Sunday, September 22, 2013

Family and Loved Ones with Emotional Regulation Issue Seminar

A week from today Sunday 9/29 from 4-5:30PST Debbie Corso from Healing from BPD, myself and guest Dr. Perry Hoffman from NEA BPD (National Education Alliance for Borderline Personality Disorder) will be facilitating an global seminar for family and loved ones of those with Emotional Regulation Issues.  We will be talking about how loved ones can help, what resources are available to both clients and their families and have an open Q&A session.  

There are 2 days left to get the discounted price.

If you have any questions e-mail

Friday, April 5, 2013

Ask Any DBT or BPD Questions This Weekend!

Hi All,

Quick note.  This weekend I will do a Q&A on twitter.  Feel free to ask me any questions about DBT or BPD.  Tweet them @apazma, DM me to be anonymous, e-mail or leave them in the comments below.  I will re-post all questions (minus names) here after I am done.

Great way to get some professional information!

Thursday, March 21, 2013

My Job: Dual Diagnosis Counselor at a Womens' Prison

Today's post is a little off topic, but today was the inmates graduation and being the emcee I posted about my nerves on Facebook and told my friends with an interesting response.  I have been working there for 8 months and it always seems to be an interesting topic to talk about with friends, family even strangers.  The reactions are mixed, but people have the same few questions so here goes.  If I seem vague it's because well it's a prison and although some information is open, certain some things are not.

  • My job is Dual Diagnosis therapist, although not all my clients are what the program considers DD.  To them DD is MH medication+therapist+diagnosis of MH & Addiction.  The medication they can receive is not the same medication they often have Rx with their regular MH doctor.
  • The programs main focus is substance abuse and they attend 16+ hours of group a week including cognitive skills, seeking safety, and process.  They learn a lot of skills for their recovery and must attend 2-12 step meetings a week.  
  • We have a wait list of over one year most times, some of them are parole-board recommended- which translates that they need to complete the program.  
  • The program is 6 months long.  There are reviews of their progress every 30 days- it's very time consuming.
  • My caseload is about 20 people, although not all people graduate due to various reasons most are due to lying, manipulating and confidentiality.
  • The "program" is all housed together- the rooms hold from 2-6 people, most are "2-man cells."
  • We utilize a peer-support program which includes 10 "lifers," all which are murderers some of which have been incarcerated for 25 years.
  • We are contracted by the state.
  • A vast majority of these women have been the victim of horrific abuse as a child (often sexual,) abusive relationships, raped, started using substances around age 13 and have or in the process of losing their kids permanently.  Most would meet the criteria for PTSD.
Now to the questions people have most often:
  • I always feel safe- the rare time I don't is when I am with general population and someone s cursing or yelling at someone else.  There are physical fights- but rarely .  There has been 1 in the 8 months I have been there, and I don't think there was more than one prior.
  • The "lifers" and inmates in general are not scary or mean.  Part of it is because they in some way need the program to parole or stay out of another more-strict.more dangerous unit (or they have an extra 2 years+ typically.)
  • Some do recovery- this is probably the #1 question.  Some come back.  We don't know statistics on how many, but I would assume half of them relapse on substances with in first 2-3 years.  If they relapse they often go to a different program, rather than repeating this one although we have had a few come back 5 years later.
  • Half of my co-workers are in recovery, my boss has 33 years and my co-worker has 13 years clean! We had a counselor pass this year and she has 13 as well, she died due to complications from her Hep C she contracted at age 17 using heroin.
  • It's very, very stressful- these women have been through so much and get "caught up" in what we call "prison bullshit," relationships, manipulation and lying to staff.  A lot of my time is spend in crisis mode, especially in the beginning of the 6 months.  
  • I cry, I try not to and most of the time I am fine.  They write an autobiography about halfway through and share it with the group- it's all triggering.  Some stories don't affect me so much and then there are a few that keep me up at night, make me cry or change the way I look at the inmate.  These women have such strength and perseverance and their stories are so tragic.  
  • We can't hug!  Nope, no touching on shoulder, no embracing at all.  This is a strict rule and could lead to termination.  It is difficult and un-natural at times, especially when someone comes to be on-on-one and tells me their child died in the streets selling dope or there mom has terminal cancer.  Life goes on while they are in jail and they often feel and are powerless.I am called by my last name only
  • Yes, they eat crap.  Carb and calorie heavy food is the norm around here. They are allowed to work out at times and watch videos during the day.  There really isn't healthy options and most gain weight while incarcerated. Food is a commodity and is traded like cash.
  • There are drugs in the prison.  Seems strange, but like all institutions there are drugs.  Most often it's Rx drugs that another inmate "cheeks" and sells, but there is also narcotics.
  • 3" toothbrushes, and other strange things (to me) are used as if it's normal.  They are allowed to purchase (or someone purchases it for them) certain products these mostly include non-name brand lotions and such.  They are not allowed make-up (they use paint,) nail polish, headbands, etc.  Many still have them though.  A "full size" toothbrush that is easily 15 years old can go for $25.
That's all I can think of off-hand, I am open to answering any questions as I often think people think I work in one of those "reality" TV shows that fill prime-time TV now.  Here's a secret- the inmates in one of those shows is told to yell obscenities and appear aggressive for the cameras...I know I have 3 people in my group that were on it!

**Trigger Warning: There is a movie Sin By Silence (trailer here) which is a documentary about abused women who kill their husbands.  It's very sad, and triggering but very empowering as they work to change California laws and get out**

Thursday, January 17, 2013

Profiles of Borderline Personality Disorder: Tess Smith

Misdiagnosis and Invalidating Environment

Tess Smith was diagnosed with Borderline Personality Disorder in 2006 after 16 years of treatment for dysthymia, anxiety, and obsessive compulsive disorder.  A misdiagnosis that resulted from her lack of trust in adults as a child, and miscommunication with therapists as an adult. "In 2006 my primary diagnosis was BPD in addition to depression, anxiety and OCD. I started seeing a therapist when I was 14, it took many years for them do diagnose me correctly because I didn't trust anyone enough to admit I was a cutter.  Growing up mental illness was not anything we talked about in my family. When I was first diagnosed (with depression, anxiety, and OCD) my mother didn't want to discuss it or even look into it. She told me I was “in control of my feelings” and I “just needed to get better”, so for many years it was a dark secret. I hid it from everyone, I didn't talk about it, and I sure didn't look for others like me. There’s a lot of shame in a mental illness diagnosis."  

Tess's secret kept her sick and her environment growing up was very invalidating, "my father died when I was 12, he was sick for years so growing up I wasn't close to any adults. We weren't able to ever express how we were feeling, it was always very important to look perfect. There were several situations in which I felt I had been lied to and my trust betrayed. I never felt like I could trust my mom, and her reaction to my initial mental illness diagnosis made it clear she wasn't going to be very supportive.” Tess's secret mental health issues continued throughout her teen and early adult years, " In my teens I never felt like I could talk to anyone about what I was doing without them telling my mother... and when I became an adult, no one ever came out and asked me if I was a self injurer."  It has taken Tess a long time to get to where she is today, “22 years of off and on therapy and prescriptions for Prozac, Wellbutrin, Remerol, Ambien, Xanax, Clonazepam, and Trazadone."

BPD and Stigma

In 2006 Tess found little information about her diagnosis online, "I had never heard of it... and when I found out what little there was out in the mainstream media about it - it wasn't easy to wrap my head around.   The movie everyone knows is Fatal Attraction... no one wants to be that crazy chick... and accepting the diagnosis is one of the hardest things - but the first step I think in getting better."  

Treatment & Hope

When she was diagnosed in 2006, she was referred to Dialectical Behavioral Therapy.  Unfortunately, the first class was full, then there weren't any that met her work schedule, and then she lost her insurance coverage.  When she again had coverage to attend DBT classes, she couldn't get time off of work to go. At that point Tess took her treatment into her own hands, "I did my own research and thank gods for the internet in 2011 because it gave me access to self help and the DBT tools I needed to at least get going. This is a long term thing… something I will have to manage for the rest of my life. Has it improved? YES! Simple skills I was able to find online have helped me when interacting with everyone and in almost every situation. My personal relationships have improved and are more stable and I find myself willing to put a little more of myself out there, in order to improve life. I do continue to take Prozac to alleviate the symptoms of anxiety and depression, but use DBT skills to manage my Borderline Personality Disorder."


Along with Tess's new coping skills, she is also developing friendships, "I'm very careful with whom I let get close... I've surrounded myself now with a handful of friends who I depend on.  I'm better with some distance though... I don't talk on the phone or hang out - I text, IM online... I don't go out.  I am more comfortable when I can control my environment and who I am with.  I don't seem to have conventional relationships...I've been married 4 times, and the longest relationship I've ever had is with my cat."

Ongoing Struggles

For Tess the hardest part of her BPD diagnosis is the emotional dysregulation, "my rapid and intense mood swings. I go from loving the ground you walk on to 'I can’t stand the sound of you breathing' in 2 seconds flat.  It’s hard for me to pin-point what I'm feeling, and then I have to figure out why I'm feeling it... every swing is an internal dialogue.  It’s hard to just 'be'… it seems like I’m always trying to figure out what I’m feeling and if it’s appropriate.  I feel tired a lot."  


For Tess getting the right diagnosis made a big difference, "it helped because I finally knew what I needed to do. My life was always on reset about every 4 years; a new address, new husband, and a new job. I didn't feel like I could be anywhere for very long without destroying everything. I had a stressful job, the diagnosis made me realize that maybe I liked what I was doing but not the position I was in, because it was just too demanding. I’m not built for that kind of long term exposure to stress. I now have a career in the same type of industry, but my day to day is very different. My interpersonal skills have improved, and I'm able to communicate what it is I want - instead of just being upset about not getting what I need. This whole time it’s been like being lost... and then getting a GPS.”

What would Tess like those without Borderline Personality Disorder to understand about those who do have it? "I’d like them to know that we don't mean to be cruel. It’s a protective mechanism that's a knee jerk reaction - we don't aim to hurt you.  We can seem distant or self-absorbed… if you get burned you pull away and it looks/seems like were lashing out. I think the main underlying issue of BPD is that we grew up in an environment we didn't feel safe in, and no one ever taught us coping skills - so we made our own."

"I used to think having a mental illness made me weak... I felt emotions more than other people and it made me different. I've learned now to look at it as a source of strength, my perspective has changed. With tools, friends, and willpower - I am strong enough to get better."

Tuesday, January 15, 2013

Why I needed a Twitter-cation

After being away from Twitter, other social media and MIA from e-mails for a week, I returned this Sunday to peak back out and say hello.  I also decided to write a brief explanation of why I needed a break from anything besides my 9-5 job.

The Bad:

  • As a Counselor on twitter, it's hard to continue to be engaged.  I often felt like I worked 8 hours then came home and kept working on twitter; interacting and (hopefully) helping with people with mental illness.
  • My passion for helping people became overwhelming and I was staying up late to finish a conversation, complete a blog post of think about someone on twitter.
  • The (TW) ongoing suicide, self harm or pro-eating disorder posts; as a Counselor in person if someone is going to hurt themselves there are things I can do and feel powerful and in control.  On twitter, especially with the high rates of those with BPD and self-harm/suicide I feel hopeless and ignoring certain people or posts was still not preventing me from sleepless nights or thinking I should have done something to help at 2am.
  • My 9-5 job is very, very stressful.  If you are unaware I work as a Dual Diagnosis Counselor in a Women's Prison.  Until this evening at 8pm, I was 6 months behind on filing- now I am 2. 40 hours a week doesn't cover the workload and I mostly refuse to stay much later for my own sanity leaving me with heaps of work that sits, stresses me out then gets noticed by the boss.
  • I have "too much compassion," this might sound weird, but I begin feeling too much for people (maybe the honest words is co-dependent) and I was struggling with drawing a boundary.
  • Having boundaries is difficult online for me, and I found myself not being able to say no to the many requests for help.
  • Essentially I was not going a good job of self-care and didn't feel like I was ever "off the clock."
Moving Forward:
  • Although I will be back on twitter, I am going to set some self-limits on how often I am on.  Checking twitter while I do my 9-5 is no longer going to happen. Just morning, evening and maybe a check in during lunch.
  • I will continue with the contests (I really enjoy it) but need to figure out some online format that is simple for me to track.  I will not be mailing books out, as that turned out to be more expensive than I presumed as well as it taking 4 weeks. The last contest probably took 6 hours to tally, choose, order, mail, track and in one case even re-order.
  • I plan on continuing to respond to DM's from those I know, or answering brief questions, I am no longer responding to people in crisis- but refer elsewhere for their help.
  • If anyone posts about suicide or anything I feel I can not handle, I will *edit* Report to Twitter to follow and possibly re-tweet for others to help, but not give support myself and not engage in any "therapy-like" behavior.  If the same person has ongoing SI or ED chat, or continues to post pictures I will "block" them for my own safety.
  • I will continue the BPD Interviews, but only set-up one a week.  If it takes 6 months to get them all done, so be it.
  • I will be in bed by 10pm if I have work early the next morning, midnight if I do not.  
  • I will drink 6-8 glasses of water and weekly Vitamin D supplements.
  • I will eat better, consume less caffeine and spend more time playing with the dog than hitting refresh.
  • I will stop from extending myself too far and pull away before I feel overwhelmed.  
  • If I need to take a break, I will not beat myself up or feel like I let anyone down.
  • I will read a book every 2 weeks to once a month.  These books will not ALL be mental health or addiction literature.
  • I will be more gentle with myself.
  • I will remind myself that I am not a masterpiece, but a work in progress.