intense mood shifts 3. Impulsivity 4. Problems with anger 5. Recurrent suicidal behavior or self-mutilating behavior 6. Pattern of unstable and intense relationships 7. Chronic feelings of emptiness 8. Unstable sense of self, “chameleon-like” 9. Stress-related paranoia or dissociative symptoms

DSM 5 BORDERLINE PERSONALITY DISORDER
A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following: Family Connections: NEABPD Aust: Barb Mullen

People who meet fewer than 5 criteria may still have significant symptoms that severely impact their lives. People who meet fewer than five criteria may still have significant symptoms that severely impact their lives. To get a better understanding, we’ll now go over the Diagnostic Criteria as described and numbered, in the DSM-5.

Criterion 1 Fear of abandonment
Frantic efforts to avoid real or imagined abandonment sensitive to environmental circumstances experience intense abandonment fears and inappropriate anger even when faced with a realistic time-limited separation or unavoidable changes in plans belief that “abandonment” implies they are “bad” related to an intolerance of being alone and a need to have other people with them. Criterion 1: Fear of abandonment Individuals with BPD make frantic efforts to to avoid real or imagined abandonment. They are very sensitive to environmental circumstances. They experience intense abandonment fears and inappropriate anger even when faced with a realistic time-limited separation or when there are unavoidable changes in plans: e.g. sudden despair in reaction to a clinician’s announcing the end of the hour; or panic or fury when someone important to them is just a few minutes late or must cancel the appointment They may believe that this “abandonment” implies they are “bad”. These abandonment fears are related to an intolerance of being alone and a need to have other people with them. Their frantic efforts to avoid abandonment may include impulsive actions such as self-mutilating or suicidal behaviours, which are described separately in Criterion 5.

Criterion 2 Pattern of unstable and intense interpersonal relationships characterised by alternating (switching) between extremes of idealisation and devaluation prone to sudden/dramatic shifts in their view of others family members often bear the brunt of this criteria, whereas friends or work colleagues can walk away where the person with BPD has children, the dynamic for loved ones changes completely. Criterion 2: Pattern of unstable and intense relationships This is characterised by the individual alternating between extremes of idealisation and devaluation. They may idealise caregivers or lovers at the first or second meeting, demand to spend a lot of time together, and share the most intimate details early in a relationship. However, they may switch quickly from idealizing other people to devaluing them, feeling that the other person does not care enough, does not give enough, or is not” there” enough. These individuals can empathise with and nurture other people, but only with the expectation that the other person will “be there” in return to meet their own needs on demand. They are prone to sudden and dramatic shifts in their view of others, who may alternatively be seen as beneficent supports or as cruelly punitive. Such shifts often reflect disillusionment with a caregiver whose nurturing qualities had been idealised or who rejection or abandonment is expected. Family members often bear the brunt of this criteria…once a parent, always a parent…whereas a friend or work colleague can walk away. Where the person with BPD has children, the dynamic for loved ones changes completely.

Criterion 3 Identity disturbance
markedly and persistently unstable self-image or sense of self “Chameleon-like” sudden and dramatic shifts in self image: shifting goals, values, and vocational aspirations sudden changes in opinions/plans about career, sexual identity, values, and types of friends at times, may have feelings that they don’t exist at all. Criterion 3: Unstable sense of self, “chameleon-like”: There may be an identity disturbance characterised by markedly and persistently unstable self-image or sense of self. There are sudden and dramatic shifts in self image, characterised by shifting goals, values, and vocational aspirations. There may be sudden changes in opinions and plans about career, sexual identity, values, and types of friends. Things are often seen in black and white. These individuals may suddenly change from the role of a needy supplicant for help to that of a righteous avenger of past mistreatment. Although they usually have a self-image that is based on being bad or evil, individual with BPD may at times, have the feelings that they do not exist at all. Such experiences usually occur in situations in which they feel a lack of a meaningful relationship, nurturing, and support. They may show worse performance in unstructured work or school situations.

Criterion 4 Impulsivity
in at least two areas that are potentially self-damaging: gambling spending money irresponsibly engaging in unsafe sex abusing substances driving recklessly binge eating Criterion 4 – Impulsivity – as above

Criterion 5 Recurrent suicidal behaviour, gestures, threats, or self- mutilating behaviour Criterion 5 - Individuals with BPD display recurrent suicidal behaviour, gestures, or threats, or self mutilating behaviour. Completed suicide occurs in 8-10% of such individuals, and self-mutilating acts (e.g. cutting or burning) and suicide threats and attempts are very common. Recurrent suicidality is often the reason that these individuals present for help. These self-destructive acts are usually precipitated by threats of separation or rejection, or by expectations that the individual assumes increased responsibility. Self-mutilation may occur during dissociative experiences and often brings relief by reaffirming the ability to feel or by expiating or make amends for the individual’s sense of being evil.

Criterion 6 Affective instability due to a marked reactivity of mood
intense mood shifts may include intense episodic dysphoria (a state of unease or generalized dissatisfaction with life), irritability, or anxiety usually lasting a few hours and only rarely more than a few days these episodes may reflect the person’s extreme reactivity to interpersonal stresses. Criterion 6: Affective instability due to marked reactivity of mood such as intense episodic dysphoria (a state of unease or generalized dissatisfaction with life), irritability, or anxiety usually lasting a few hours and only rarely more than a few days. The basic dysphoric mood is often disrupted by periods of anger, panic, or despair and is rarely relieved by periods of well-being or satisfaction. These episodes may reflect the persons extreme reactivity to interpersonal stresses.

Criterion 7 Chronic feelings of emptiness As if you are wearing a mask behind which there is nothing. Criterion 7: Individuals with BPD may be troubled by chronic feelings of emptiness As above

Criterion 8 Inappropriate, intense anger or have difficulty controlling anger. Frequent displays of temper tantrums, constant anger and reoccurring fights. Criterion 8 Easily bored, individuals with BPD may constantly seek something to do. They may express inappropriate, intense anger or have difficulty controlling their anger. This may include extreme sarcasm, enduring bitterness, verbal outbursts, frequent displays of temper, or recurrent physical fights. The anger is often elicited when a caregiver or lover is seen as neglectful, withholding, uncaring, or abandoning. Such expressions of anger are often followed by shame and guilt and contribute to the feeling they have of being evil.

Criterion 9 Transient, stress-related paranoid ideation, or dissociative symptoms (depersonalisation) zoning out - a way of removing yourself from a painful experience feelings of detachment from one’s own body or thinking these episodes occur most frequently in response to a real or imagined abandonment Criterion 9: Transient, stress-related paranoid ideation, or dissociative symptoms (depersonalisation) During periods of extreme stress, transient paranoid ideation or dissociative symptoms may occur. (Paranoid ideation = an exaggerated, sometimes grandiose, belief or suspicion, usually not of a delusional nature, that one is being harassed, persecuted, or treated unfairly) This includes zoning out as a way of removing yourself from a painful experience, or feelings of detachment from one’s own body or thinking. But these are generally of insufficient severity or duration to warrant an additional diagnosis. These episodes occur most frequently in response to a real or imagined abandonment. Symptoms tend to be transient, lasting minutes or hours. The real or perceived return of the caregiver’s nurturance may result in a remission of symptoms.

Emotional dysregulation (ED) From Wikipedia, the free encyclopedia This is a term used in the mental health community to refer to an emotional response that is: poorly modulated, and does not fall within the conventionally accepted range of emotive response. ED may be referred to as labile mood (marked fluctuation of mood)[1]or mood swings. OPTIONAL EXTRA INFO Marsha Linehan’s theory is that individuals with BPD are emotionally sensitive from birth . This sensitivity leads to a propensity to experience negative affects across contexts and situations, which then makes it difficult to learn appropriate emotion regulation strategies. All this likely contributes to a tendency to engage in dysregulated behaviours in order to manage and reduce a negative affect. Emotional Dysregulation can present as Internalizing behaviours including[ being less able to calm themselves difficulty understanding emotional experiences becoming avoidant/dissociative when dealing with negative emotions experiencing more negative emotions Emotional dysregulation can be associated with externalising behaviours including: becoming aggressive when dealing with negative emotions exhibiting more extreme emotions difficulty identifying emotional cues difficulty recognizing their own emotions focusing on the negative difficulty controlling their attention being impulsive difficulty calming down when upset. Family Connections: NEABPD Aust: Barb Mullen

Emotion Dysregulation Disorder.
occurs when we are oriented to escape, to reduce negative arousal, regardless of the long term consequences of our methods. We lose the big picture. This diagram illustrates emotional dysregulation, which contributes or leads to… (see diagram).

5 areas of Dysregulation
Dysregulation occurs when a person is out of control (more than just upset) Emotion dysregulation • Affective lability (marked mood swings) • Problems with anger Interpersonal dysregulation • Chaotic relationships • Fears of abandonment Self dysregulation • Identity/difficulties with sense of self • Sense of emptiness Behavioural dysregulation • Suicidal and non-suicidal self-injury • Impulsive behaviour Cognitive dysregulation • Dissociative behaviour/transient paranoia. Linehan (1993) Cognitive Behaviour Treatment for Borderline Personality Disorder The diagnosis of PBD includes a very wide spectrum of behaviours. Dysregulation occurs when a person is out of control (more than just upset). See above for the 5 areas of dysregulation that map onto the 9 Criteria for BPD

depression, anger, loss, grief, guilt. We often do not acknowledge
There are a multitude of emotions that occur when a loved one’s life is changed by mental illness: depression, anger, loss, grief, guilt. We often do not acknowledge these feelings, even to ourselves or the impact that this disorder has on the entire family What has this been like for you? Our Mutual Connection The diagnosis of BPD includes a very wide spectrum of behaviours. People in this group have relatives whose levels of functioning may greatly differ. The level of functioning differs not only among sufferers, it differs at different times for the sufferer. It is for some of these reasons that the disorder is characterized, even by professionals, as “an elusive entity.” However, there are many threads of common experiences that we all share. It is these common experiences that bring us together, and are also, unfortunately, often not understood by others. Key Points Irrespective of diagnosis, there are a multitude of emotions that occur when a loved one’s life is changed by mental illness: depression, anger, loss, grief, guilt. We often do not acknowledge these feelings, even to ourselves. As we are all family members and understand the impact that this disorder has on the entire family, we hope we can feel free to talk about these feelings. Talking and education are major ingredients to managing such feelings more effectively. **EXERCISE**  What has this been like for you?

Different Perceptions: New Behaviours
As we have no control over how another person acts or behaves, we need to work to change the way we experience the world. We need to commit to changing ourselves. In FC, we will learn how to step back, to be more mindful (less emotional, more focused, observing ourselves), to analyze what works, and to acquire new behaviors. Different Perceptions: New Behaviours As above

Basic Assumptions (to be effective)
It is most helpful to interpret behaviours in the most benign way possible There is no truth or absolute truth Everyone is doing the best they can in this moment Everyone needs to try harder. So…as a way of allowing us to plan and move forward in our lives, and as a way of working out what gets in the way, we need some guidelines to be effective. Adopt a dialectical world view – and interpret things in the most benign way possible as there is no absolute truth about behaviour and experience (Dialectics is a method of examining and discussing opposing ideas in order to find the truth). 2) We need to acknowledge that everyone is doing the best they can in this moment And… 3) Everyone needs to try harder. Don’t give up, make sure you maintain support and take care of yourself

Research So far, there are three(3) published studies on FC and more ongoing. All show similar results: Family Connections leads to significant benefits for family members including: Decreased grief Decreased burden Decreased depression Increased mastery/empowerment.

Practice Exercises > this week
Write 1 sentence on each for next week’s discussion From your perspective, what are your relative’s predominant behaviours, emotions and cognitions (thoughts, feelings, beliefs)? Which ones interfere with his/her life the most? Which ones are most problematic for you? Practice Exercises With each module, there are exercises that are designed to reinforce what we have covered during the weekly session and, as skills are discussed, to provide a focus to practice behaviours of change. People often say that even after they have finished the Family Connections course, the exercises are very helpful as a means of remaining mindful when dealing with difficult situations. Some post exercises that are particularly helpful to them in their family situation on the refrigerator!

Family Connections Welcome to Family Connections!

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