Overcoming Borderline Personality Disorder: A Family Guide for Healing and Change PDF
Preview Overcoming Borderline Personality Disorder: A Family Guide for Healing and Change
Overcoming Borderline Personality Disorder Overcoming Borderline Personality Disorder A Family Guide for Healing and Change VALERIE PORR, M.A. Oxford University Press, Inc., publishes works that further Oxford University’s objective of excellence in research, scholarship, and education. Oxford New York Auckland Cape Town Dar es Salaam Hong Kong Karachi Kuala Lumpur Madrid Melbourne Mexico City Nairobi New Delhi Shanghai Taipei Toronto With offices in Argentina Austria Brazil Chile Czech Republic France Greece Guatemala Hungary Italy Japan Poland Portugal Singapore South Korea Switzerland Thailand Turkey Ukraine Vietnam Copyright © 2010 by Oxford University Press Published by Oxford University Press, Inc. 198 Madison Avenue, New York, New York 10016 www.oup.com Oxford is a registered trademark of Oxford University Press All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior permission of Oxford University Press. The lines from “since feeling is first”. Copyright 1926, 1954, © 1991 by the Trustees for the E. E. Cummings Trust. Copyright © 1985 by George James Firmage, from COMPLETE POEMS: 1904–1962 by E. E. Cummings, edited by George J. Firmage. Used by permission of Liveright Publishing Corporation. Library of Congress Cataloging-in-Publication Data Porr, Valerie. Overcoming borderline personality disorder : a family guide for healing and change / Valerie Porr. p. cm. Includes bibliographical references and index. ISBN 978-0-19-537958-7 (hardcover) 1. Borderline personality disorder—Popular works. I. Title. RC569.5.B67P67 2010 616.85′852—dc22 2010009506 1 3 5 7 9 8 6 4 2 Typeset by Glyph International, Bangalore, India Printed in the United States of America on acid-free paper This book is dedicated to a very special TARA who taught me to understand suffering and compassion and motivated me to find a way to help people onto the path out of suffering Contents ONE Loving Someone with Borderline Personality Disorder: The Family Experience TWO The Science of Borderline Personality Disorder THREE The Principles of Behavior Change FOUR Understanding Dialectical Behavior Therapy FIVE Understanding and Applying Validation SIX Mindfulness SEVEN Grieving and Radical Acceptance EIGHT Dialectical Behavior Therapy Skills for Behavior Change: Interpersonal Relationships, Emotion Regulation, and Distress Tolerance NINE Mentalization: Understanding Misunderstandings TEN Putting It All Together: Integrating Skills for Acceptance and Change Afterword: For Clinicians Resources Bibliography Index Foreword IF YOU ARE READING THIS BOOK, CHANCES ARE THAT YOU, LIKE Valerie, come to this moment and these pages not by choice. You come desperate, having already traveled a long and arduous road as you sought answers, explanation, and the possibility of real help for your loved one with borderline personality disorder (BPD). You seek an understanding that is only possible among those who have stood in your shoes, who need no words to truly get the horrors you have faced, the fear as you consider the future, the profound sadness and grief, and the yearnings of your heart. You come hoping against hope that perhaps you will find the way out of the hell you and your loved one have endured. However you got here, whatever your own path has been, you have arrived well. You can take comfort in knowing that your guide, Valerie Porr, has devoted decades of her life scaling the mountain tops far and wide, also searching for answers and explanations about BPD, and for a way out, for those she loves and for those she may never meet. She has applied her brilliant and creative mind, her seemingly endless and bountiful energy, and a determined passion to the pursuit of gathering, piecing together, distilling, and disseminating all that is known scientifically about BPD. This book, a compilation of all she has learned and now teaches to those in her family classes, is a labor of love if there ever was one. Valerie has read scientific journals copiously, often making connections unseen by researchers themselves until hearing her astute observations. She and her members attend scientific conferences throughout the world on an annual basis (American Psychiatric Association, American Psychological Association, Association of Behavioral and Cognitive Therapy, International Society for the Study of Personality Disorders, to name a few). She engages deeply in these meetings, fearlessly asking hard questions, and reminding the scientific community that our research “subjects” are her and her members’ sons, daughters, wives, and husbands. You can expect to find Valerie seated near the front, with camera in hand, taking digital images of the presenter’s slides so she can immediately incorporate what she has learned into her next class or workshop. There is no time to wait. People are dying and lives are being destroyed by the disorder of BPD. I originally met Valerie shortly after she formed TARA, her nonprofit organization that seeks to assist and support loved ones of those afflicted with BPD. She had applied to attend a 10-day Intensive Training in Dialectical Behavior Therapy (DBT), a scientifically proven treatment for BPD developed by Marsha M. Linehan, Ph.D. at the University of Washington. Her application sparked a number of interesting and important conversations for our training organization about the role of families in “treating” individuals with BPD. DBT, like those it seeks to treat, is difficult to learn, even for well-trained mental health professionals. DBT is a comprehensive treatment built on multiple theories, containing numerous principles, strategies, procedures, and skills. Linehan’s primary treatment manual (Linehan, M.M., Cognitive and Behavioral Treatment of Borderline Personality Disorder, New York: Guilford Press, 1993) is thick, tedious, and technical. How could family members with no training in mental health treatments be expected to learn DBT, let alone use it well? Furthermore, was it even ethical for them to do so? Over time, I discovered how naïve and wrong I was. I learned that in fact the most ethical and effective approach to treatment is, when possible, to actively engage families who seek to help in the treatment. Indeed, few others will go the distance as will family members of those with BPD. The contents of this book have their roots in that DBT intensive. Valerie’s team returned to the second part of the DBT Intensive Training having established TARA’s first DBT psychoeducational program for family members. Through her tireless actions and her commitment to rigorous scientific research and evidence-based therapies, she has the ear of the scientific community and has helped those who treat BPD to understand the rightful place of family members in treatment. As she has told me and other treatment professionals on many occasions, while we therapists can go home at night and observe our limits with respect to responding to our clients’ crises, family members of individuals with BPD are never off duty. My time with a particular patient is limited to an hour or two a week, whereas a family member’s contact may fill the remaining hours, to care for and coach in more effective ways of responding. You arrive on this scene at a very exciting time, as many advancements have been made in the understanding and treatment of BPD over the past two decades. BPD is no longer the life sentence it once was. Those who receive an evidence-based therapy can expect very positive outcomes, including full remission from the disorder. There are now several manualized and empirically supported psychosocial therapies for BPD, including DBT and mentalization, the two therapies described within these chapters. Valerie’s emphasis on DBT is rightly placed, as it is the treatment most rigorously researched to date. Currently, there are over ten published randomized controlled trials conducted by
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