The Impact of Borderline Personality Disorder on Relationships

All too often, family members, friends, fellow employees, and even therapists become reactive, judgmental, and walk on egg shells when they interact with someone who displays characteristics of borderline personality disorder.  Let me start off by summarizing some of the core characteristics of the disorder, specifically focusing on those traits which play out in the interactions with others.

  1. Affective Instability – This is where those with BPD struggle to regulate their emotions in predictable ways.  Often, their mood does not match with expected life or social situations, thus making it difficult for those around them to understand or relate to the distress they are experiencing.
  2. Fear of real or imagined abandonment – Those struggling with BPD are often afraid of being rejected, abandoned, or left alone emotionally. These feelings are triggered when the potential abandonment is indicated, as well as times where it isn’t.
  3. Identity disturbance – It can be difficult for those with BPD to maintain a consistent sense of self. There is typically a variance of self-doubt, instability in self-image, and self-acceptance.
  4. Impulsivity – Due to the emotional and personal instability, impulsivity is often a regular occurrence for those with BPD. While this may not feel disruptive for the individual, it can be highly disruptive for those around them.
  5. Paranoid ideation and dissociative symptoms – In certain situations, those with BPD may struggle with feeling paranoid, especially in relation to how they perceive other’s intentions or motives. Also, they may experience dissociative symptoms, which is a disconnect from themselves, their reality, or their sense of self.

What we need to understand about personality disorders is that they are just that, disorders which occur within the core personality of the individual.  This is important to consider, because it is extremely threatening to the individual when a personality disorder is suggested, or when a diagnosis is made, especially since it is difficult to be “objective” about your own personality.  Because of this, it can be very threatening for someone experiencing symptoms of BPD to identify and accept that the symptoms are present in their life.

It is my professional belief that the symptoms of BPD are treatable, and that through treatment, people can reduce the identified symptoms to the degree that they no longer qualify for the diagnosis.  This perspective can bring hope to those struggling with BPD, as well as those who are involved in their life.  However, the process of therapy can be challenging, and typically requires long term treatment.

Selecting a therapist who can treat BPD effectively is an important step in the process.  The therapist must be able to accurately diagnose the disorder, as well as position themselves in the therapeutic relationship as to control for and manage the identified symptoms.  A careful balance between soliciting BPD symptoms and maintaining safety and security within the therapeutic relationship is critical.  Failure to challenge the BPD symptoms results in no change, while doing so without carefully creating a safe therapeutic relationship will typically result in early or even immediate rejection on the part of the client.

Once someone with BPD can effectively accept the diagnosis, identify how the symptoms play out in their life, and learn new ways of managing and responding to the symptoms, then they can focus on the primary relationships in their life, and work on how they relate to others in new ways.

Written by Dr. Tony Alonzo, DMFT, LMFT, CFLE therapist at the Holladay Center for Couples and Families

Medication Management and Mental Health

In my career in healthcare, I have seen far too many patients who have been prescribed medication and continue to take that medication faithfully; Yet after a time, they are not really sure why they are taking that specific medication or if it is even helping with the diagnosed issue.  

 What is missing for these patients? Medication management 

Medication management is the process of following up with the healthcare provider on a regular basis to assess the effectiveness of the prescribed medication therapy, discuss any side effects that may go along with the medication, and make adjustments in order to achieve proper dosing. In some cases, the follow-up may be to change the prescribed medication therapy, if it is not providing the desired outcomes. Medication management should be an ongoing process. It should include open dialogue between the patient and provider about the effects of the medication combined with any other therapies or treatments that may be in place. This is to ensure useful data is being collected, so decisions can be made based on the whole picture; not just the medication piece. 

When it comes to psychiatric and mental health services, the importance of quality medication management cannot be overemphasized. Not all people who seek psychiatric help will require medication. In some cases, amino acid therapy may be appropriate or continued therapy and counseling with regular psychiatric follow-up is warranted. If medication is prescribed, the patient should plan to see the psychiatric provider within 2 weeks (in most cases) for the first medication management visit.  Continued follow-up visits should be scheduled monthly, or as needed depending on the individual case. 

During these visits, the patient should plan on communicating openly with the psychiatric provider about their use of the medication, any side effects that they may be noticing, and any changes they are feeling in relation to their mental health diagnosis. At times, genetic testing can be used to pinpoint what medications are more likely to work for each individual patient. This testing can be used not only for patients who are just beginning psychiatric treatment but also for patients who have been prescribed medication therapies that aren’t working. The patient should also plan to consult with the psychiatric provider before taking any other medications. They should inform the provider of other mental health therapies being used or medical complications that may arise during treatment. The patient should expect the provider to ask questions that will direct and lead the conversation, so time is well spent and modifications can be made with confidence. 

Ultimately, the key to effective psychiatric medication management is open and continual communication between the patient and provider. At the Center for Couples and Families, our psychiatric providers strive to provide thorough psychiatric assessment, follow-up, and medication management. 

Originally published on http://utvalleywellness.com/

 

Divorce – Counseling

Once the decision to divorce becomes imminent, components of the family system must prepare for change.  As a marriage and family therapist, its always my initial response to determine if the marriage can be repaired.  However, when people choose to end the relationship, the best course of action is to remain engaged in a therapeutic process throughout the transition.

The couple will need to work with one another to at least determine how to make decisions required for the legal aspects of dissolving the relationship.  If a couple can manage this on their own, and collaboratively and respectfully complete and submit the required documentation directly to the appropriate State department, and implement resulting legal stipulations, then this is typically the least intrusive and cost-effective method for divorce.  However, most couples have a level of financial, family, possession, and interactional patterns and history to require a divorce mediator to become involved. Typically, within a few sessions, the mediator can direct a process which results in immediate and long-term legal conditions to best assist the couple in divorce.  

All too often, individuals facing divorce immediately discontinue therapy because the marriage is over.  This can be biggest mistake they make in the process, especially considering how many different aspects of their life will require adjustment and change.  While I do not request that the couple meet together in session once they decide to divore, I strongly encourage them to remain engaged in individual therapy, and if children are involved, to make arrangements for each parent to attend therapy with their child(ren) in order to work through the questions, fears, concerns, and aspects of change they will all face, and most importantly, how to establish a new relationship with each parent individually.

Finally, without each partner exploring how they contributed to the dissolution of their marriage, they will most likely repeat harmful interactional and communicative patterns in future relationships.  Even if individuals post-divorce do not have the current intention of entering into another relationship, they should engage in the work which would otherwise place them in a position where they can, in the most healthy way, be available to engage in a future relationship.

Written by Anthony T. Alonzo, DMFT, LMFT, CFLE, Director at the Holladay Center for Couples & Families

Cleaning Out Your Marriage Closet – Couples Counseling

People are often worried about drudging up the past with their loved ones. There is controversy as to what is healthy for the relationship. People certainly don’t like to bring up an old fight when everything is going well. The issue is that we all have a closet of sorts where we hide everything that “isn’t worth the fight.” At first this closet is empty and the intention of putting things in there is good, you intend to talk about it later, it’s just not the right time.

The problem is that you enjoy the times you’re not fighting, who wouldn’t! You soon forget about what you’re storing in the closet, and you continue to throw everything “not worth the fight” into the closet. Your closet becomes full, and when you try to fit one more thing in there everything topples over. This is the fight of all fights, this is when you seemingly “loose it” out of nowhere about nothing and everything. This fight happens at a time when something was already “not worth the fight” and you were trying to put it in the closet. Therefore, you are probably not up for resolving everything in that closet either. It’s like if your junk closet toppled over just as company is coming over, you’re going to scoop everything up and stuff it back into the closet because you don’t have time to sort through it. This fight leaves everyone upset and confused and often nothing is resolved in this fight.

So how does one clean out this closet? Well its much like spring cleaning, you are going to take everything out and you begin to sort everything into categories. You evaluate if it is something that only happened once and will never happen again, if this is the case it truly isn’t worth the fight and can be thrown out. If it is something that continues to happen you need to address it, you will be bringing up the past not as a weapon against the other person, but as a justification for bringing it up as an issue. It is absolutely necessary that cleaning this closet is done at a time when your calm and you remain calm to be able to assess what the core of the problem is, what does their behavior tell you about your relationship with them. For instance, If someone is always late, how does their behavior effect you, why does it feel disrespectful to you and how does it create distance in your relationship, what is the message you receive about their feelings toward you. As opposed to judging their behavior as something you wouldn’t do and lecturing them about how it affects them.

When you clean out the closet you are transferring responsibility to the people it will be useful with. You will find that the cleaner your closet becomes the more clarity you will have in your relationships. Your intent in cleaning out the closet is not to change other people’s behavior, it is meant to change your relationships. You will find that some people will choose to become more distant because they are unwilling to make changes, but the relationships that become closer and the internal peace will be worth the distance in others.

Written by Madison Price, MS, LAMFT – therapist at Holladay Center for Couples and Families

Relationship Land Mines – How to Handle Them

All people have topics or behavior that are emotional landmines. I think of watching M.A.S.H seeing a big sign saying, “DANGER-MINE FIELD.” I love to picture this sign in my relationships. If these emotional landmines are going to be there I think it is essential for survival to create a boundary around the mine fields. I have found it courteous to set boundaries around mine, so that people have more freedom within a relationship with me. If people don’t set boundaries around their own boundaries I have to create boundaries to keep myself safe from their emotional landmines, unfortunately I don’t know exactly where the landmines are, so I have to create a boundary with large radius for extra safety. This is unfortunate because If boundaries are bigger than they need to be for the emotional safety this is limiting the potential for emotional intimacy in the relationship.

This is not only unfortunate for the person who “steps” on the emotional landmines, but also the person with the emotional landmines without appropriate boundaries. People thrive on relationships and connections. People who don’t create boundaries are absolutely terrified of being alone. Without knowing about emotional landmines, if you had the choice between land without blocked off areas and land that had nothing on it, the land without any blocked off areas seems more attractive, at least until you start walking over it! A person without boundaries want to attract people, and boundaries are not attractive. Their need for connection is not inherently bad, they are meeting this need in the only way they know how, because they haven’t experienced a long term intimate relationship as an example. Therefore, they have people around them who are avoiding a close relationship, or freeze to avoid any emotional landmines.

When you are in a relationship with someone who doesn’t create boundaries, you will often find yourself apologizing without knowing how you’re at fault. If apologizing becomes your default to suppress emotional explosions, you will attract people who have a need to blame.  People who blame are only considering their own needs, people who apologize as a default only consider the needs of others. A healthy relationship will balance your emotional needs with the needs of others with consideration of the context. If this isn’t happening your efforts to get closer to people will result in resentments. If you’re thinking “if they only knew what I was really thinking, they wouldn’t love me.” You will feel lonely in a room of people who love you.

When you share your truth, unfortunately you do risk losing people in your life.  However, knowing that even the one person who stays loves every part of you, and respects you enough to respect your boundaries will be worth anyone you lose. This is the most difficult part of setting boundaries, you have to reach a point where you can accept losing a relationship all together in order to do what it takes to be a healthier person. Accepting that you could lose a relationship means that if they are uncomfortable with boundaries they may cutoff communication with you. When you respect yourself and you respect other people enough to show them where your boundaries are to keep you and them emotionally safe, you will begin attracting healthier relationships.

Written by Madison Price, MS, LAMFT – Therapist at the Holladay Center for Couples and Families

 

Why Couples Therapy Often Fails

Couples often start therapy years after they first need it. I work with couples who tell me about their struggles years before they end up in my office. Its sad to hear how they saw the need for help, but didn’t get it for one reason or another. I hear them talk about things they try, reading books, talking with church leaders, trying harder, date nights…to no avail. There is nothing wrong with these types of activities as they do help strengthen a marriage. The problem is that the couple needs more fundamental healing and work. They need a solid relationship foundation (i.e., secure attachment, emotional safety), not a superficial fix (i.e., date night).

Here is what I tell these couples – start focusing on yours and your spouses emotional needs and experiences. Most couples struggle to do this because it is scary and unfamiliar. Understanding what your emotional needs are helps you to know what to communicate with your spouse. The trick is, at that point, communicating those needs in an appropriate manner. Extending an Invitation rather than an Demand regarding these needs is important. Invite your spouse to understand your needs and collaborate with you how to get them met. The more you then do this for your spouse the better your relationship will be. Understanding their needs and trying to meet them will help them feel safe and secure in your relationship and give them the ability to do this for you. This can be a difficult experience for both of you. Its scary to be that vulnerable and exposed with your spouse. No one else can hurt you like they can in this world. Opening up in this manner requires that you trust them to take care of you and be soft and caring. Them opening up in this manner requires the same type of trust in you.

A couples counselor can help you learn to be that vulnerable with each other while maintaining emotional safety.

By Dr. Triston Morgan, LMFT

Hidden Signs of Depression

Studies show about 1 out of every 6 adults will have depression at some time in their life. This means that you probably know someone who is depressed or may become depressed at some point. We often think of a depressed person as someone who is sad or melancholy. However, there are other signs of depression that can be a little more difficult to detect.  

Trouble Sleeping 

If you notice a change in a loved one’s sleeping habits pay close attention as this could be a sign of depression. Oftentimes depression leads to trouble sleeping and lack of sleep can also lead to depression.

Quick to Anger
When a person is depressed even everyday challenges can seem more difficult or even impossible to manage which often leads to increased anger and irritability. This can be especially true for adolescents and children.  

Losing Interest 
When someone is suffering from depression you may notice a lack of interest in past times he or she typically enjoys. “People suffering from clinical depression lose interest in favorite hobbies, friends, work — even food. It’s as if the brain’s pleasure circuits shut down or short out.” 

Appetite Changes
Gary Kennedy, MD, director of geriatric psychiatry at Montefiore Medical Center in Bronx, New York cautions that a loss of appetite can be a sign of depression or even a sign of relapse back into depression. Dr. Kennedy also points out that others have trouble with overeating when they are depressed. 

Low Self-Esteem 

Depression often leaves people feeling down about themselves. Depression can lead to feelings of self-doubt and a negative attitude.  

What to do
If you suspect you or someone you love may be suffering from depression talk about it, encourage him or her to get professional help and once he or she does be supportive. Remember that at times symptoms of depression need to be treated just like any other medical condition.

Originally published on http://utvalleywellness.com/

 

Couples Counseling (near Cottonwood Heights, Sandy, Holladay)

“Couples counseling” isn’t a four letter word. Knowing when to get help is important and something that every couple needs be aware of. Here are a few signs that you might need help.

  • Failed attempts to fix your marriage – many couples have/will have an experience where they need help in their marriage. They try and try and nothing gets better. They talk with friends, family and read books. They listen to online video’s from experts, but just can’t seem to get it right.
  • Significant stress in your relationship during transitional periods – couples often experience stress during transitions. Children being born, children moving out, retirement, loss of a job – or getting new job, a change in health, a move to a new city, etc… These all bring stress (even positive stress is still stressful!).
  • 4 Horsemen of the Apocalypse – Researcher John Gottman found that if you have any of the following in your relationship, that it could be in trouble: Defensiveness, Criticism, Contempt or Stonewalling. See his book, Seven Principles for Making Marriage Work.

A competent couples counselor will help you work through any of these types of issues. Couples come in to therapy years after it would be good to start. Don’t wait until its too late – most couples do.

Fighting Fair – Couples Therapy

Couples often fight. Leading researcher, John Gottman, found through decades of successful research, that it’s not the presence of fighting or arguing in a marriage that causes divorce. He found that it was how a couple fights that would cause them to divorce. Learning how to fight fair, in a sense, is important for a healthy relationship.

 

Here are a few principles to consider when learning to fight fair:

  • Soft Start-up – how you start your discussion matters. If you come at your spouse with an accusatory tone, it would be called a harsh start up and usually not end well. Starting your discussion with a softness can really help. For example, you might say, ‘I’m trying to understand how you feel about this, but struggling to do so. Can you tell me more about…’ This sends the message that you are not looking for a fight, but rather to partner up with your spouse in this difficult time.
  • Solve your solvable problems – There are solvable problems and perpetual problems. Knowing the difference and then knowing how to focus on your solvable problems will help you not get stuck. Perpetual problems are ones that seem like they just won’t budge. Most of marriage problems fall into this category. However, you don’t’ have to solve these for your marriage to work well. You just want to know how to deal with them in a manner that allows for them to be present and for your marriage not to fail.
  • Listen to your body – When you argue, your body often reacts in a manner that makes it difficult to use the skills you know. John Gottman calls this flooding. Your body gets overwhelmed. The trick is to let your body calm down when you are in an argument. This often takes some time alone. Let your body’s signals tell you when it’s the right time to take this time-out. Your body might respond to arguing by an increased heart rate, body temperature, sweating, or pressure. As soon as you feel this, know that you are becoming flooded and need to take a break.

Using these three simple principles will help you have a happier marriage and one that can last. If using these principles don’t seem to help, come in to see a therapist. We can help with marital problems such as infidelity, pornography problems, depression, anxiety, arguing, parenting issues,

Taken from John Gottman’s book: the Seven Principles for Making Marriage Work.

 

Written by Dr. Triston Morgan, LMFT

 

Telling Your Kids About Divorce

Making the decision to divorce is hard enough when thinking about only the spouses involved, add kids to the mix and things get ten times more difficult. If you are going through a divorce, most likely you are concerned about how your decision to separate will affect your children, and how are you going to tell them? As parents we are constantly trying to protect our children from any pain and suffering, the reality is that the news of your parents’ divorcing, no matter how carefully delivered, is going to cause some kind of pain, hurt, or confusion in the eyes of your child.  Although you can’t control how you or your child will feel during this stressful time in your lives, you can make the choice to commit to seeking out effective ways to handle and offer a positive healthy source of support for your children. Committing to this will allow them to adjust to the divorce in a positive way, and in their own way as you lovingly guide them through the process.

TIPS 

  • If possible the news of the divorce should come from both Mom and Dad together as a family.  During this conversation stress the fact that even though family life is going to look very different, you will both continue to love them.
  • Tell the children that the divorce has nothing to do with anything that any of the children may have done or not done. Reassure them that they are not the cause of the divorce.
  • Children thrive on structure, especially during transition periods. Keep a daily routine with school, activities, and their regular everyday life. Keeping as much consistency as possible helps the children to feel more secure.
  • Having some kind of a plan of what life might now look like for them can be very beneficial. It is comforting for them to know where they will be going to school, where they will be sleeping, and how often they will see mom or dad. Nothing is permanent in this arrangement but offering them some sort of idea of how their lives will and won’t change will again help them to feel secure. 
  • Address your children’s concerns. Encourage them to talk, scream, cry or celebrate. Help them to feel safe in expressing their feelings.
  • Lastly, make sure that they are told how much you both love them and how that will never change.

Studies show that children do best and have fewer long-term emotional, social or academic problems when parents can establish a healthy, respectful, co-parenting relationship. Transitioning into a new type of relationship and putting aside the hurt and anger that are associated with the broken marriage can be extremely difficult for many parents to accomplish. But through patience with each other and hard work, it can be done. Divorce changes families but it does not end your commitment to your children. Make sure you take the time to find the solutions that work best for your family to ensure a positive outcome for you and your children.

**If you or your children are struggling to deal with the life transitions involved with divorce, seek out professional assistance for individual or family therapy. The therapist can assist in encouraging better communication, and be helping all families members to properly heal and process the trauma of divorce.

 

Brandi Hess, MA, LAMFT

Brandi Hess has a passion for helping people to work through life’s difficulties, assisting them in finding joy, and the strength to reach their full potential. Brandi strives to ensure that she understands each of her clients’ unique needs. She provides therapy and counseling sessions tailored specifically to obtain her clients’ goals, in an individual or family setting. She offers a kind, honest, and straight-forward approach in therapy, allowing for trusting relationships to be built. She specializes in couples and family distress, pre/post-divorce, and adolescent treatment. One of Brandi’s many strengths is being able to connect with adolescents by creating a therapeutic environment where the adolescent feels safe and willing to start the process of change. Brandi works with a variety of concerns such as depression/anxiety, women’s issues, and trauma. Brandi received her Bachelors of Science in Human Development and Family Studies at the University of Utah, and her Master’s degree in Marriage & Family Therapy from Argosy University.