Borderline Personality Disorder

Borderline Personality Disorder

Show: Behind Closed Doors

Topic: Borderline Personality Disorder

Hosts: Dr. Kate Balestrieri and Lauren Dummit

Guest: Dr. Sandra Powers

Announcer: This show is furnished by Triune Therapy Group.

Kate: Good evening Los Angeles, welcome to Behind Closed Doors heard every Saturday at 6 PM right here on Talk Radio 790KABC. I’m Dr. Kate Balestrieri.

Lauren:  And I’m Lauren Dummit, Marriage and Family therapist.

Kate: And together we’re the co-founders of Triune Therapy Group, a psychotherapy practice based in Los Angeles that specializes in treating trauma, addiction, mental health, sex, and relationship issues. And Behind Closed Doors is a show about all of that especially sex and relationship issues as we come into our adult lives and reflect on all of the impacts of growing up that have influenced how we show up in our relationships.

So today, specifically, we’re focusing on addressing Borderline Personality Disorder and all of the myths and realities that come along with that condition. It’s one of the most misunderstood diagnoses that we see and one of the most feared diagnoses that patients often wonder about if they are impacted with or if one of their loved ones is impacted with. So we thought it would be a great opportunity to just really talk about, what is this condition? Why is it so scary? What are the myths and the realities?

Lauren: How does one develop it?

Kate: Yeah. And how does one heal from it really?

Kate and Lauren: Most importantly.

Kate: So I wonder, Lauren, when you were telling me a story earlier today about an instructor you had in grad school and how the instructor gave everyone a case study and said: “Okay now, calm down, get off your ledge.” You’re all diverse.

Lauren: Split personality disorders was the topic and so he was saying: “I know you’re all diagnosing yourself right now.” Because the truth is we could all relate to a lot of the symptoms associated with each personality disorder but we have to look at how it’s impacting us. Like is it impacting our ability to function in life? And the answer in class, mostly around the room was no. But when we see it in more severe form, that’s when the diagnosis is really appropriate.

Kate: Right. Well the way that I think about a personality disorder, whether we’re talking about a borderline personality disorder, a narcissistic personality disorder or an antisocial personality disorders, really that it’s a systematic organization of how someone approaches their own identity, their relationships and their engagement with the world. And it’s persistent across different contexts in their lives. And really has a negative impact that can compromise their ability to function in a way, that they might feel is ideal and certainly in a way that impacts the people around them. Like the people who love them.

Lauren: Right. I know in another episode we’ve been talking about like Big T trauma and little trauma. And big T. Trauma being those things that everyone would agree is trauma of being raped or held at gunpoint.

Kate: Or having a horrific car accident or some more natural disasters.

Lauren: And little T being kind of the trauma that we experience in our family of origin. Frequently within our relationship with our parents and kind of the dynamics and how that kind of molded us to have this perception of ourselves in the world and in relationship with others.

Kate: So the reason it’s important to think about traumas, whether big T or little T traumas, is because oftentimes the development of a personality disorder is the result of a lot of little T traumas or persistent invalidation in our families of origin or feeling like our feelings didn’t matter or we weren’t able to be ourselves or we had lots of little undermining of our reality and a foreclosure on what other people decided was to be our reality. And so we really were flummoxed in our understanding of who we were and what was going on around us. And oftentimes when we’re working with people who have a Borderline Personality Disorder or a cluster of borderline symptoms, they have their world invalidated so often.

And we’re going to talk a lot more in-depth about how Borderline Personality Disorder develops but I really want to focus on the impact of a lot of these little T traumas. So we talked about this last week with Dr. Ken Adams. This kind of death by a thousand little pokes and that’s a really important distinction to make. Because oftentimes people will come into our offices at Triune Therapy Group and say: “Oh, my childhood was great or I’m really close with my family now. I don’t understand why you’re saying that has any relationship to the symptoms that are showing up in my life.”

And they’re really confused about that.

Lauren: Yeah. You get people all the time saying like: “No, me and my mom are best friends.”

And that can indicate an enmeshed relationship at times which they might not even recognize as traumatic. And as we talk about a little T trauma with personality disorders, I think it’s important to also point out that it’s not only these covert ways but if someone has been the victim of any type of physical or emotional abuse or neglect, it’s also like a prime breeding ground for that type of reaction.

Kate:  Absolutely, absolutely. I remember when I was in grad school and we had our class about the more acute and severe conditions. And I can’t remember what the class was called now, but just like your experience we had to get together in little groups and everyone got a different case. And inevitably people in the room were like: “Oh my gosh! I think I’m schizophrenic or oh my gosh! I think him an anti-social personality disorder or oh my gosh! I think I’m bipolar.”

And you know when we came around to the borderline presentation, it was interesting to me how quiet the room got. And that to me sparked a real curiosity about why there’s so much stigma around Borderline Personality Disorder? Why is that the condition that creates a lot of fear for people?

Lauren: There really is and you also hear that term kind of being thrown away or turned around- I’m sorry- kind of in a really pejorative manner.

Like: “Oh my God! He’s so borderline. She’s so borderline.”

And I don’t think people necessarily have a true understanding of what that means.

Kate: And I don’t think they understand how hurtful it is either. I mean it’s really dangerous to refer to anyone as a label. But also what they’re really saying is, I don’t understand what I’m seeing and it scares me. And I think that’s why some people really get stuck in a kind of pejoratizing any psychiatric or mental health issue.

But when it comes to Borderline Personality Disorder, often we see it diagnosed more frequently with women. Whereas when these symptoms show up with men, they’re usually given a different cluster of diagnoses. Usually related to either narcissism or antisocial personality disorder. So it does bring up an interesting question about, how do our constructs for gender and sexuality in this culture impacts the way we see symptoms and the way we label people?

And oftentimes women are labeled as crazy. And oftentimes what people are describing as crazy, could be perceived as symptoms of Borderline Personality Disorder. So I think that it’s really dangerous to throw those labels around without really understanding.

Lauren: And I know we were talking earlier, because a lot of our work at Triune Therapy Group we treat a lot of people that have gone through a significant Big T trauma. Sometimes it’s the partner of a sex addict that can be a multitude of things. But they’re often presenting with symptoms of PTSD that can look very much like borderline. And so often if for example, it’s a betrayed partner, their spouse quite frequently can be pointing the finger at them as one of the causes of why they acted out. When in fact, that didn’t exist until post.

Kate: Exactly. And I thank you for bringing that up, because I think it’s a really important distinction that a lot of people are afraid to talk about when they come into the therapy room. And really when we think about borderline personality disorder, we think about it as a complex presentation of post-traumatic stress disorder. And we’re going to talk more about that after the break.

But when someone endures a trauma, they often feel really crazy and like they’re spinning out of control and they don’t know what end is up and they feel dysregulated. They often feel invalidated and we see this a lot for people who are in abusive or toxic relationships or relationships with sex addicts who are not getting treatment. And the kind of betrayal that comes from that level of repeated gas-lighting and manipulation, often will create a construct of reactions in someone that may or may not be a borderline organization or be an exacerbation of a predisposed borderline organization. But really we want to start redefining this as a type of trauma response.

Lauren: Yes, absolutely. Another thing I hear all the time from betrayed partners is: “I don’t even know who this person is. I thought I knew them.”But that also brings into question like they have a loss of sense of self themselves. Because who are they in context of this person that they don’t even know? And so the symptom of kind of not having a solid sense of self may not have been an issue throughout their life but it’s coming up now.

Kate: So there’s a lot of co-occurring issues that can be present with the symptoms of Borderline Personality Disorder. And we’re going to talk a little bit more about that after the break when we bring Dr. Sandra Powers on the show from Clearview Treatment Center, to really talk about this. That is their area of expertise and we’re so excited to have her on.

Lauren: Yes we are.

Kate: Yes. But one of the things that we often talk about when we are addressing trauma complex PTSD, is the necessity for a cognitive and emotional and a cinematic approach to treatment and that’s so key. Because when we have endured a lot of trauma in our lives inevitably, that trauma builds residue in ourselves, in our physical selves. And we create a pattern of adaptation that once served us very appropriately and now no longer does. But our body doesn’t recognize that so it still reacts. And that’s often the source of a lot of ongoing trauma symptoms.

Lauren: And it just gets stored in our bodies.

Kate: And so one of the things that we often treat at Triune Therapy Group is the long term effect of early relational and developmental trauma. We have an amazing group called Revive And Thrive. And that group is designed for women who are looking to recover from all different kinds of relational developmental trauma that really integrates sematic work with cognitive work with effective work and with building community amongst our women. Which is really key when you’re healing from anything is building community and reducing the isolation.

So for more information about that group or about Borderline Personality Disorder, you can always call us at Triune Therapy Group at 3-1-0-9-3-3-4-0-8-8 or message us on Instagram or Facebook @Triune Therapy Group for more information or to schedule a consultation about treatment options available to you.

We have to take a quick break now, but when we come back more about the myths and realities about Borderline Personality Disorder with the Clinical Director of Clearview Treatment Center, Dr. Sandra Powers. Stay with us we’ll be right back. Welcome back. You’re listening to Behind Closed Doors. I’m Dr. Kate Balestrieri.

Lauren: And I’m Lauren Dummit. Marriage and Family therapist.

Kate: And together we’re the co-founders of Triune Therapy Group, a psychotherapy practice based in Los Angeles treating trauma, addiction, sex and relationship issues.

Today’s episode of Behind Closed Doors is focusing on the myths and realities of borderline personality disorder. And we are so excited to have with us here, the Associate Clinical Director of Clearview Treatment Center. Which is a facility here in Los Angeles that really specializes in treating Borderline Personality Disorder.

So Dr. Powers thank you so much for being here with us today.

Dr. Powers: Thank you.

Lauren:  Thank you.

Kate: So tell us a little bit about yourself, your expertise. How you found yourself in this field and what you guys do at Clearview.

Dr. Powers:  I’d be happy to. As you say, I’m a licensed psychologist and I work at Clearview treatment programs. We specialize in dialectical behavior therapy which has been shown to be very effective at treating borderline personality disorder. I have been there for four years now. And what brought me into this, personally, is that I found that not only was it so helpful for my clients to learn coping skills, for managing emotions and thoughts and all the other components that come together for borderline personality disorder, for mood disorders, and substance use disorders as while.

Also finds it personally helps the mindfulness goals, emotion skills, assertiveness skills.

Lauren: I was thinking, who couldn’t benefit from it?

Kate: Really I mean DBT is such a robust treatment program and we’ll talk more about DBT in a little bit and kind of what that’s about.

What are some of your experiences of some of the biggest myths that you encounter when you hear people talking about borderline personality disorder?

Dr. Powers: I think you touched on this before. One of the biggest ones we don’t even say out loud, is the association with women over men. That women are more likely to have borderline personality disorder. And we also see men with this condition as well.

Kate: We really do, and I think it’s often misdiagnosed as something else.

Lauren: Yeah. And I think also, I was reading a statistic that 70 percent of women have borderline personality disorder. The other 30 percent are men. However, that was believed to be skewed because women are far more likely to seek treatment.

Kate: So I just want to clarify that statistic because you said 70 percent of women have Borderline Personality Disorder?

Lauren: Seventy percent of people with Borderline Personality Disorder are women. Although I believe that statistic is skewed because women are far more likely to seek treatment for that.

Kate: What do you think about that Dr. Powers?

Dr. Powers: I think that’s accurate. I would say, yeah, probably two to three times more women than men are diagnosed with Borderline Personality Disorder.

Kate: So to be clear, the people who are seeking treatment are showing up in and we’re seeing two thirds of the people who are seeking treatment in women versus men. That’s interesting.

Lauren: When you mention at Clearview also that you treat a lot of substance abuse. And I think in my experience, a lot of people that are in recovery when they look back on their behavior and presentation while they were drinking or using, they present as if they had a personality disorder yet often with recovery, that kind of goes away and so it’s not necessarily organically the personality disorder that could possibly have been the symptoms of their disease.

Dr. Powers: Absolutely. There are a couple of ways that we look at that. One, is that when we are diagnosing someone Borderline Personality Disorder it’s important to look at their general presentation not only in the throes of addiction or depression or whatever it might be.

The other piece to it too is that there’s a similarity in problems with managing emotions. That oftentimes we’re seeing people using substances to avoid emotional experiences because emotions are so difficult to cope with. Emotions like shame, is a big one for people with addiction and also with Borderline Personality Disorder.

Kate: Yes, that’s such a good point. What are some of the other myths that you encounter in your work at Clearview?

Dr. Powers: I think that the stigma is really a big one. That people used to think that this wasn’t something you could recover from. Whereas, actually there’s a lot of support for and showing that you really can recover from borderline personality disorder. There is healing, there is treatment, people do improve. Sometimes people improve to the point that they don’t have a diagnosis anymore of borderline personality disorder.

I think this was a misconception, not only in the public but also among practitioners, medical practitioners and therapists as well. That there wasn’t something to do about it and that’s really hasn’t been the case for a long time.

Lauren: I think when I was first becoming a therapist, I heard from multiple people that personality disorders you want to avoid diagnosing those because you can’t get better. And I was thinking, really? That seems odd to me and I definitely found that not to be true as I have continued in my experience as a clinician.

Kate: Yes. Oftentimes we see people significantly improve in their symptom reduction and the quality of life when they engage in any kind of rigorous treatment program. And I think it’s important to really emphasize that there is hope and it’s an opportunity for people to recover.

One of our Facebook questions that we received. Last week we put out to Facebook and Instagram a poll on: What are your questions about borderline personality disorder?

And one person asked: “Well if I have it, can I ever recover or is it something I’m always going to have to be managing throughout my life?”

And I’m curious Sandra, what your thoughts are on that?

Dr. Powers: Absolutely. A person can recover. It takes treatment. Oftentimes, it takes learning new ways of managing feelings and thoughts and impulses. And just like any other mental health disorder, it is something that may need to be managed over time. That we want to be aware of the potential for a relapse in symptoms. And over time people also become more habituated to and used to their new more effective ways of living.

Kate: And just like with any skill, when you practice the new interventions that you’re learning, the new ways of coping, the new ways of communicating, they’ve become second nature over time. And it becomes less of a chore of, okay, I have to practice that DBT skill now.

Lauren: And yet they might become more vulnerable if they’re experiencing a trauma or increase stressors or things like that. They might kind of have a regression into old behavior and so it might require management during that time.

Kate: So I think in those cases, recovery from my perspective, looks like recognition of the regression, recognition of a triggers and an implementation of coping strategies that have been effective more quickly.

Lauren: And one of the things I have seen a lot of my patients that come in presenting with these symptoms, is frequently they’re in so much pain and they are so motivated to get help. And I think any time there is really high motivation, there’s more buy-in and there’s more results.

And most of the people I work with that struggle with this, I’ve seen vast improvement.

Kate: Dr. Powers, how do you define a Borderline Personality Disorder? What are some of the common symptoms that you observe in your work?

Dr. Powers:  The classic symptoms that we think about are suicidality and self-harm which is hurting oneself without the intention of death but causing temporary pain to the body. We also think about frequent changes in mood that are very sudden. Intense emotion shows up at a small stimulus, last for a long time before returning to what we call the baseline.

In addition to that, fear of abandonment is one that we think of a lot. That loneliness is so painful that a person will sometimes go to extreme lengths to avoid even the possibility of feeling loneliness.

Kate: What would some of those extreme lengths look like?

Dr. Powers: It could be physically trying to keep someone from leaving the house so that you’re not alone in the house, for example. Or making threats to try to get the person to stay in their relationship.

Kate: So we work with a lot of people who will either in their partnerships have heard things like or even said things like: “If you leave me, I’m going to kill myself.”

Is that what you’re talking about?

Dr. Powers: It can be and that can be so hard on the partner. And I’m sure it’s hard on the person who’s saying those things as well.

Lauren: Another thing I see a lot is that there’s a lot of perceived threats of abandonment, that there’s a filter through which they perceive things that may or may not be true. And sometimes this comes out between therapist and client where the therapist might say something and the patient perceives that as a threat of abandonment and might have a really severe reaction to that.

Kate: What are some of the other symptoms that you observe?

Dr. Powers:  Impulsivity is another one. Engaging in behaviors that are reckless or dangerous. And some of it is to avoid emotions like using substances or anorexic behaviors. Some of it has to do with intense emotions prompting behaviors without thinking them through. Like, reckless driving.

Kate: And that impulsivity often we find is something that is unconscious and it really hijacks their ability to be present. And it becomes a dissociative endeavor, as you said, to mask those difficult emotions that are showing up or fears that are coming up relationally.

Dr. Powers: And the dissociation is also stress related. Dissociation is another symptom of borderline personality disorder. That once someone is under high distress, they are not in touch with what’s going on internally in their body and in their motions or externally what’s going on the world around them.

Kate: And so that creates a big disconnect because here they are trying so hard to engage in life and be present. But in fact, they’re so disconnected from their body and from what’s going on in the present moment, that it’s sort of like their head is operating over here and the rest of them is operating over there. And it can create a lot of confusion for people.

Lauren: Absolutely. I hear a lot of like the texting while driving while doing this and doing that and it’s very, very dangerous. And there’s a big dissociation with what they’re actually doing.

Kate: Yes. Well, we have to take a quick break but when we come back more about the myths and realities of Borderline Personality Disorder with the Associate Clinical Director of Clearview Treatment Center, Dr. Sandra Powers.

Follow us on Instagram and Facebook at Triune Therapy Group and message us with your questions. You can also call us at 3-1-0-9-3-3-4-0-8-8 for a twenty minute consultation to see how we can best help you and your treatment needs.

So stay with us, we’ll be right back.

Welcome back you’re listening to Talk Radio 790KABC. This is Behind Closed Doors I’m Dr. Kate Balesterieri

Lauren: And Lauren Dummit, Marriage and Family therapist.

Kate:  Together we’re the co-founders of Triune Therapy Group, the psychotherapy practice in Los Angeles that focuses on treating trauma, addiction, sex and relationship issues.

If you’re just tuning in, today we’re discussing Borderline Personality Disorder and the myths and realities that accompany it. And we have with us here in the studio a very special guest, the Associate Clinical Director of Clearview Treatment Center, Dr. Sandra Powers.

Thanks so much for being here.

Dr. Powers: Happy to be here.

Kate: So when we went to break, we were talking a little bit about the symptoms of borderline personality disorder. Is there any that we left off?

Lauren: I don’t think so. I think we covered most of them except the other thing I’m thinking of as frequently there’s a loss of sense of self. Like they don’t have a solid sense of self. Like who they are in there, Often people often feel or report feeling like they’re a chameleon and they’re kind of adopting to whoever they’re in relationship with.

Kate: Dr. Powers, what do you hear people describing, as they talk about that kind of absent sense of a solid self?

Dr. Powers: People saying: “I don’t know who I am.”

That awareness that their personality kind of changes in different contacts. So with some people they’re into certain things or acting a certain way in another context otherwise and internally it’s really confusing. And they’re not sure which one is the real them. Or that they might have an idea that I really like the ‘me’ that’s so outgoing and pretends like everything’s okay.

Lauren: I’m thinking about, often I hear when I talk about how in recovery a part of recovery is being our authentic selves and being able to own that. And quite frequently I hear the response like: “I have no idea who that is. I don’t know what I like. I don’t know who I am. It’s all a measure of who I am in relationship with.”

Kate:  The patients that I’ve worked with, who have a more borderline organization, will often report to me things like: “I feel empty inside and I feel like I have nothing in my core.”

And it is terrifying to hear. Which is often why this fear of abandonment is so real. Because a lot of times, people with a borderline organization will align themselves from a sense of identity to whomever they’re in relationship with. And so they feel safe in that alignment, they feel secure in that alignment. And when there’s any kind of perception or reality that they might be rejected or abandoned, not only do they stand to lose the relationship but also the safety in their identity that they’ve constructed around it. So it can be really terrifying and it makes sense why people would go to such great lengths to secure their relationships in order to protect that.

Dr. Powers: I think those really are hand in hand the not knowing who a person is and that emptiness inside. And it’s connected also to not being clear on what a person’s values are. I think oftentimes a person with Borderline Personality Disorder is aware that some of their behaviors are not who they want to be and that’s so confusing.

Kate: That’s a really good point. So it makes me wonder, how from your perspective does a Borderline Personality Disorder develop?

Dr. Powers: It’s that classic nature and nurture combination. Biologically, there are genetic markers that have been found and we can look at the brain research and see also that the connections are different to emotional parts of the brain. Some people have bigger emotions. They’re born to have bigger and more intense emotions. And so that’s a component that can contribute to the development of Borderline Personality Disorder that’s not it in itself. We can see other people that have intense emotions that don’t meet that.

And then the other part of it, that from the nurture side is the environment. And what we would describe as an invalidating environment. Can look like the classic being traumatized is the most extreme of invalidating experiences. And the smaller invalidations that can happen repeatedly over time, whether it’s with parents or at school, in social groups. That a person when they’re child they’re being told: “That doesn’t make sense how you’re feeling, that doesn’t fit, that’s not okay to show right now.”

That is so confusing and for a child if they’re not being shown how to cope with how they’re feeling: “Okay, this doesn’t fit. What do I do with it?”

And nobody’s telling them what to do, it’s so confusing. And that can turn into really problematic impulsive behaviors and problems with thinking.

Lauren: Another question that I get asked is: “My mom was borderline, does that mean I am borderline?”

Dr. Powers: There isn’t really the research to support that at this time because there’s so much that goes into it. And actually if a parent has bigger emotions they’re actually they might be more likely to be more invalidating sometimes. If the kid has a big emotions to a lot of times that we see is that it doesn’t match. That either the parent has Borderline Personality Disorder or traits and the kid is so different from that. And that created some difficulty in their home. Or the opposite. The parents were not very emotional, did not know how to manage their big emotions and that can be the cause of invalidation as well.

Kate: I think that it’s really important to focus on invalidation being one of the core facilitators for this disorder to manifest itself with people because as you said it’s really a nature vs nurture problem. Nut when we think epigenetically some of the risk factors that can influence the development of borderline personality disorder, really is around feeling invalidated all the time. And that can show up in so many different ways.

As you said, parents telling their children: “You’re not angry right now. Don’t be angry. You have nothing to be angry about.”

And really creating for them a divide between their reality and what is being supposed on them or imposed on them.

Lauren: And I’m also thinking about parents that are extremely inconsistent and don’t necessarily have boundaries and limits. It develops a situation where the child doesn’t learn to trust. And also in terms of mirroring your child, that’s also frequently how they develop a sense of self is to interaction and attention and validating their experiences. And if someone doesn’t that, then they are often lacking a sense of self. So you see that a lot with especially neglect.

Kate: There’s that pattern and like what you said about inconsistency. Because what we need to thrive growing up, is structure, consistency even though most of us let’s face it, we fight the struggle every day because it’s not that fun.

Lauren: And kids will always test limits and boundaries.

Kate: of course. But it’s the parents’ role to really enforce them consistently, not perfectly. No parent is perfect but when there’s a systematic undermining of any kind of rules or boundaries and a parent’s presence is felt inconsistently and intermittently that’s really confusing for children. And they tend to create a context of understanding that the way they are, needs to be malleable and. adaptive to what’s going on. And that creates a lot of fear, relationally and contextually for the world.

Lauren: And you mentioned the lack of a solid sense of values. And I think about some of my patients who are talking about like their parents, perhaps, were addicts and behaved very much like teenagers. And so they didn’t learn to trust but also they didn’t really raised with any sense of values. And so it was very confusing to what they believed and what was okay and what wasn’t okay. Because the parents certainly weren’t enforcing that.

Dr. Powers: Yes. A parent might communicate certain values and not live up to those values and that’s really confusing for a child.

Kate: Right. A lot of people talk about how they heard the message: Do as I say not as I do. And I think that’s what you’re describing. We have these value ideals but we’re not seeing them enforced and that’s really confusing. And then if children are reprimanded for not living up to the bar that their parents have set but are not themselves living, it can be really disorganizing for them.

So what do you think it’s like for somebody with Borderline Personality? What’s their experience like?

Dr. Powers: In a word chaos. It’s emotionally so painful to be walking around and being so sensitive to invalidation at every corner. And the way that a person who’s unable to soothe their emotions goes through life, is chaotic, causes problems in so many areas of somebodies life, in their relationships, in their sense of who they are, in their behaviors, in their thoughts and in their fear of experiencing emotions. That so much has to do with trying to keep these things from becoming out of control and often failing at it.

Lauren: And kind of feeling like it’s a roller coaster.

Kate: Well, interestingly our nervous systems learn to seek out what is familiar. So if we’re raised in an environment where there is a lot of inconsistency and chaos that makes sense to me that then later as adults we would unconsciously repeat and generate the kind of chaos that we’re used to because it’s familiar.

Lauren: Right. You often see people seeking intensity and seeking caste and what most people might perceive as peace they perceive as boring.

Dr. Powers: Yes. I think that people are going to go with what they think is acceptable. And if somebody is trying to control the things around them so that they are facing fewer things that make them upset, for example, that efforts to do so may not be effective.

That if I’m afraid of emotions and that fear is what’s motivating me to try to control my environment I’m not necessarily going to do it in a way that’s going to be successful for me or for my relationships.

Kate: That’s a really important thing to really pay attention to. What do you think it’s like or how would you describe what the loved ones of your patients experiences? They are learning to love this person who is in so much pain.

Dr. Powers: I would say I hear it described as burden and grief. You’ll hear, in terms of burden, there’s no room for my emotions because I’m constantly trying to help the other person with their feelings. That there can feel like a real imbalance in the relationship.

Lauren:  And do you have advice for people that have a loved one that suffer from this condition?

Dr. Powers: There’s a lot of information online if I can say. The National Educational Alliance on Borderline Personality Disorder has a lot of support for family members in general. And they talk about, understanding that progress is slow for somebody who has been engaging these behaviors for so long and behaviors that are so pervasive in every area of their life, that progress is slow. And there are setbacks and so remembering that.

The other thing I would say is, the same thing that I say to clinicians working with someone with Borderline Personality Disorder, which is, the best thing you can do is to stay calm. The other person is upset and if you match that you can make it worse.

Lauren: It becomes an escalation trap.

Dr. Powers:  Exactly. And so staying calm is really helpful. I also really encourage partners to get their own support for what they’re going through and for learning about this. This isn’t something you would necessarily go into and try to learn about entirely on your own.

Kate: I think that’s really key, whether you’re the person suffering from this condition or trying to support and love someone who suffers from this condition. It’s important to remember that you don’t need to do this in a vacuum and really it’s contra-indicated to try and muscle through this on your own. And the healing element is community and learning to build trust and showing up consistently for yourself and for each other and that can be best done within a community.

So we need to take a quick break but when we come back more on Borderline Personality Disorder the myths and realities with the Associate Clinical Director of Clearview Treatment Center, Dr. Sandra Powers.

Follow us on Instagram and Facebook @Triune Therapy Group and message us with your questions or call us at Triune Therapy Group at 3-1-0-9-3-3-6-0-8-8 for consultation and stay with us, we’ll be right back.

Welcome back you’re listening to Talk Radio 790KABC. If you just tuned in, you’re listening to Behind Closed Doors. I’m Dr. Kate Balestrieri.

Lauren: And I’m Lauren Dummit, Marriage and Family therapist.

Kate: And together we’re the co-founders of Triune Therapy Group, a psychotherapy practice in Los Angeles that focuses on treating trauma, addiction, sex and relationship issues.

Today’s episode of Behind Closed Doors is dedicated to dispelling the myths and discussing the realities of Borderline Personality Disorder. And we have with us here in the studio Dr. Sandra Powers, the Associate Clinical Director of Clearview Treatment Center. A really, remarkable program here in Los Angeles that specializes in using Dialectical Behavior therapy to treat borderline personality disorder.

So thank you for joining us again.

Dr. Powers: Yeah.

Lauren: Sandra I’m wondering if you could possibly tell us a little bit about DBT, or Dialectical behavioral therapy for people who don’t know what that is.

Dr. Powers: Absolutely. The Behavioral part is I think the part that we as clinicians think about. It’s about changing behaviors. It’s about learning how to stop engaging in problematic behaviors and finding new avenues. And in particular building towards a life worth loving. Having a life that is satisfying and fulfilling and that is worth continuing with effective behaviors to stay in in your life.

Because suicidality is such a big component here, that having a life worth living is so important to people with borderline personality disorder.

Kate: But one of the symptoms of Borderline Personality Disorder that I often come across in my treatment with people at Triune Therapy Group is a lot of catastrophic and black and white thinking. What I love about Dialectical Behavior Therapy the word dialectical really means the blending together of two opposites. Which is really important when we’re thinking about combatting the black and white thinking that comes with a borderline organization.

Because that kind of living in those polarities and living with those dichotomies is what can be really painful and what can create intensity and emptiness for people who are struggling with this condition. So living in the gray is what is ideal, living in the moment is what’s ideal. When we think about this treatment modality.

Lauren:  Dr. Powers I’m wondering if you could give us an example of what a dialectical is.

Dr. Powers: A dialectic is what you’re saying. Two opposite that we try to work with at the same time. And the classic in DBT is the dialectic the opposites of our reasonable rational side and our emotional side. So my emotional side says: “I really don’t want to get up that this early hour in the morning I want to hit the snooze.”

And my reasonable side says: “Think about all the things you have to get done today you really got to go out there.”

And I’m trying to find that grey area, what we call my wise mind. As the way of making decisions that are effective that have to do with my values and what really matters to me in my life and trying to bring that into all the different areas of my life. So somebody doesn’t say hi to me when they’re walking by, and my emotional side say: “Oh, how dare they.” Or: “They’re clearly so mad at me I must have done something to them.”

And how do I bring in this other side, for it to come to a wiser response so that I don’t act on them with just what my emotions are telling me.

Kate: I think that’s so key to point out. Because often times when someone has a borderline organization they often fluctuate between feelings, like things are all good or all bad. And there’s a lot of judgments that they place on themselves and other people. And so one of the other things that I love about DBT is the replacement of the words good and bad with effective and ineffective. And really helping people start to examine, am I living in my wise mind? Or am I living in my rational or emotional mind? And is that effective in what I’m trying to accomplish? Either as myself or in relationship with other people. And so I think it helps people really get out of that shame trap.

And the shame trap can perpetuate a lot of that black and white thinking of: “Oh my gosh! They must be so mad at me. Maybe I did something to really upset them the other day.”

When in fact, maybe the person walking by is just focused on all the things they have to do and they didn’t pay attention to what was going on.

Lauren: And we also talked about like lacking a core set of values. So I think in this work and helping them to be more effective and creating a life worth living. You’re also directing them to help kind of look at and examine what are the values that are important to them.

Dr. Powers: Absolutely. And putting aside what your parents values are, what society’s values are and figuring out what’s really important to you is so important to you and so needed in order to figure out what your life is going to like that is worth living.

Lauren: So we talked about the behavioral piece. Can you talk a little bit more about the other side of DBT?

Dr. Powers: Well DBT is based off of CBT cognitive behavioral therapy. So there is a component to changing our thinking process as well. And the other part that’s different from CBT is acceptance. Mindfulness and learning to accept situations as they are even when we really don’t like them because sometimes we can’t change them.

Lauren: And I think the term used with DBT quite frequently is radical acceptance. Can you talk a little bit about what that is?

Dr. Powers: Radical acceptance is when we give up the fight against reality itself. When we accept something that we really don’t want to, it’s so painful, we really wish it was different and it’s just not changing. And the radical part is that we’re doing this whole heartedly. Putting our full self into this with our body is trying to get into a place of acceptance internally and the way that we talk to ourselves. Letting go of the struggle was something that is the way it is at least in this moment.

Lauren: Where all of the behaviors being engaged in an order to be in denial.

Kate: Well, I radically accept the fact that I have not won the lottery yet. Not happy about it but case in point.

Lauren: Well, I think quite frequently we see people really being shocked by a behavior, for example, by their parents. That is the typical behavior of their parents and there’s a grieving process that might need to go on about like the fact that I will never have the parents that I deserved and that I want.

Dr. Powers: Absolutely. Grieving is a big part of radical acceptance. Because we’re letting go of the struggle with— people keep going back to the same relationships and hoping it’s going to be different.

Kate: And it’s really not. And that well is never full enough to drink from and that can be so painful because we are hard wired for connection. We say that on the show all the time, we are hard wired for connection. And it’s really key that we’re recognizing our very basic human needs for connection and love and relationships and at the same time learning how to get those needs met from sources that are actually going to be plentiful instead of going back to the same dry well.

Lauren: I’m wondering if maybe you can talk about it. Maybe like a pivotal point or a moment in working with someone that struggles with this, where they really made a lot of progress.

Dr. Powers: Sure. I mean we see people who are for example in and out of the hospital or in a place of loss of all relationships in their lives because they’ve come to such disastrous ends. And what we find is, if we can get one step forward in terms of finding that there are coping skills that are helpful, there’s sort of this ‘aha’ moment. Where it’s: “Wow something is actually working. Something can actually help me to improve or to feel better momentarily, to at least not make things worse like I have in the past.” That moment and to see it in someone’s face is why we do this work.

Lauren: And what are some of those coping skills that you’ve seen being successful?

Dr. Powers: I’ve seen a lot of different DBT skills. Be that for somebody, it can be mindfulness skills, it can be the acceptance, the radical acceptance you’re talking about. It can be interpersonal skills.

Like I’ve been trying and trying to get this person to do something different. it’s never work and yet suddenly I tried this DBT skill and it helped.

Kate: We also use a lot of the somatic skills. Having people hold on to an ice cube or put cold water on their face is a way to change their sematic response. And that can be a way to kind of bring together their emotional mind with a wise mind moment because it interrupts what’s happening in their nervous system just long enough for the rest of their consciousness to kind of jump on line and say: “Hey, wait a minute. I can actually survive this emotional wave.”

Lauren: Yeah. And I’m seeing a lot of people use the mindfulness practices to really create some space between feeling the impulse to react. Being able to slow down practice some mindfulness skills. And then choose how they want to respond which is huge for someone that is typically just been used to responding emotionally and reacting in a very impulsive way.

Kate: What are some of the biggest difficulties that people have in coming in for treatment or once they get into treatment, staying there?

Dr. Powers: Talked about earlier that the relationship is such an important component of their being in general. And that if somebody is sensitive to unveil invalidation in their relationship that that can really get in the way of the treatment itself.

Talked about how people may not be used to their being really set limits around them and if treatment involves those limits, it takes a lot of willingness to look at your own behaviors and work within that system.

Kate: So what would you say to someone who’s struggling with whether or not they need to get treatment?

Dr. Powers: I like what Lauren was saying earlier. Is this a problem in your life? Is this causing problems that are keeping you from moving forward? Is it really getting in the way? And if so, then therapy is an option for how to move forward. If you’re feeling stuck, if you’re feeling like things are getting worse or not getting better, it doesn’t hurt to talk to someone about it and find out if therapy can help.

Kate: Great. So how can people get ahold of you at Clearview if they want more information about DBT or the programs that you have available there so that they can get the help that they need?

Dr. Powers: Clearview has a set of different programs under one roof. And so we have a website where you can learn about the different programs that we offer. And we also have a phone number that I can give it is 8-6-6-3-8-1-3-5-7-4 for more information about our programs.

Kate: Wonderful. Thank you so much Dr. Powers for joining us and for being on the show today. We could not have been more excited to have you on as the Expert in this treatment arena.

And so for all of our listeners out there right now, feel free to call Clearview Treatment for more information about DPT or getting treatment for borderline personality disorder.

You can also call us at Triune Therapy Group for free twenty minute consultation at 3-1-0-9-3-3-4-0-8-8 to learn about the multitude of programs that we have at Triune to help begin your healing path.

So a big thank you today to Dr. Sandra Powers and Clearview Treatment Center for being part of this episode. And feel free to follow us on Instagram and Facebook. Send us your questions, message us with any topics you’d like heard and a big thank you to all of you, our listeners. We do this for you and we hope you have a great weekend.









Ask the experts

Often, when anger is the first response, it’s considered impolite, crazy, bitchy or dismissed as overly emotional. Yet, there are many instances in which one’s anger is stirred, and the key is putting it to good use. For instance, when a loved one is unfaithful, or when insensitive remarks are made concerning one’s ambitions or dreams, when feelings are questioned or when a woman is told to be more vulnerable and subservient. Though family and social expectations place unnecessary burdens on women (and men too), they can channel their anger-filled responses into action by going against the grain, pursuing their own interests or business, going to graduate school and much more. In turn, they’re encouraged to surround themselves with like-minded individuals, committed to supporting and cheering on one another, and ultimately helping the other discover their true potential. This system of support will continue to help individuals convert their anger into action, and perhaps enjoy a few laughs, too.

Yes. One hundred percent. Women are socialized to put relationships before themselves, and this often leads to stifling anger or any feeling that might compromise the bond between two people. This is especially the case in their relationships with men, or in competition for men, and over time, women’s anger and aggression has become more user wraps, or covert. Passive aggression seems to be both the only “acceptable” means of communicating anger, but women are also labeled “manipulative” when they attempt to express themselves indirectly. It becomes a vicious circle of anger, denial or minimization of anger, and then make ourselves smaller just to avoid being a “problem.”

While it is becoming more acceptable for women to show anger, progress is slow. Most of the time, female anger is couched in comedy or parody, and only accepted in small soundbites. Those invested in a patriarchal perspective, men and women, hold firm in their beliefs that women ought to act a certain way, or not make waves. The vary act of saying “we’re angry!” is a bold and pioneering move. Further, some women hold more internalized oppressive views, and refuse to participate in a movement that is labeled feminist or angry. For some women, to do so would compromise their social standing, romantic relationships, financial security, etc. It is scary, because the backlash is real. To take a stand is mark of bravery, and not everyone is ready to avail themselves to the fiery response of those in opposition. My opinion is that over time, the backlash will subside and change will take place. Cultural growth is a slow moving process, and with every voice heard, the collective voice of a paradigm shift grows louder and more effective. I don’t think women (or men) should care about acceptability. The more those who are angry attempt to hustle for the approval of their oppressors, the more power is given away. From my perspective, those who are angry a well suited to unite and establish new norms, refusing to tolerate mistreatment any further.

There are so many way to channel one’s anger constructively. I do not condone any violence (unless in self-defense) and instead think about using anger as a collaborating force within and with others. Being of service to others is one way to channel anger. This is especially relevant because so many women today do not have strong female role models, who they can turn to for advice. Get engaged. Mentor younger women, get a mentor, get creative. How can you pass along the resources (i.e., emotional, financial, logistic, etc) that were not available to you and resulted in your marginalization? What do you wish existed that could have helped you through a particularly challenging experience? Create it. I did, and it changed my relationship with anger and helped me take it for what it is a healthy emotion that lets us know when we feel disrespected or mistreated. This is key information that keeps us psychologically and rationally healthy. Anger is invaluable and an essential part of the human experience. When we embrace that, we can make it work for us in myriad ways.

As a psychologist, patients, friends and family are always asking me advice on their relationships and, let’s be real, everyone else’s relationships. One of the biggest questions they have, is why are there no good men or no good women out there? There are good people out there, I reassure them, but they inevitably come back with some retort about having to settle or face being single forever; for some, a fate worse than death. So herein lies the conundrum stay single forever or settle. Well, let’s back out of the black and white thinking that keeps us stuck for a moment and think about what it means to settle. Most of us have arbitrary ideas or checklists we drag around to assess our swiping situation. Does he make a certain amount of money? Is she pretty enough to take around my friends? Is she/he tall enough/too tall? Is she/he fit enough? What kind of car does he/she drive? Do they like dogs? All-important questions, but what do they really mean about a person’s character or how well you’ll get along? When considering the question of settling, it is important to ask what we:

  1. need in relationships
  2. want in relationships and
  3. won’t tolerate in relationships?

No two relational blue prints will look the same, and there are no right or wrong answers. Let’s look at needs first. We all have intimacy needs, like support, trust, security, communication, touch, respect, etc. They may change over time. That’s okay. Its hardwired in us. We also have relationship wants, the qualities that might ignite our fire a little more intensely. Physical appearance, fitness level, similar hobbies, values, job, financial standing, etc. are examples of wants. There is nothing wrong with wanting whatever you want in a partner. But many times, we mistake our wants for needs and then we feel like we’re settling if the want boxes are not checked, because we’re ignoring the meaning we assign to these traits. For example, consider meeting someone who is two inches shorter than your preferred height in a partner. He or she is funny, witty, charming, consistent, honest, and generous with their time, all of the other wants and needs you’ve identified. They just happen to be a little short-changed in the height department. What does height mean to you? Does it represent strength? Safety? Protection? Status? What does it mean about you if you date this person anyway? Whose judgment do you hear in your head? Why is their judgment so important? Asking these tough questions can help you decide if this is a want or a need, and if the underlying meaning is a need, can that need be met in other ways by this partner or other people in your circle? We often expect our partner to meet all of our needs, and overlook the inevitable disappointment in that expectation. Many people do not know what they need or want in relationships, because they are so eager to be in a relationship that they haven’t stopped to consider what they are looking for in their other half. They accept what is available, to avoid being alone. One day, they wake up and think, “Hey, I think I want more than this. I wish my partner would….” and realize that they might be settling but are afraid to leave. This brings me back to the last point, knowing what you won’t tolerate in relationships. It is just as important to know what doesn’t work for you when considering whether to start, stay in or leave a relationship. For some, deal breakers might include violence or infidelity. For others, perhaps smoking or liking heavy metal is the end of the line. Knowing yourself is key in defining your needs, wants, and deal breakers for relationships. If you don’t know some answers to these three factors, perhaps you’ve been neglectful (and settling!) in the most relationship of all, the relationship you have with yourself. Only when you set intentions and cultivate a relationship with yourself can you invite in the kind of love you are seeking and deserve to have. Until then, you’ll be running in circles, chasing ideas and looking to define yourself in the reflection of another.

Obsession, a thought that continually preoccupies or intrudes on a person’s mind, is often what drives addiction. Obsession is about hypervigilance. When we feel the object of our affection (whether real or in fantasy) may not feel the same way, we perseverate about them, ourselves and the relationship. This rumination and over-focus is an emotional survival strategy that keeps our brain playing out all of the what-ifs and looking for answers to the sometimes unconscious ques- tion, “How can I make sure my partner doesn’t leave me?” A milder version of obsession can look like ruminating thoughts. “What if he likes her more than me?” “Did she talk to her ex-boy- friend last night?” “If only I lost those last 10 pounds…” Perhaps you find yourself checking their social media accounts for proof they are with you, or have moved on. Maybe you enlist your friends or family to investigate or check on your desired. At the extremes, obsession can morph into stalking and domestic violence. If we feel threatened at the loss of someone, and re- taliate with this level of possession, it can be dangerous for everyone involved. Contrary to what may be glamorized in movies, extreme jealously and stalking are not healthy courtship behaviors, and can lead to emotional and physical trouble.

Obsession with another person may be a symptom of love addiction, which is essentially an ad- diction to the experience or “high” of being in love, and generally appears on the form of putting another person on a pedestal, creating the fantasy that they are perfect or the one, ignoring their faults or certain red flags that point to the contrary. Love addicts often expect their partners to care for all of their needs. Love addicts often neglect to care for or value themselves while they in the relationship. There often exists a toxic bond or an obsessive attachment in love addicted relationships. Love addicts often continue to engage in the relationship, trying desperately to connect as they search for their self-worth in the relationship, even if the object of their desire is pejorative, hurtful, or abusive. Inappropriate boundaries, abuse, neglect, intimacy issues, chaos, drama are some of the deleterious characteristics of these relationships. Love addicts suffer from profound feelings of shame, anguish, and fear of abandonment.

Since love addicts typically suffer from an anxious or preoccupied attachment (hypervigilance about their partner or the relationship), some signs to watch out for would be someone who is wanting speedy closeness, says “I love you before the first argument, has poor boundaries, is constantly expressing insecurities and worrying about rejection, is often very unhappy when not in a relationship, plays games to keep your attention, has difficulty with direct communication, struggles to effectively express their wants, needs, thoughts, and feelings, expecting you to guess or read his or her mind, acts out, tries to make you jealous, always makes things about him/her- self in the relationship, lets you set the tone of the relationship, seems preoccupied with the relationship, calls or texts excessively, stops by your home or work unexpectedly, fears that the small acts will ruin the relationship, seems to be trying too hard to keep your interest, and is extremely jealous.

If you suspect that the person you are getting to know has obsessive or love addicted tendencies, this does not mean you have to cut them out of your life completely. However, it is important to take things slowly, establish very clear boundaries, assess what works for you and get consulta- tion from friends and loved ones about your experience, pay attention to any attempts to get you to change or disregard your boundaries or needs, use direct, clear communication, and effectively verbalize your wants, needs, thoughts, and feelings. – Dr. Kate Balestrieri, Psy.D., CSAT-S, Licensed Clinical and Forensic Psychologist, and Lauren Dummit-Schock, LMFT, CSAT, CoFounder

The first step to getting help from this type of toxic relationship is to recognize narcissism in your partner or spouse. This involves identifying the traits and warning signs of this disorder, which you may have been living with for quite some time. At Triune Therapy Group, we have skilled clinicians who are highly trained to treat those that are in a relationship with a narcissist.

To help you understand the condition and how you may or may not have been affected, please explore the following Frequently Asked Questions and Answers provided by Licensed Psychologist Dr. Kate Balestrieri: Read More FAQs About Narcissistic Personality Disorder

Perhaps the greatest hope surrounding the #MeToo movement and other similar movements is that it will generate an awareness of the magnitude of sexual assault and harassment, particularly in the workplace. In doing so, maybe it will initiate and rebirth conversations regarding equality that have since gone underground. This is important, because many people fail to see the ways in which others misuse power and privilege, and how this leads them to engage in predatory behaviors. In another sense, the #MeToo movement could educate people on how to avoid being exploitative, while enlightening them on affirmative consent, power imbalances and how to classify and pursue intimacy and happiness in a authentic, healthy manner.

I work with new mothers and I have on multiple occasions worked with mothers who have experienced a the loss of a pregnancy close to becoming a mother. It is indeed a double whammy. There is so much that gets stirred up, and it intensifies the transition into motherhood and the processing of these loss, exacerbating common life-cycle events, and resulting in undue pressure on new moms, emotionally, physically, spiritually. When we’re trying to understand how motherhood and losses affect us, it is imperative to remember that the transition into motherhood and assimilation of loss are multi-dimensional and encompass physical, social, emotional, spiritual aspects of humanity. Although we mostly associate motherhood with new beginnings and joy, the questions of loss and death and endings actually also come up. Becoming mothers is a definite end to our earlier self, our pre-motherhood bodies and relationships, and mothers must mourn how the idealized fantasy of motherhood is never matched with the reality of the day to day. This is all considered “normal” to go through unless it gets complicated with trauma or major stressors. But if the transition to motherhood coincides with a loss, mothers get all of this thrown at them at the speed of light. It’s like existential pressure overload. – Helena Vissing, M.S., Psy.D. Clinical Associate, Psychological Assistant

The mental health of mothers is a major public health concern. Research demonstrates that depression and anxiety in mothers impact their children. The exact ways children are impacted by their mothers’ mental health involves a complex interplay of factors. We always have to look at the unique combination of risk factors and protective factors for each mother-child couple. If you grew up with a mother who suffered from postpartum depression, you are not necessarily determined to suffer. But we know that on a large public health scale, there is a clear connection between mothers’ mental health and lifelong mental health of their children. The immediate effects of mothers’ depression is that babies become withdrawn and irritable. This is happening at a sensitive time when babies are beginning their lifelong development of emotion regulation. Development is layered and scaffolding throughout life, so a baby who is experiencing these challenges already during their first years will be What we often experience in the consulting room is adults who struggle with feelings of shame and inadequacy or “never being enough”, even when they are normally functioning. They might describe a vague sense of unworthiness that has always “haunted” them. Although it’s widely acknowledged now that our sense of ourselves is rooted in our earliest relationships, it is still overlooked how issues in this area can stem from the emotional pain the child of a depressed mother experienced. This pain does not just disappear as the child grows or if the mother’s mental health improves, as it has influences the very core of the child’s sense of self. Infants and children are developmentally unable to make sense of the intensity of their mother’s depression, but they still feel it. This is because our earliest sense of self is built from our early nonverbal and physical experiences of being cared for. The only way and infant can interpret the signals from a depressed mother is to internalize it, which manifest as a sense of never being enough. Even when the child grows up to be an adult who can rationally separate their mother’s emotions from their own self-worth, the early experiences can still linger and manifest as issues with unworthiness. For each person, it’s a unique story of with all the risk factors and the negative impact on one hand, and then all the mitigating factors and strengths on the other hand. The adult who describes feeling shame and unworthiness might struggle to pinpoint the root of their issues, especially if their mother’s emotional issues were hidden, denied in the family, or minimized. The mother’s emotional state during the crucial early years is often that missing piece to help an adult fully understand their development and life story. Often they are not in a position to communicate about sensitive material with their mothers. This is why it’s crucial that maternal mental health is addressed clearly at all levels of society. The taboo still surrounding motherhood and postpartum emotional issue has devasting consequences for the entire family. I know this is a lot. Feel free to use what makes sense, and let me know if I should clarify things? I tried to use language for laypeople. – Helena Vissing, M.S., Psy.D.