1
Those Borderlines Removing Stigma and
Facilitating Recovery
Reneé Kopache Hamilton County Mental Health and
Recovery Services Board
2
Agenda

• Recovering and Facilitating Recovery
• Hope
• Empowerment
• Self-Responsibility
• Meaningful Role
• Issues to Contend With
• Stigma
• Co-dependency
• Substance abuse
• Trauma
• Self-Injury and suicidal actions

3
Recovering Facilitating Recovery from BPD
4
Stages of Recovery

• HOPE
• Empowerment
• Self-Responsibility
• Meaningful Role
• ---------------------------
• Recovered

Village Integrated Services, Inc.
5
Hope

• Becoming rational thinkers
• Hope is basically an attitude (influenced by
  thought).
• Those of us with BPD struggle a great deal with
  irrational thought patterns, which hinders our
  sense of hope.

To obtain and maintain a sense of hope, we have
to change (control) our thoughts we have to
become rational thinkers!
6
The Role of the Provider - Hope

• Engagement
• Trust
• Dialogue
• Dont hide the diagnosis from the consumer
• Education
• Help the consumer understand why they do what
  they do and think the way that they think
• Separate the illness from the individual
• Avoid Stigma

Teach rational thinkinginstill a sense of Hope!!!
7
Hope Cont

• Helpful Coping Skills/Techniques
• Support from a trusted, third party observer
• Journaling
• mood logs
• Positive self-talk and/or affirmations
• medications
• Barriers
• Stigma discrimination from having a mental
  illness
• Were difficult, manipulative, and nobody wants
  to work with us because were so bad off - - how
  can we have hope when the system has no hope for
  us?
• Fears (change, abandonment, emotions, etc.)

8
Empowerment

• Become active in your treatment
• Medications alone will not improve your life
• Your treatment providers cannot fix you

• Become Knowledgeable
• know your illness yourself
• learn to distinguish between symptoms and you
• warning signs
• Triggers
• rights
• Utilize Support
• Professional
• Peer
• Friends/family

9
The Role of the Provider - Empowerment

• Educate
• Support the process of gaining self-awareness
• Homework assignments
• Boundaries
• Consistency
• Avoid getting trapped
• Support
• Begin to assist the consumer with the process of
  developing a healthy support system

10
Empowerment Cont

• Helpful Coping Skills/Techniques
• Continue using skills from previous stage
• Read, read, read
• Self-Assessment
• strengths, weaknesses, needs, wants, goals, etc.
• Let people help
• Exercise.pursue hobbies
• Barriers
• Stigma
• Triangulation
• Fear of abandonment
• Trust

11
Self-Responsibility

• Changing Behaviors/Regulating Emotions
• Advanced recovery
• critical stage where we shift from an external to
  internal locus of control
• taking responsibility for our livesbeing willing
  to do whatever it takes to get better
• for some, progress in recovery stops here
• Anger is not the only emotion we have
• taking on responsibility for our well-being opens
  the door to feeling the positive emotions
• Creating a positive lifestyle
• change, change, change
• risks, risks, risks

12
The Role of the Provider

• Self Responsibility
• Support the efforts to change
• Provide tools and techniques
• Cheerleader
• Sounding Board
• Expect failure and be ready to deal with it
• Help the consumer improve self-esteem and sense
  of self
• Help the consumer deal with co-dependency issues

13
Self-Responsibility Cont

• Helpful Coping Skills/Techniques
• Continue previous skills as appropriate
• Identify the problems as well as reasonable
  solutionsthen, develop a plan to implement the
  solutions (Impulse Control Logs)
• Physical
• Thought/Emotional
• Relationships
• Barriers
• Self-sabotage (fear of success)
• Fear of failure
• Low self-esteem poor social skills

14
Meaningful Role

• Integrated life in the community
• Life extends beyond mental illness and the mental
  health system
• Valued Role in the community
• Employment/volunteering
• Faith community
• Family
• Friendships/relationships
• Community organizations
• Giving back
• Pursuit of interests/hobbies (outside of MH)

15
The Role of the Provider

• Meaningful Role
• Youre job is just about done!
• Encourage activities in the community
• Help the person connect to natural supports
• Help the individual transition out of services
• Be prepared for self-sabotage

16
Meaningful Role Cont

• Helpful Coping Skills/Techniques
• Keep doing whats worked
• Try new things
• Give back
• Barriers
• Old habits are hard to break
• returning to the comfort zone
• Self

17
Issues to Contend With

• Stigma
• Co-dependency
• Substance Abuse
• Trauma
• Self-Injury and suicidal actions

18
Overcoming Stigma

• Stigma from others (external)
• Mental Health System
• Providers
• Peers
• Community (family, friends, neighbors, etc.)
• Self-stigma (internal)
• Serenity Prayer
• Self-Esteem
• Empowerment

19
Co-dependence BPD

• "Codependence is about giving away power over
  our self-esteem. (Burney, Robert)
• It is this lack of a "self" that leads the
  person with BPD to continually set and re-set
  themselves up as victims. (Mahari, A.J., 2000).

Robert Burney From his Column "Codependence vs
Interdependence-- In an article by A.J. Mahari
(2000) titled Co-dependence Where Borderlines
and Non-Borderlines Often Meet.
www.borderlinepersonality.ca/bordercodepdance.htm
20
Codependence Cont

• Recovery from co-dependence
• is about knowing that you want and deserve
  healthier relational realityIts about meeting
  your own needs!
• you NEED to learn to validate yourself from the
  inside out and you must stop seeking others to
  define you and or to meet your needs for you
  (Mahari, A.J., 2000).
• Recovery from BPD
• involves overcoming co-dependence and becoming an
  emotionally healthy adult by taking
  responsibility for oneself, and building a sense
  of self (identity), self-esteem and self-worth.

21
Substance Abuse

• 54 of those with BPD have a problem with
  substance abuse (bpdcentral.com).
• Individuals with BPD who abuse substances
• are at greatly higher risk for suicide and for
  death or injury from accidents.
• often abuse substances in an impulsive fashion
  contributing to a lower threshold for other
  self-destructive behavior.

22
Trauma

• Research suggests that between 40 and 70 of
  individuals with BPD are victims of trauma (NIMH
  website).
• Approximately 25 of individuals with BPD are
  also diagnosed with PTSD (NIMH website).
• Challenges to treatment due to trauma
• Threat to therapeutic alliance
• Issues with transference
• Traumatic memories
• Splitting

23
Self-Injury and Suicidal Actions

• Approximately 70-75 of patients with BPD have a
  history of at least one deliberate act of
  self-harm.
• According to Linehan et al, the mean estimated
  rate of completed suicides is 9.
• Self-mutilation is distinct from suicidal
  behaviors, but such behaviors double the risk of
  actual suicide
• Purpose most often those with BPD self-mutilate
  to punish themselves, but some are seeking relief
  of dysphoric states
• http//www.afsp.org/education/gund_ridolfi.htm

24
Self-injury and suicidal actions

• Managing Suicidality
• Split treatment (multiple providers)
• Identify the Primary Clinician
• Contracting for safety
• Responsibility for reporting feelings/thoughts
  falls on the consumer
• When the crisis has passed, process it
• how you felt about it
• how the consumer felt about it
• plan to respond differently in the future
• http//www.afsp.org/education/gund_ridolfi.htm

25
Resources Books

• I Hate You, Dont Leave Me
• Kreisman, Jerold
• Managing Intense Emotions and Overcoming
  Self-Destructive Habits A Self-Help Manual
• Bell, Lorraine
• The Angry Heart Overcoming Borderline and
  Addictive Disorders An Interactive Self-Help
  Guide
• Santoro and Cohen
• Life at the Border Understanding and Recovering
  from the Borderline Personality Disorder
• Heller, Leland M.D.

26
Books Cont

• Skills Training Manual for Treating Borderline
  Personality Disorder.
• Linehan, Marsha M.
• Eclipses Behind the Borderline Personality
  Disorder
• Ford Thornton, Melissa
• The Feeling Good Handbook
• Burns, David M.D.
• Pathways to Recovery A Strengths Recovery
  Self-Help Workbook
• Ridgway, Priscilla McDiarmid, Diane Davidson,
  Lori Bayes, Julie and Ratzlaff, Sarah

27
Resources Websites

• Borderline Personality Disorder
• http//www.bpdcentral.com
• http//www.bpdresourcecenter.org/
• http//www.laurapaxton.com/
• http//www.biologicalunhappiness.com/
• http//borderlinepersonalitydisorder.com
• General Recovery Websites
• http//www.mhrecovery.com
• http//power2u.org

28
QA and Contact Info.

• Renee Kopache
• reneek_at_hamilton.mhrsb.state.oh.us
• www.mhrecovery.com

Angela Ostholthoff aostholthoff_at_gcbhs.com www.reco
verycenterhc.org