Treating Addictions and Borderline Personality Disorder Symptoms
Counselor Toolbox for Mental Health...

 
 
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Treating Addictions and Borderline Personality Disorder Symptoms
Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC
Executive Director, AllCEUs
Host: Counselor Toolbox Podcast

CEUs are available for this presentation at AllCEUs https://www.allceus.com/member/cart/index/product/id/1002/c/

Objectives
~ Review the characteristics of BPD and Addictions
~ Explore the functions of these symptoms
~ Identify interventions to help the person more effectively manage emotions and relationships

Internal Reality
~ Lack of a sense of self—If they aren’t someone’s something, then they are nothing
~ Unlovable for who they are
~ Constant fear of abandonment

Consequences
~ Lack of emotional boundaries
~ Anger is used to control others and is rewarded
~ Emotional dyscontrol
~ Inability to self-soothe/Impulsivity
~ Lack of coping skills
~ Relationship problems
~ Physical health problems and complaints
~ Cognitive distortions are reinforced
First
~ Identify the most salient symptoms
~ Their function (and alternate ways to meet that need)
~ Identify what it looks like for that person
~ When X happens, how do you feel? What do you think? What are your urges? What do you do?
~ How that behavior is being maintained (what are the benefits and other ways to get the same benefit)
Frantic efforts to avoid real or imagined abandonment

~ Function: The person only knows how to exist as a role, such as being someone else’s spouse/parent etc. (Co-dependency)
~ Preventing abandonment means preventing death or dissolution
~ What does it look like (Benefits/Drawbacks)
~ Hypervigilant/hypersensitive to rejection/criticism
~ Anger at/belittling others to control them
~ Acting out to control through guilt, manipulation
~ Emotional dyscontrol
Abandonment cont…
~ Origins
~ Failure to develop a sense of self due to constantly trying to appease the caregivers
~ Addict –Don’t Talk, Don’t Trust, Don’t Feel
~ Borderline –Do as I say or else…
~ History of abandonment/rejection/CPR
~ If they are something to someone then they are filling a need and are less likely to be abandoned
~ History of neglect/abuse (You (as a person) are not worthy of love)

Abandonment Cont…
~ Interventions
~ Develop a sense of self and self-esteem
~ Differentiate between who you are and what you do
~ Explore what makes someone/something “lovable”
~ Dogs/horses
~ Children
~ Others
~ Which of those characteristics do you have in yourself?
~ Identify and address messages/events in the past that communicated unlovability

Abandonment Cont…
~ Interventions
~ Explore the notion of responsibility (Who and what are you responsible for)
~ Not responsible for the parent
~ Responsible for you
~ Nobody else can make you…
~ Explore and address abandonment/rejection triggers
~ Is it about you? What are alternate explanations?
~ Explore faulty thinking

Relationships are Unstable
~ Function: Controlling others provides a feeling of safety and predictability
~ What does it look like (Benefits/Drawbacks)
~ Intense and unpredictable interactions
~ If you do what I want, I love you
~ If you do not, you are rejecting me and I hate you
~ Everyone walks on eggshells
~ Jekyll/Hyde

Relationships are Unstable
~ Origins
~ Children were rejected (or the caregiver was unavailable) at an age in which they were still thinking in concrete, all-or-nothing terms
~ The A/B expects rejection and has never experienced an authentic relationship with self-or others
~ Inability to self-soothe is terrifying and the A/B fears they cannot cope on their own
~ Repeated rejections become most salient and support all-or-nothing thinking

Relationships are Unstable cont…
~ Interventions
~ Use CBT to explore and address perceived rejection
~ From others in real life
~ From the gallery/hecklers
~ From yourself
~ Use contextual approaches to separate REactions to the present
~ Differentiate dislike of actions/ideas from dislike of person (People can disagree or dislike something you do but that doesn’t mean they don’t like you

Relationships are Unstable cont…
~ Interventions
~ Learn to identify and assertively communicate needs and wants
~ Explore characteristics of healthy relationships and address parts that feel scary
~ Honesty
~ Trust
~ Hope
~ Faith

Self-Damaging Impulsivity
~ Function: Distraction/Escape
~ What it looks like (Benefits/Drawbacks)
~ Self-harm
~ Spending
~ Addictive behaviors
~ Violence toward self or others
~ Overly sexualized behavior
~ Origins
~ Lack of coping skills in the face of overwhelming emotions
~ Inability to self-soothe

Self-Damaging Impulsivity
~ Interventions
~ De-escalation/Distress tolerance
~ Self-soothing
~ Mindfulness
~ Coping skill development
~ Vulnerability prevention

Transdiagnostic Interventions
~ A/B both have high levels of HPA-Axis overactivation and corresponding physical, emotional and interpersonal issues
~ Vulnerability Prevention
~ Sleep
~ Nutrition
~ Pain management
~ Temperament
~ E/I
~ J/P
Transdiagnostic Interventions
~ Acceptance & Tolerance / Serenity
~ Urge surfing/Don’t swat the bee
~ Distress Tolerance

Transdiagnostic Interventions
~ Mindfulness/Honesty/Wisdom
~ Increases awareness of
~ The present moment wants, needs, sensations, thoughts, feelings in the present moment
~ Picture test
~ 5-4-3-2-1
~ Picture memories and sensations
~ Scent memories and sensations
~ Sound memories and sensations
~ Current: Sensations, physical cues, emotions, thoughts, urges, needs

Transdiagnostic Interventions
~ Mindfulness/Honesty/Wisdom
~ Increases awareness of
~ The influence of the past on the present

Similar situations in the past The present situation (objective)
What I learned about myself, How I am different now
others and the world What my current needs are
What I did to protect myself/survive The best use of my energy
Transdiagnostic Interventions
~ Psychological Flexibility
~ The serenity to accept the things I cannot change
~ The courage to change the things I can
~ The wisdom to know the difference

Reactive behaviors Active behaviors
(What I want to do) (What I could to do toward a RML)

Reactive thoughts/feelings Reactive thoughts/feelings
(What I want to do) (What I could to think toward a RML)

Summary
~ People with BPD first need to learn how to safely deal with intense feelings
~ Specific Issues which may trigger intense feelings and interventions include:
~ Poorly developed, or unstable self-image, often associated with excessive self-criticism and feelings of inadequacy
~ Development of self-concept
~ Differentiation of whats from whos

Summary
~ Interpersonal hypersensitivity (i.e., prone to feel slighted or insulted)
~ Desensitization
~ Self-Soothing
~ CBT Interventions
~ Intense, unstable, and conflicted close relationships, marked by mistrust, neediness, fear of abandonment, and difficulty trusting people due to alternations between feeling appreciated and condemned
~ Learn how to be honest with yourself about wants/needs/fears
~ Develop the ability to trust self
~ Learn what it means to trust others
~ Learn how to set healthy boundaries