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 dbtpath@gmail.com

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!

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.

BPD and Relationships

In group I have my clients work on the Power and Control Wheel numerous times in the 6 month program.  I think it is really important for those with mental illness and addiction issues to be able to identify what is abuse.  The most interesting part is when I ask them to identify ways in which they were the abuser and used the P&CW against someone else.  It's harder to come to grips with, but a few are vocal about using abuse against someone else, most of the examples are holding children as pawns, physical abuse, comments about a man's sexual performance to belittle him and cheating as a way to demean him.  I bring this up because as I have been considering writing about Borderline Personality and Romantic Relationship, but everyone I try- I get distracted and a more optimistic blog idea pops up.

Until I read "A Woman With BPD Explains Her Actions in Romantic Relationships"  by the author of Stop Walking on Eggshells: Taking Your Life Back When Someone You Care About Has Borderline Personality Disorder. In it she has the very honest and personal account of someone with BDP who explains her past relationships and the abusive tactics she has used:

• Purposely broken a gift you gave me 
• Flirted with several other people at a time or having a crush on others while I'm still dating you
• Said some of the most cutthroat things you've ever heard .
• Talked about suicide even though I know it hurts you
• Pulled a "Dr. Jekyll and Mr. Hyde"
• Pushed you away then pulled you right back
• Started an argument out of nowhere

The author of the article goes into depth about why someone with BPD would act this way, most of it boils down to the fear of abandonment as well as mood swings that can cause quick fluctuations of love and hate. Reminds me of I Hate You--Don't Leave Me: Understanding the Borderline Personality.  And yes according to the Power and Control wheel the above 7 bullet points could be broken down like this:

• Purposely broken a gift you gave me Intimidation & emotional abuse
• Flirted with several other people at a time or having a crush on others while I'm still dating you Intimidation & emotional abuse & using coercion and threats
• Said some of the most cutthroat things you've ever heard emotional abuse & isolation & minimizing, denying and blaming
• Talked about suicide even though I know it hurts you emotional abuse & using intimidation & isolation & using coercion and threats & denying, blaming and minimizing
• Pulled a "Dr. Jekyll and Mr. Hyde" emotional abuse 
• Pushed you away then pulled you right back emotional abuse, denying, blaming & minimizing
• Started an argument out of nowhere emotional abuse, minimizing, denying and blaming

So that's the bad news, those with BPD are often the abusers (not saying they are not as often abused) in romantic relationship.  And it may sound like a broken record, but there are ways to get better and once again this is why boundaries are so important. So what steps can be taken to have healthy relationships?  Here is a great article from BPD Central with the 10 Essential Limits for Romantic Relatonships:

The 10 Essential Limits

Keep in mind that a limit is not about rules or telling the other person what to do. You can't control their behavior; you can only control your own. Limits are based on your personal values and about what you will do to take care of yourself. For more information about limits, what they are and what they're not, and how to set and observe them, see my book The Essential Family Guide to Borderline Personality Disorder.

1. No mindreading. Your job is verbalize your own thoughts, feelings, concerns and preferences. By contrast, assuming you know the other person's thoughts and motivations (e.g., "You think that.." or, "You did this/said this because....") is almost always guaranteed to get you into trouble. Mindreading is one of the biggest obstacles to effective communication; it is invalidating, provocative, and almost always based on misinterpretations.

2. Build routines of taking a time out when things begin to get heated. People who are furious simply can't think straight; their brain is so focused on their feelings that logic gets thrown out the window. This is especially true with BPs and NPs. You can test this yourself. Think about something you said in the moment of anger that you regretted the next day (or week).

Talk about time-outs at a calm before they are needed, letting your partner know how this will work and assuring him or her that you two will come back to finish the discussion when you are both calmer. (Your partner, of course, has the option of initiating a time out too.) Find a safe place that is sacrosanct to you where no one else can enter when you need to be alone.

Early exits when either of you is beginning to feel a temperature rise prevents unsafe, hurtful mistakes--verbal as well as physical. Take the pot off the stove by removing yourself early on from a situation you may not be able to handle calmly.

3. Regularly do things you both enjoy and share positive reactions to your partner. The two of you need positive shared time and interactions to keep the relationship connection solid.

Positivity makes relationships worth having. The more appreciation, agreement, affection, playfulness, attention, etc you offer each other, the sunnier your relationship will be.  And the more you give, the more you'll get.

4. Focus on what you can do to improve situations rather than criticizing each other. And if you do feel it could be helpful to say something to your partner about what she or he has been doing, offer it as feedback, not as a criticism or complaint. People with personality disorders take criticism very badly, so it doesn't work to change their behavior.

Instead, learn ways to bring up your concerns without being critical and triggering the other person's defenses (well, as much as you can for a person with BPD/NPD). To give feedback offer a when-you statement, as in, "When you xyz, I feel abc"). Especially avoid the phrase, "You make me feel."  That's blame.

Remember that it's not your job to tell your partner what he or she should or shouldn't be doing. It is up to you to be honest about how you react as a consequence of your behavior. Your partner's concern for your feelings will tell you a lot about their capacity to show their love.

Just because you stop criticizing them won't stop them from criticizing and blaming you. With your own therapist or one of my books, formulate a strategy for how you will respond. My books go into this in detail.

5. Do not speak with contempt, ever. Studies have shown that couples who communicate contempt for each other are the most likely to break up. This principle is most important with regard to listening. Dismissive or eye-rolling as a form of listening dooms relationships.

6. No hostile touching; no putting hands on each other in anger. No threats or hurting property, either. Have a zero tolerance policy. Men, take any physical aggressiveness by your girlfriend or wife seriously; abuse of men is an underreported epidemic. Document, document, document, and be in communication with the police.

Never put your hands on your partner. Even if it is a mild pat, your partner may exaggerate it and make false abuse claims. You may end up in jail and unable to see your children.

7. Each person needs to have his or her own space, private time, and friendships as well as joint ones. Keep up with your friends and family and never become isolated. Isolation is the kiss of death to your confidence level, well-being, and sense of reality. Find at least one friend or counselor you can be honest with about what's going on. You need outside perspective, even if that threatens your partner.

8. Take responsibility for having and managing your own feelings, verbalizing your concerns and preferences, and being responsive to your partner's concerns and preferences.

9. Come to a mutual agreement about monogamy (or lack of) so you are honest and on the same page. Do not put up with infidelity (however you define it) that goes against your values. With infidelity, your sense of self-esteem will take a huge nosedive and your marriage will eventually be in name only. Again, formulate strategies with a therapist.

10. Work on problem-solving, not blame, and find win-win solutions so "Your-way" and "Their–way" differences lead to an "Our-way" solution that you both feel good about.

BPD and Medication

A counselor friend this week asked me the following question:  If there is no medication for Borderline Personality Disorder why are so many on medications?  Pretty valid question.

No medications have been approved by the U.S. Food and Drug Administration to treat borderline personality disorder. Only a few studies show that medications are necessary or effective for people with this illness. However, many people with borderline personality disorder are treated with medications in addition to psychotherapy. While medications do not cure BPD, some medications may be helpful in managing specific symptoms. For some people, medications can help reduce symptoms such as anxiety, depression, or aggression. Often, people are treated with several medications at the same time, but there is little evidence that this practice is necessary or effective. source

I have meet many people with BPD who have another diagnosis (or 5); Anxiety disorders, depression, PTSD, etc.  So for some people they are receiving medication for a separate disorder, which sometimes has overlapping symptoms.  For those of you who follow me on Twitter you know my issue with being people misdiagnosed with a plethora of other diagnosis, that gets added to each year when BPD is the only one.  Putting that aside I also think some people with BPD (especially those whom are newly diagnosed) are given Benzodiazaphines (I will save my opinion on that for another rant) to cope with the anxiety caused my BPD.

I work full-time in a prison, the female inmates are in a 6-month program, I find that month 1 everyone is knocking on my door about medications, someones their mental illness is valid often it is not (mostly due to drug use.)  Month 2-3 some mental health issues come to surface, as the program is intensive 20-hour a week therapy and people are now dealing with things they have stuffed for so long and they have a decent amount of clean time.  Right now my group is in month 3, what started as 11 on medication (out of 21) is now 5.  I asked the group why it has dwindled down significantly in 90 days.  The answers not surprising; 'we now have cog skills, I started journaling, grounding techniques, coping skills, I take to my bunkie about it.'  Many of these women are using skills over medication.*

So maybe medication is not available to you (Big Pharma will be another rant as well,) or maybe you are on medication and looking to gain more coping skills- here is a list of modes to get well for BPD:

• Dialetcical Behavioral Therapy Self-study material
• EMDR mostly used to handle trauma
• EFT (tapping)
• MBT used more in UK (Thanks to anon comment for the info)
• Social Support. Talk to others who may understand what you are going through. 
• Behavioral Activation. Engage in an activity that might take your mind off the stressful situation for a little while. 
• Relaxation Exercises. Practice a relaxation exercise, such as deep breathing or progressive muscle relaxation.
• Grounding. Practice grounding exercises that are designed to keep you "grounded" in the present moment, rather than caught up in replaying events in your head, worrying about the future or zoning out. 
• Mindfulness Meditation. Practice mindfulness meditation, which helps you to observe and describe your experiences without judging or rejecting them. 
• Active Problem-Solving. Consider the problem at hand: Is there a way to solve the problem directly? (source for 5-10)

*I am not saying medication may not be necessary for some

Blog Roll

Just wanted to make a short post to bring attention to the blog roll on the right. New blog coming soon on romantic relationships and BPD.

Hope you are enjoying the winter (or summer depending on where you are!)

Book Contest Winners!

*The e-books were e-mailed out today and the other 2 books were ordered and will arrive shortly*

I am happy to announce the winners, whom  all have been notified.  I received 53 entries and had 12 winners in total- twice as much as November's contest.  Some of you entered here and on twitter and a few daily.  Below are the winners.  If you won Buddha and the Borderline or Gift of Imperfection please e-mail (alicia.paz.ma(at)gmail.com) or DM on twitter your physical address so I can have it shipped to you via Amazon.  I will send the e-books and 2 other books out once I get everyone's e-mail and physical addresses- hopefully Monday.) I abbreviated all names listed below for privacy.

Stop Sabotaging: 31 Day DBT Challenge to Change Your Life

• Stephanie J (Blogger)
• Jennifer C (Blogger)
• Paul K (Twitter)
• Tee B (Twitter/Blogger)
• Befuddled N (Twitter)
• The Guy... (Twitter)
• HeavensP (Blogger)
• Rhonda (Blogger)
• Cass (Blogger
• Dltd (Blogger)

The Buddha and the Borderline

• MsStitch (Twitter)

The Gift of Imperfection

• Stephanie E (Twitter/Blogger)

November Book Giveaway

Update: After seeing all the lovely comment's about Debbie Corso's work I have decided to give away 10 copies of her book instead of 5

It was a great success last month, with 5 people winning Debbie Corso's last book (1 person even paid it forward giving away another 5 copies!)  On November 30th her new book Stop Sabotaging a 30 Day DBT Challenge to Change Your Life will be available for purchase on Smashwords.

And I am happy to announce I am the introduction writer!

Starting on Friday November 23rd at 11:59pm until Friday November 30th at 11:59pm I will be giving away 10 copies of Debbie's new book as well as 1 copy of Brene Brown's The Gifts of Imperfection: Let Go of Who You Think You're Supposed to Be and Embrace Who You Are and the 1 copy of Buddha and The Borderline

There are 2 ways to win one of *10* of Debbie Corso's book:

1) Leave a comment here with an e-mail address stating which book your prefer

2) Become a fan of my twitter then tweet: "Just entered to win 1 of 10 copies of Stop Sabotaging by Debbie Corso.  Follow @APazMA and RT to enter #BPD #DBT"

There are 2 ways to win the other 2 books:

1) Leave a comment here with an e-mail address stating which book you prefer. 
2) Become a fan of my twitter then tweet: "Just entered to win 1 of 5 copies of (book title).  Follow @APazMA and RT to enter #BPD #DBT"

Rules: After I receive 200 entries or by 11/30/2012 at 11:59pm EST, whichever comes first I will contact the 7 winners and ask for an e-mail address for those on twitter so I can "gift" the Stop Sabotaging e-book to you.  I will not use your e-mail address for anything else besides sending the book and an e-mail confirming the book was sent if there are any issues.  If I can not get in touch with any winner within a week (and I will try my hardest to do so) I will give the remaining book(s) to another contestant.  The winners of the other 3 books will need to send me their physical address to have the book shipped from Amazon via DM on twitter or e-mail.  The winners will be selected at random from my blog and twitter.  2 entries per person per day allowed (1 on here and 1 on twitter, so 14 total max.) Failure to comply with rules, such as tweeting your entry more than once a day will make you disqualified.  If you have questions tweet me!

Please play fair as I plan on doing this once a month with different books I purchase.  Next month I might give away Linehan's DBT workbook & 3 months of DBT coaching for the holidays....will update!

DBT Coaching Chat

I have talked for a while about helping those doing self-taught DBT, whom are learning DBT without the benefit of a group or a DBT Counselor.  Here are some great resources for those taking this path.  I have also started a DBT Chat room so you can ask me questions and they can be answered publicly for others to see.  I will answer as soon as I can, but it might take a day to get a response.  Feel free to help each other out as well.  There is no sign-up, nothing to download and you can remain anonymous!

http://www.99chats.com/room_333142

Disclaimer: I am a licensed Mental Health Counselor in Michigan, specializing in DBT and BPD. This chat is intended to assist those doing self-taught DBT with coaching. I am not able to provide any personal counseling on this site.

*Please begin any question with "TW" if the content may trigger someone else*

Dealing with trauma issues with BPD

Although the DSM IV-r criteria for Borderline Personality Disorder does not include trauma, it is often a common thread in those with the disorder.  Often on Twitter I see a tweet started with "TW" (trigger warning) before something that may be triggering, it's a safety boundary for many in the BPD community.  In DBT we strictly enforce the rules about saying things that can be triggers, sometimes those who don't have BPD don't realize how harmful what they say can be, sometimes people try to stir up some drama and some are so disconnected from their trauma they don't understand how someone could be hurt by what they are saying.

Adults with borderline personality disorder (BPD) showed excessive emotional reactions when looking at words with unpleasant meanings compared to healthy people during an emotionally stimulating task, according to NIMH-funded researchers. They also found that people with more severe BPD showed a greater difference in emotional responding compared to people with less severe BPD. The study was published in the August 1, 2007, issue ofBiological Psychiatry. [source]

This week myself and a client came to the conclusion that talking about her trauma only continues to hurt her more than help her.  Creating a boundary became necessary since other clients continue to push her to speak about the horrific trauma thinking that like them she needs to "get it out and give it away." In group she announced this decision and the overall look was puzzled, so we decided to allow questions as this appeared to go against everything they have been taught since being in therapy.  The questions were in 3 categories; 1) doesn't keeping it in, keep us sick? 2) How does talking about it make it worse? 3) So what are you going to talk about then?  The group decided to respect her boundary, although they were skeptical.  I decided to not go into the details of Borderline Personality Disorder since the client had told me she was not comfortable with that.

The end question was then "Ms. Paz, how is she going to work on her trauma issues without talking about it?"  I spoke about working on how the trauma affects you now; relationship issues, boundaries, PTSD symptoms and focusing on coping skills and grounding techniques instead of living in the past.  The group was still unsure about this plan as it goes against what they have (thought) they have known for most their life.  HEre are some ways to work on your trauma without talking about the trauma [source]

1. Tell yourself that you are having a flashback  

2. Remind yourself that the worst is over.  The feelings and sensations you are experiencing are memories of the past.  The actual event has already occurred and you survived. Now it is the time to let out the terror, rage, hurt, and/or panic.  Now is the time to honor your experience.  

3. Get grounded.  This means stamping your feet on the ground to remind yourself that you have feet and can get away now if you need to.  (There may have been times before when you could not get away, now you can.)  Being aware of all five senses can also help you ground yourself.  

4. Breathe.  When we get scared we stop normal breathing.  As a result our body begins to panic from the lack of oxygen.  Lack of oxygen in itself causes a great deal of panic feelings; pounding in the head, tightness, sweating, feeling faint, shakiness, and dizziness.  When we breathe deeply enough, a lot of the panic feeling can decrease.  Breathing deeply means putting your hand on your diaphragm, pushing against your hand, and then exhaling so the diaphragm goes in.  

5. Reorient to the present.  Begin to use your five senses in the present.  Look around and see the colors in the room, the shapes of things, the people near, etc.  Listen to the sounds in the room:  your breathing, traffic, birds, people, cars, etc.  Feel your body and what is touching it: your clothes, your own arms and hands, the chair, or the floor supporting you.  

6. Get in touch with your need for boundaries.  Sometimes when we are having a flashback we lose the sense of where we leave off and the world begins; as if we do not have skin.  Wrap yourself in a blanket, hold a pillow or stuffed animal, go to bed, sit in a closet, any way that you can feel yourself truly protected from the outside.  

7. Get support.  Depending on your situation you may need to be alone or may want someone near you.  In either case it is important that your close ones know about flashbacks so they can help with the process, whether that means letting you be by yourself or being there.  

8. Take the time to recover.  Sometimes flashbacks are very powerful. Give yourself time to make the transition form this powerful experience. Don't expect yourself to jump into adult activities right away.  Take a nap, a warm bath, or some quiet time.  Be kind and gentle with yourself.  Do not beat yourself up for having a flashback.  

9. Honor your experience.  Appreciate yourself for having survived that horrible time.  Respect your body's need to experience a full range of feelings.  

10. Be patient.  It takes time to heal the past.  It takes time to learn appropriate ways of taking care of yourself, of being an adult who has feelings, and developing effective ways of coping in the here and now.

 Stay safe.
AP

Grieving The Death of Your Counselor

This week I received an e-mail from my boss stating my co-worker (of a team of 4) passed this week.  I was at first dumbfounded and was unable to continue the conversation I was at the time having with one of the inmates.  Two hours later we held a "Family Meeting" to announce it to the 95 total clients, and her group of 17 clients.  The moment it was announced the room feel apart; women were sobbing and the staff was still in disbelief and shocked.

I worked as a grief counselor at a hospice about 6 years back in which my primary job duty was to call the next of kin listed and "check in;" how are you eating? sleeping? coping?  It was a difficult job at times and at age 20, I often went to the bathroom to cry between calls.  In my life I have not experienced loss to the extend that many of my client's have, and I have the coping skills to handle some things the clients/inmates do not.  The e-mails began at 4pm on Friday about what to do to provide the client's closure and a place to express their feelings about the grief.  They have had 2 process groups since, and have had been talking about it among each other, each client is in their own place with the grief cycle.  The ideas have been back and forth including having a memorial ceremony, creating a paper quilt/banner to display at graduation and having them 'bury' goodbye letters to her.  I am open to ideas about what we can do in a prison to help these women with the process, as a ex-grief counselor I feel like I "should" know what to do/say to these women and yet with 17 different views, mental illnesses, and past trauma related to loss it is a difficult task to begin unraveling as each person handles grief differently.

If you are dealing with grief here are some ideas of how to work through it [source]

Coping with grief and loss tip 1: Get support

The single most important factor in healing from loss is having the support of other people. Even if you aren’t comfortable talking about your feelings under normal circumstances, it’s important to express them when you’re grieving. Sharing your loss makes the burden of grief easier to carry. Wherever the support comes from, accept it and do not grieve alone. Connecting to others will help you heal.

Finding support after a loss

• Turn to friends and family members – Now is the time to lean on the people who care about you, even if you take pride in being strong and self-sufficient. Draw loved ones close, rather than avoiding them, and accept the assistance that’s offered. Oftentimes, people want to help but don’t know how, so tell them what you need – whether it’s a shoulder to cry on or help with funeral arrangements.
• Draw comfort from your faith – If you follow a religious tradition, embrace the comfort its mourning rituals can provide. Spiritual activities that are meaningful to you – such as praying, meditating, or going to church – can offer solace. If you’re questioning your faith in the wake of the loss, talk to a clergy member or others in your religious community.
• Join a support group – Grief can feel very lonely, even when you have loved ones around. Sharing your sorrow with others who have experienced similar losses can help. To find a bereavement support group in your area, contact local hospitals, hospices, funeral homes, and counseling centers.
• Talk to a therapist or grief counselor – If your grief feels like too much to bear, call a mental health professional with experience in grief counseling. An experienced therapist can help you work through intense emotions and overcome obstacles to your grieving.
  
  
  
  

Coping with grief and loss tip 2: Take care of yourself

Face your feelings. You can try to suppress your grief, but you can’t avoid it forever. In order to heal, you have to acknowledge the pain. Trying to avoid feelings of sadness and loss only prolongs the grieving process. Unresolved grief can also lead to complications such as depression, anxiety, substance abuse, and health problems.When you’re grieving, it’s more important than ever to take care of yourself. The stress of a major loss can quickly deplete your energy and emotional reserves. Looking after your physical and emotional needs will help you get through this difficult time.

• Express your feelings in a tangible or creative way. Write about your loss in a journal. If you’ve lost a loved one, write a letter saying the things you never got to say; make a scrapbook or photo album celebrating the person’s life; or get involved in a cause or organization that was important to him or her.
• Look after your physical health. The mind and body are connected. When you feel good physically, you’ll also feel better emotionally. Combat stress and fatigue by getting enough sleep, eating right, and exercising. Don’t use alcohol or drugs to numb the pain of grief or lift your mood artificially.
• Don’t let anyone tell you how to feel, and don’t tell yourself how to feel either. Your grief is your own, and no one else can tell you when it’s time to “move on” or “get over it.” Let yourself feel whatever you feel without embarrassment or judgment. It’s okay to be angry, to yell at the heavens, to cry or not to cry. It’s also okay to laugh, to find moments of joy, and to let go when you’re ready.
• Plan ahead for grief “triggers.” Anniversaries, holidays, and milestones can reawaken memories and feelings. Be prepared for an emotional wallop, and know that it’s completely normal. If you’re sharing a holiday or lifecycle event with other relatives, talk to them ahead of time about their expectations and agree on strategies to honor the person you loved.

When grief doesn’t go away

It’s normal to feel sad, numb, or angry following a loss. But as time passes, these emotions should become less intense as you accept the loss and start to move forward. If you aren’t feeling better over time, or your grief is getting worse, it may be a sign that your grief has developed into a more serious problem, such as complicated grief or major depression.

Complicated grief

The sadness of losing someone you love never goes away completely, but it shouldn’t remain center stage. If the pain of the loss is so constant and severe that it keeps you from resuming your life, you may be suffering from a condition known as complicated grief. Complicated grief is like being stuck in an intense state of mourning. You may have trouble accepting the death long after it has occurred or be so preoccupied with the person who died that it disrupts your daily routine and undermines your other relationships.

Symptoms of complicated grief include:

Intense longing and yearning for the deceased Intrusive thoughts or images of your loved one Denial of the death or sense of disbelief Imagining that your loved one is alive

Searching for the person in familiar places Avoiding things that remind you of your loved one Extreme anger or bitterness over the loss Feeling that life is empty or meaningless

The difference between grief and depression

Distinguishing between grief and clinical depression isn’t always easy, since they share many symptoms. However, there are ways to tell the difference. Remember, grief can be a roller coaster. It involves a wide variety of emotions and a mix of good and bad days. Even when you’re in the middle of the grieving process, you will have moments of pleasure or happiness. With depression, on the other hand, the feelings of emptiness and despair are constant.

Other symptoms that suggest depression, not just grief:

Intense, pervasive sense of guilt. Thoughts of suicide or a preoccupation with dying. Feelings of hopelessness or worthlessness.

Slow speech and body movements Inability to function at work, home, and/or school. Seeing or hearing things that aren’t there.

Can antidepressants help grief?

As a general rule, normal grief does not warrant the use of antidepressants. While medication may relieve some of the symptoms of grief, it cannot treat the cause, which is the loss itself. Furthermore, by numbing the pain that must be worked through eventually, antidepressants delay the mourning process.

When to seek professional help for grief

If you recognize any of the above symptoms of complicated grief or clinical depression, talk to a mental health professional right away. Left untreated, complicated grief and depression can lead to significant emotional damage, life-threatening health problems, and even suicide. But treatment can help you get better.

Contact a grief counselor or professional therapist if you:

• Feel like life isn’t worth living
• Wish you had died with your loved one
• Blame yourself for the loss or for failing to prevent it
• Feel numb and disconnected from others for more than a few weeks
• Are having difficulty trusting others since your loss
• Are unable to perform your normal daily activities

Boundary Garden

Those with Borderline Personality Disorder struggle with healthy boundary setting.  From my perspective this is part of their black/white, all/nothing thinking.  Sometimes it's obvious when someone has poor boundaries. The story I always tell to describe what poor, or low boundaries look like is this personal one from when I was 15 years old.  I had just walked off the city bus to walk to go home, as did another classmate I had not seen before.  It was the first week in school, so I guessed she might be new.  I began talking to her, figuring if nothing else it would give me someone to walk home from school with.  Our walk and only conversation lasted 8 minutes and in it she told me her mother had killed herself, she was now living with her father, he didn't know how to cook, was "icked" out buying her tampons, she had an array of mental health issues, told me what medications she was on and showed me scars from when she tried killing herself a few months back.  My radar went into the red danger zone and I immediately knew this was not someone I would want to be friends with, even if it was 16 minutes a day round trip.

Those with all/nothing thinking struggle with making, having and often keeping friends for this primary reason; "they are either my all-time best friend or my worst enemy."  This was a quote from a client, whom I didn't at the time know much about BPD to diagnosis.  I have my clients create boundary gardens to illustrate this point and have a visual for where their friends lay.  Below is the outline of the garden I have them fill in.

Here is an example of one filled in for someone who has low boundaries,

After I have the clients fill in the garden I ask a few questions; which section has the most people in it? Why are people in old brush and not out of the garden? Is there anyone who has been moved towards the old brush or into roses since starting therapy/group/recovery?  It's a great starting point for creating and enforcing boundaries.  I also have the clients put lines where they would like to move people, for example, "my step mom and I have had a better relationship the last few years since she stopped drinking, so maybe it's time to have her as a violet," or "My brother is a close friend now, but I think he has been stealing money from my purse, so maybe we need more distance and he needs to be moved to Geraniums."

It doesn't solve their boundary issues, but it gives them a starting point and a nice visual to begin working on.