The Lighter Side of Transformation

with Lisa Wessan, LICSW

From Borderline to Balance: Dialectical Behavior Therapy for Post-Traumatic Stress Disorder (DBT-PTSD)

When I first became interested in the Dialectical Behavior Therapy methods and curriculum (DBT), one of my mentors said, “Lisa, I strongly advise you NOT to get involved with this work. If you offer DBT Skills, you will attract the WORST clients!  They will all be severely agitating with Borderline, Bipolar or severe mood disorders, it will be a nightmare for you!”

I heard what she said, and I did respect her opinion, but there was something so powerfully intriguing about the evidence-based science behind DBT, and the fact that so many people were getting well from it – who had been considered “treatment resistant” prior to their DBT exposure.

I do like a challenge, however, and I was not afraid of this high risk population. Something inside me told me to continue…against the advise of this mentor, and others practitioners I knew.

So fast forward to today, six years post-DBT training, sharing the DBT curriculum with teens (14-17) and adults (18+) in my office in Westford, MA for several years now.  I have had the privilege  of witnessing dozens of my DBT clients, in both individual and group therapy, go through this cognitive re-structuring process, shed their false beliefs, deconstruct their traumas, grieve and move on to have healthy, happy, contented lives.

In the process, I have learned that approximately 70% of my clients with Borderline Personality Disorder (BPD) suffer from severe co-occurring post-traumatic stress disorder (PTSD),  related to traumas that occurred during childhood. These traumas were not processed or expressed at the time,  and they caused a corruption of the client’s personality, mental and social skills.

These unresolved traumas, when treated, often bring upon a rebirth process, and the client is no longer exhibiting the Borderline symptoms.  Therefore, I humbly submit that it would serve everyone if BPD could be renamed Intense Trauma Syndrome (ITS).

Here is why:

  1. The term Borderline is heavily stigmatized in my guild.  “Borderline” sounds as if someone is on the edge of a cliff about to jump, perhaps on the verge of…suicide? Murder? Something worse?  Witness my mentor’s advice above, plus,  each week I receive calls from clients who tell me “No one will work with me because I am Borderline.”  This is frustrating and heartbreaking to me.  Why is this heavily traumatized group eschewed because of their condition? Where should they go?  How will they get well?   If BPD was re-labeled as Intense Trauma Syndrome, I think they would be helped by more therapists!  But this requires more than a branding campaign…
  2. Borderline clients often exhibit highly dissociative symptomatology, chronic suicidality, and ongoing non-suicidal self-injury.  This is also a big turn-off to my guild.  Many of my colleagues will NOT work with suicidal clients.  Why?  Too much liability, too many collateral calls, too much danger. Moreover,  my clients feel as if they are tacitly shamed by the mental health profession for being Borderline.   Yet I have found that this population, when they are truly sick and tired of being sick and tired, pick up these DBT Skills and other therapeutic interventions, and start their healing process.  They do agree to a Safety Plan and stick with it. They learn, grow, and become healthier and successful members of society.   They do recover!
  3. When I tell my Borderline clients they have Intense Trauma Syndrome, and request that they stop describing themselves as Borderline, they start to feel so much better about their emotional challenges.  Many Borderline clients have described severe shame and self-hate due to their diagnosis. They feel hopeless and bereft of a cure. Receiving the Borderline diagnosis can make them feel worse! Here’s the H.O.P.E.  for Borderline clients,  Hold On, Pain Ends.

Solution Focused Therapy

My DBT Skills groups cover the entire curriculum in one year (42 weeks), which includes the strengthening of the commitment to wellness and psychoeducation, DBT skills training, skills-assisted exposure, with radical acceptance of the past trauma and its effects on their lives.

Four leaf DBT

Finally, we explore the promotion of self-compassion and efforts to prepare for returning to everyday life, to build a life worth living. When a client has graduated from their Intense Trauma Syndrome to the more normative anxiety, career, dating, relationship challenges they are on their way to be fulfilled and satisfied with their lives.

The Intense Trauma Syndrome causes people to become quite polarized in their thinking. They often see the world in black and white, all or nothing, right or wrong, good or evil terms.  There is not much wiggle room for the vast spectrum of imperfection that exists in all of us!  One of the earliest cognitive shifts we work on is the ability to hold OPPOSITE VIEWS in their minds without having a meltdown.

For example, I teach them that it is perfectly all right to love someone, but also hate them at times. It is fine to be in a room of friends or family, and yet feel very lonely.  It is not a serious problem to want to go out, and want to stay home.

Prior to learning DBT skills, these opposing thoughts would cause a lot of stress for them, and cause them to feel as if they were having a meltdown.  To help them decompress from their polarized inner self-hating dialogue, I have learned to reduce their stress by saying, “You are not having a breakdown, you are having a breakthrough!”  This often helps them to reframe the intensity of their emotions into a more helpful view.

Borderline1

What they need to learn is to go within and ask, “What do I need now?”  or “How can I make this better?”   Instead of saying “What’s wrong with me? Why am I like this?   I hate this!  I feel crazy! I can’t take it, I want to die!”

I teach my clients to stop asking WHY questions, but to ask HOW questions instead.  When we ask WHY, “Why am I like this?  Why don’t I enjoy parties?  Why am I so annoying to people? Why is this person ignoring me?  Why do people dislike me? “Why am I still single?” they are on a slippery slope into anxiety and depression and possible self-harm.

When they learn to ask HOW questions, they start to change, “How can I make this better?”  “How can I be useful?”  “How can I learn to stay calm when I am triggered?”  The HOW questions lead to discovery, growth, healing and empowerment.

In Conclusion

Dialectical Behavior Therapy for Post-Traumatic Stress Disorder is a powerful healing modality.  From my experience, those clients suffering with BPD are particularly helped by this cognitive restructuring process, since typical pharmacological and talk therapy interventions do not help them very much.  From my perspective, DBT really feels like a new software program is slowly downloaded into their minds and replaces their previously corrupted and faulty software that was hurting them.
Copyright © by Lisa Wessan 2019. All rights reserved

 

 

Leave a comment »

Some Mindfulness and Emotion Regulation Resources for a More Peaceful Holiday Season

Hi,

I hope this message finds you well.

During the holidays, especially Thanksgiving-Christmas/Hanukah/Kawanzza-New Year’s-Valentines Day, aka The Red Zone, there are many more opportunities to feeling the pain of Compare and Despair, neglect, arguments,  loss, grief and a boatload of intense feelings.

You may also be forced to spend time with a relative you despise, or be tempted to eat food or drinks that make you feel sick. Being triggered all over the place your impulse issues may be whispering in your ear, “Drink me, eat me, buy me, smoke me, shop me, gamble me, escape into video games/Netflix” on and on.

Everyone goes through this, but some of us feel it a lot more deeply.

To that end,  I want to offer you a few resources from my MirthMaven archives to help you get through The Red Zone.  May you find some wonderful skills and tools here to get through those midnight blues, or whenever the intense feelings feel like too much:

  1. Extra Tools for Letting Go  (Wessan, November 2018, 25 min). You may enjoy this useful and entertaining video of ways to quickly let go of harsh feelings.
  2. The Red Zone – Chock full of tips and techniques for help with this holiday season.
  3. Compare and Despair – added insight for social media distress, feeling left out, unloved, unwanted.

As always, let’s remember that “Feelings are not Facts,” and to practice being a good observer as the storm passes through you. “This too shall pass” and “Never Give Up” have helped to carry me through some tough times in the past.  

At the very least, remember to use the “Take 5” breathwork method: breathe in to the count of five, hold for five seconds, and release to the count of five.   Repeat for at least six rounds of Take 5 breaths, to get re-centered and regain some inner calm. 

May you have  a more  peaceful holiday season,

thanksgiving2

Copyright © by Lisa Wessan 2019. All rights reserved.

 

 

 

 

 

Leave a comment »