Karyn Hall's Blog, page 20

Self Compassion and Acceptance

 

Bene Brown's work on shame is consistent with DBT's approach on treating shame.  Brown advises us to live authentically and accept our humanness, our imperfections.  She suggests that we live outloud, without fear of not being good enough and acknowledges that most everyone feels like an outcast at times, feels not good enough. Not skinny enough, not pretty enough, not smart enough, not cool enough, not whatever enough.  Those are normal human feelings and we all have them.  Opening ourselves to vulnerability and sharing our stories of not being good enough, our failures, our mistakes and our hurts is a path to connecting with others and feeling the belonging that we want.  Her work on shame is similar to Linehan's treatment of shame. Linehan says to overcome unjustified shame we must hold our heads high and not keep our shame secret.  We must say who we are proudly and with understanding that all humans struggle and make mistakes. In that way we can stop hiding and excluding ourselves from close relationships and blocking love and caring offered by others.

Unjustified shame is different from justified shame.  Justified shame means you will truly be excluded from a very important group, one that is critical in your life, if you reveal what you have experienced.  This would be like being excommunicated from a church that is important to you or expelled from a school where you are getting your degree.  In those circumstances, the shame serves to help you make different decisions in the future, to keep the values of the groups that are important to you.  Forgiving yourself and moving forward with compassion for yourself is the best path.

I Thought It Was Just Me is one of the best books about shame and vulnerability that I have read. Thanks, Dr. Brown.

 

 

Crisis Plans

No one wants to think about a crisis occurring.  When the last emotional emergency was over, no doubt you hoped it would be the last.  Planning for emergencies is uncomfortable because it means thinking about upsetting events when they aren't happening and it means thinking about difficult choices.  But one of the characteristics of Borderline Personality Disorder is unrelenting crises and you will decrease your stress and be able to respond more consistently if you have a Crisis Coping Plan.

Your crisis plan might include how you will respond to various behaviors that your loved one is likely to exhibit. Record your plan in detail.  Write down the phone numbers of your loved one's psychiatrist, therapist, and anyone else you may need to call. Maybe you would keep a list of her medications, her license plate number, and the phone numbers of her best friends.

Helping yourself cope with the stress of crises is also important.  What are your primary self soothing skills?  What are activities you can use to distract yourself?  Who are people you can spend time with and who are people you can talk openly with about your feelings?  Write down their names and phone numbers.

When you are not in crisis, remember to take good care of yourself.  Having a loved one suffer from BPD can be stressful on the family and chronic stress reactions are not unusual for family members.  Nurturing yourself will help you and your loved one.

Understanding Anger

Many times people describe another person as an "angry" person or someone who has an "anger problem" and shake their heads. Emotionally abusive spouses, the controlling boss, the critical parent–all may be described as angry people. Bullies are angry people, whether they are twelve or forty-five. Maybe it's hard to understand why someone would be angry most of the time. After all, being chronically angry has many negative consequences for both the person who lives in anger and those around that person. Why would anyone continue a behavior that seems so negative?

Anger is a complicated emotion but we're beginning to understand it better than ever before.  There are different types of anger.

First consider Stephanie. That's a made-up name of course and doesn't refer to any real person. Stephanie is focused on self-esteem. Focusing on self-esteem is a trap, as we know from Dr. Neff's book Self Compassion (2011).  She looks for achievements to feel good about herself and assesses herself in terms of whether she is better than others in various ways, such as being smarter, more fit, wealthier, and the like. Because she sees her value as measured through these comparisons, there will be times when she realizes others are smarter, wealthier, or in better shape than she is. There are many ways of responding, and her way is to be angry when that happens. Loss of her value as a person hurts and anger is one response to feeling hurt. In some situations where someone isn't clear about who they are, the anger may be intense because they feel so worthless. Some people routinely compare themselves to others who they judge as being superior to them and the result is also anger.  Believing that you are worthless is one root of chronic anger.

Jake is an abusive spouse. When his wife Wendy returned home late from a meeting, he raged at her, demanding to know where she had been. He "knew" she was cheating on him.  Wendy apologized over and over and reassured him she loved him. To avoid his anger she told her boss she couldn't stay late any more. She made many changes in her life to avoid Jake's anger. Anger for Jake is a way of controlling his fears of abandonment.

Allison is a pretty  twelve-year-old girl who goes to a private school. She's the Queen Bee with a group of three or four followers. She puts others down and believes she is superior to other students and deserves to be adored. When she wasn't chosen as homecoming queen she was enraged. She stayed angry for months and tormented the girl who was chosen as queen. She believed she deserved it, she wanted it and she saw herself as the prettiest girl at the school. She stayed angry for months and tormented the girl who was chosen as queen.

Wesley continues to form relationships that seem promising. He has a certain closeness that he is comfortable with. He is fine until he talks about marriage and then he finds a reason to be angry with the one he cares about. He has the same pattern in business. He works well with someone until he thinks about having a business partner. Then he destroys the relationship by finding fault with the other person.

Anger is often a secondary emotion, triggered by fear. Think about your child running onto the road in front of your house. Fear comes first, then anger. Sometimes the change from fear to anger happens so quickly and automatically people aren't even aware it occurred.

Steven Stosny, in his book Treating Attachment Abuse (1995) talks about anger as an emotional salve to cover up core hurts. He identifies core hurts, some of which are feeling ignored, unimportant, accused, guilty, untrustworthy, devalued, rejected, powerless, and unlovable. The healthy person has the power to self-validate and cope with these difficult emotions.

If someone doesn't have the ability to soothe through self-validation, then they may use anger to invalidate the person who has hurt them. By assuring oneself and others that the hurt was not legitimate, that the other person was in the wrong, the person establishes their superiority. Thus they avoid feeling the difficult emotion.

For example, Allison believes that the girl who won the contest did not deserve it and thus does avoids dealing with the feeling of rejection or legitimate loss. She attacks the girl who did win to prove her point.  Allison is exhibiting a narcissistic anger–she does not feel insecure, she feels entitled.

Jake is attempting to avoid terrifying feelings of abandonment. He does not have to see himself as wrong or selfish, or mean because he is sure his wife was the one at fault.

Stephanie feels powerless and inadequate. When someone feels powerless, anger can be empowering. What a different feeling that is! Empowering can also mean control.  For fearful people, feeling in control may be soothing and they can often get that feeling through anger.

Anger can create distance when someone is afraid of getting too close.  If someone has grown up with distant parents, they may crave closeness but at the same time be afraid of it. Anger can be protective in those situations. That's Walter's pattern.

Anger can also be a safe way to engage with someone. I fight with you, therefore we are connected.

Stosny also points out the chemical rush that comes with anger. When a person gets angry, the brain secretes norepinephrine. norepinephrine works much like a pain reducer. When provoked the brain also produces the hormone epinephrine, which causes a surge of energy throughout our body. The chemical reactions may be comforting as well. Some report feeling an almost addictive like response to the adrenaline-like rush they experience when angry.

Treating anger problems requires careful assessment to find the reasons for its occurrence.

 

 

 

 

Self Compassion

Dr. Kristin Neff's book on self compassion was published in April 2011. We've followed her website for some time and used her work in the work we do. Our expectations for her book were high. She didn't disappoint.

Human minds seem to naturally be judging, judging, and judging some more. Many people tend to build themselves up by putting others down. The idea seems to be that if someone see themselves as better than someone else then they feel better about themselves. Bullies do this to an extreme and gather allies to join them to  further prove their superiority over another human being. Given that in this country we seem fixated on being above average as a way of having self-esteem, that means finding someone or lots of someones you see as beneath you. The judging doesn't stop with others but usually includes harsh judgments of themselves as well.

Dr. Neff explains clearly how that is a set-up for problems and why it doesn't work. She offers self compassion as an alternative to self esteem.  She points out that if people see conflicts as being between two groups of people, such as between women and men or between different nationalities,  they tend to be more accepting of the differences than if they think of the conflicts as being between human beings. That leads to one of her main pathways to self compassion–accepting that what we experience are is part of the human condition. We all experience loss, disappointment, failure, shame and regret.

To truly experience self compassion is to not judge. Self compassion means to understand and accept. Is she saying nothing should be judged as wrong? No. Dr. Neff describes discriminate wisdom as the ability to separate the action from the person. Stealing is wrong. Understanding that the person who stole was hungry helps you have compassion.

Teaching a nonjudgmental stance is part of DBT. Perhaps teaching self compassion as what to do instead of judging adds an important component.

Self compassion also adds to the understanding of invalidation, perhaps helping stop the behavior. Understanding that every human being makes mistakes and is fallible and that there are multiple reasons for the missteps and less than desirable decisions encourages the logic and truth of stopping invalidating statements.

Perhaps most important of all, Dr. Neff cites research that shows people practicing self compassion are less likely to be depressed or anxious and have a more stable sense of security. That's a significant result.

 

DBT-FSC

Suzanne Robinson, LCSW is currently leading a DBT Skills Class for families and friends of those who have emotion dysregulation disorder.  The class meets on Thursday evenings from 6 to 7:30 pm.  When families take a skills class that it is helpful for the recovery of the person with the disorder.  Please call Suzanne at 832-722-6514 in you are interested in this class.

I'm Late, I'm Late! For A Very Important Date! DBT Consultation Team

One of the requirements of being a DBT therapist is having a consultation team.  And one of the expectations of being on the team is that you will be on time for the team meetings.  When you are a busy therapist who is grateful for time to eat and go to the restroom, being on time for team may seem like a really silly issue.  What's the problem with being five or  ten minutes late? Honestly, people need to get a life and be more compassionate. Compassion is part of DBT too, right?

     At the moment, a phone call or getting food or taking a restroom break seems more important than getting to team meeting on time and would appear to have no negative consequences. Therapists are busy people and taking just a few minutes seems harmless.

Unfortunately, it's not really harmless at all.  What can happen over time is that other team members see the meeting as starting ten minutes later than the scheduled time and everyone comes ten minutes later.  A second possibility is that the team meeting becomes devalued or that other team members feel their time is not respected. They too have phone calls to make. The consequence is that the team meeting becomes less of a priority for everyone, something that can be done if there is time,  and that is a serious consequence for all team members. A third consequence is that the team is cheated of the late team members' input and ideas that also makes the team less effective. Finally, therapists expect their clients to manage their time and be punctual for their appointments. If that expectation is reasonable for clients, it is reasonable for therapists as well.  Therapists teach partly by being role models. Structuring their time effectively is being a good role model and helps them understand the difficulty involved in modifying behaviors even when the goal is initially viewed as a priority.

Notice how being late for team is looked at as unavoidable because of the lack of time?  Addressing tardiness means first assessing the problem.  Remember, no solutions until the problem is understood. The first step is a chain analysis to look for the contingencies that maintain the late behavior, the lack of skill involved or the structure of the environment. Is it a motivational problem?  Is there some reason the team member wants to avoid team or is rewarded for being late?  Is there a higher reward for being late than for being on time, such as food? Or is there an environmental problem, such as a too tight schedule with the bathroom too far away or food unavailable during earlier breaks?  Perhaps the therapist's last session before the team meeting habitually goes over the ending time. Once the problem is clearly understood then problem solving can begin. By addressing the problem, the therapist either becomes more effective as a therapist (e.g., deals with stopping sessions on time) or finds it easier to attend team (e.g., food is made available at the team meeting or she creates a more reasonable schedule).  Asking the therapist to chain her late behavior consistently may encourage her to solve the identified problems.

Strong DBT therapists use the DBT principles and skills to address their own behavior.  Perhaps most importantly of all, not addressing late arrival at team meeting means a deviation from DBT principles.