Creative Recovery VII - Conclusion

Something I have always felt, is that creativity can be a tool in recovery and healing.

"Scientific studies tell us that art heals by changing a person's physiology and attitude.  The body's physiology changes from one of stress to one of deep relaxation, from one of fear to one of creativity and inspiration.  Making art frees the body's healing mechanisms and unites body, mind and spirit.  In art and healing, no interpretation or therapy is necessary.  The creative process is the healer."           
                                                               Michael Samuels  Creative Healing


Mihaly Csikszentmihalyi and his concept of "flow" was perhaps one of the first researchers to identify and qualify this function of creativity:

1. intense and focused concentration on the present moment
2. merging of action and awareness
3. a loss of reflective self consciousness
4. a sense of personal control or agency over the situation or activity
5. a distortion of temporal experience, one's subjective experience of time is altered
6. experience of the activity as intrinsically rewarding, also referred to as autotelic experience

At the same time, the authors of Creative Recovery, Maisel and Raeburn, point out the potential pitfalls and vulnerabilities creative people have, when it comes to addiction and mental illness.  This is something I hadn't considered before, although there exists a significant history or mythology in our culture correlating creativity with mental illness and addiction.

Their book, while covering many of the "basics" and new research regarding addiction, also present the additional challenges creative people may encounter and suggestions of how to cope.

The authors remind us:

The fact "...that you are in active recovery doesn't mean that you won't experience depression, anxiety, emotional ups and downs, relationship difficulties, and the reappearance with a vengeance of shadowy parts of your personality."

They recommend, "A softening to the limits of being human; a toughening in the direction of personal responsibility."  And give us some tools to do so.

~~~

If there is one thing I'm beginning to "get" on my BPD Journey, it is that much of what I experience is simply the human condition.  Amplified and magnified, perhaps, by my illness--but still, essentially, what it is to be human.

Something I haven't learned how to do well.  I'm lacking a core identity.  I haven't learned how to have healthy boundaries or to give things their proper weight.  I've lacked perspective, or the ability to see alternative explanations.  I've held myself and the world to impossible standards of perfection...the list could go on.

But something I know, as I continue in therapy, research and understanding, is that I can learn new ways of coping and new ways of being.  I can become more aware.  There is hope and possibility.

During overcast days, I keep reminding myself, the sun is still there, even though I can't see it.

Creative Recovery VI - Tools for Change: Awareness & Mindfulness

In the Work of Change (27 December post) suggestions 1 - 10 are basically about becoming aware and mindful in our lives.  We can't change what we don't acknowledge.

For me, learning to listen to myself and my emotions, rather than stuffing them or running away from them, has been a huge step.  Researching and recording things I notice about myself, my interactions and responses; attending workshops and programs designed to help with mental illness; reading; trying different coping tools from aromatherapy to meditation to exercise--all these things help with managing the changes I need to make and re-programming myself.

Practice awareness:

1) Pay attention to your thoughts and learn how to manage them.

2) Notice your anxiety.  How and when it surfaces.  Learn techniques to manage it.

3) Creating meaning in our lives is critical for everyone, especially creative people.  Pay attention to how you create meaning in your life, and try to work more of that into your day-to-day activities.  Be aware there will be times of "meaning crises"--when it is difficult to see or understand the meaning of what is happening.  Learn how to overcome or live through those moments of meaninglessness and re-inject your life with purpose--however small.

4) Pay attention to your emotions and honour them.  Sometimes all you can do is "sit through" the feelings.  They will eventually pass, like a cloud passing over the sun.

5) Practice risk assessment and management.  Be aware of when you know you will be stressed or anxious and have some strategies in place to cope.

6) Take charge of your attitude.  Know that you control how you think or interpret/frame things.  Chose how you want to be, how you would like to feel, then work towards that.

Mindfulness Practice:

We hear this recommended over and over again as a tool for managing so many human diseases; but how many of us actually practice mindfulness on a daily basis?

Even when I know meditation helps me--sometimes I forget to practice it until I'm almost jumping out of my skin.  Vibrating internally.

Or, I go through periods of time when I practice daily...then my practice drops off again, until I realize I'm in some sort of panic.

One of the things I like about practicing mindfulness, is that there are so many ways of practicing.  Meditation comes in so many forms, there are walking meditations, listening meditations, guided meditations.

Meditations where you empty your mind.  Meditations where you focus on one thing (a chant, or a candle flame, or a flower).  Meditations for all different periods of time--from the duration of a few deep breaths to an hour or more.

Mindfulness can come in eating slowly and enjoying something deeply with gratitude.  Looking at a beautiful work of art.  Even working on a craft intently.

There are so many ways in which we can create mindfulness in our daily lives.  As creative people we can find/create ways to "connect" to that source of peace and gratitude in ways that will keep us engaged and grounded.

Creative Recovery V - Tools for Change: Support Groups

In coming posts, I'd like to explore some of the tools the authors of Creative Recovery suggest in their book, starting with the last suggestion on their list: Create a support network.

Use Support Groups

I completely understand anyone who is reluctant to attend a support group.  I tried several over the years, and always felt they weren't for me, for many reasons.

All I can say, is: don't give up.  You will eventually find a group that suits you.  And having that safe, support network will enhance your ability to cope with life.

Here's what I have found worked for me in finding a group:

- The facilitator is professionally trained with many years of working with dual diagnosis clients.  Her expertise helps a lot in not letting things get out of hand, or unhealthy comments go unchallenged.  Additionally, her positive comments and encouragement, the ability to re-frame experiences, creates a truly therapeutic setting and experience.

- As it turns out, although we come from all walks of life, most people in my group are middle-aged, diagnosed late in life.  We've had common life experiences of careers, family, etc.  We face very similar challenges, even though we have different psychiatric diagnoses.

- There is an incredible wealth of knowledge and intelligence sitting at the table.  I've tapped into all sorts of resources--practical, therapeutic, philosophical--through this group.

While I'm on this topic, I'll tell you what didn't work for me:

- Groups that are too large, where two or three people take over the group with their crises nearly every session. (About 6 to 9 people max, is a good size for me. Larger groups of 16 to 20 people have been useless to me.)

- Groups that don't have good professional facilitators, where people get away with saying disruptive, unhealthy things (which are often better left for one-on-one therapy) haven't worked.

- Groups having no homogeneous factor, other than the illness.

- Groups in inhospitable environments that effect my allergies or sensory defensive disorder (e.g. places with bright lights that can't be dimmed).

- Groups that reminded me of the Church I grew up in and have left.  While I understand these Christian-like groups may work for many people; they are  anathematic for me.
                                                  ~~~

Being a private person myself, it was hard for me to talk about my struggles and even my successes, in a group setting.  However, building trust over time and the bravery of others in my group, have helped me realize that I'm not so alone; that many of my experiences, which made me feel so different and alienated, are in fact, commonly experienced by people like me.

Knowing that I'm not the only one "out there" who feels this way and has these struggles has helped me so much.  It is important as humans to feel connected, and the group I attend helps: not only with sharing our feelings and challenges; but also by hearing about techniques of coping and managing life situations, emotions, etc.  We often brainstorm solutions together.

If you can find a good support group, it can become a valuable lifeline in recovery.
                                                                          ~~~
Rule of thumb advice: I think it is wise not to date or befriend anyone in your group or bring them to your home until you've been attending for at least a year.  And perhaps not even then.  One must find a balance between your therapeutic world and your personal world.

There is a tendency to want to embrace others with similar life issues; but this can turn into "the blind leading the blind".  You can bring each other down, as much as support each other.  So proceed with caution.

Creative Recovery IV - The Work of Change

There are many models of change; but suffice it to say, that it involves the realization a change is needed/or has been imposed; preparation to make the change; action--you make the change; and then maintenance--whether that becomes surviving or thriving.

Most of us don't go through this process successfully, in a linear progression without any bumps; but may cycle back through various stages until we are able to re-imagine our lives and find a way to make the change work for us or integrate it into our lives.

Whether the change is due to addiction or even life events like losing one's job or life partner, there are still stages to traverse/process/absorb and build on.

I talked about the need to become "Change Masters" in an earlier part of this blog where I addressed resilience and adaptation.

What I like about these models is that they give us a way to think about things and respond to life's challenges.  Having an intellectual approach to processing change, helps one feel more effective; having a sense of control in one's life, is a necessary component of happiness as noted in The Psychology of Happiness section of this blog.

As has often been said: "It's not what happens to us; it's what we do, with what happens to us."  Preparing for and responding to change is part of our work as humans.

Here are some of the tools Maisel and Raeburn suggest for navigating change:

1) Raise your consciousness
2) Engage your feelings
3) Self-evaluation
4) Examine consequences
5) Recognise the impact of cultural conventions, myths and institutions
6) Take responsibility for thoughts and actions
7) Learn different responses and associations
8) Avoid triggers
9) Employ new habits and behaviours
10) Establish a healthy system of rewards
11) Create a support network

I'll discuss some of these tools in coming posts.

Creative Recovery III - Creating Meaning

I believe all humans have the need to create meaning in their lives.  But perhaps for the creative person this need is an imperative.

This leads to regular "meaning crises"; because no matter what you do, even if you are successful, you are only as good as your last book, movie, hit song, scientific discovery, etc..

Once one project is finished; what will the next project be? Where do I invest myself?  Why do I invest myself? Not every day is our creative work going to be fulfilling. There are going to be frustrations, road blocks. You will be thwarted in your expression.

Without genuinely meaningful activities to pursue, our aliveness turns to listlessness. We are also stymied with not knowing what meaning to make sometimes. Discouragement and depression sets in.

How we create meaning in our lives is, of course, unique to each of us.  What will be meaningful to you, may not be meaningful to me.

Tom Wujec, in his book Five Star Mind, suggests that creativity is composed of three aspects: novelty, value and passion.

For me, these three aspects also ascribe meaning to my life.  I am curious and constantly seek new ideas, knowledge.  I enjoy seeing things in a new way. That's why I enjoy looking at art.  Value.  I do think a lot of what gives us meaning in our lives are the things we value, or perceive as having value.  And finally, passion.  As someone in my life once said, "Without passion, we are as worms."

We all know what passion feels like in our work, in relationships--and we seek that feeling often in our lives.  It is being vitally involved with something or someone.  And when we can't find that or achieve it, some of us turn to substances to help fill the void.

Something I like about what Maisel and Raeburn have to say:  They warn the reader about the reality that on some days, we may not be able to find or ascribe meaning.  I'm certain we've all felt the sensation of meaning "leaking" out of a project or a relationship.  Meaning comes and goes.

Becoming aware of this and learning how to handle it is key.  Is it time to let a project or a relationship go?  Is there a way to inject new meaning?  Or revive the meaning once attached?  Is it time to give it a rest and come back to it later?

So often, when I've felt the meaning drain out of something, I've given up.  Discarded something or someone who once made me feel vital.  Felt discouraged and deeply depressed.

I didn't realize that this is the rhythm of life.  That I shouldn't give up.  That I'm not always going to feel passion every second of every day.  That meaning ebbs and flows.  That even the human body, mind, spirit, needs those times of rest from constant and continuous application.

It is learning how to stay steady, even keel, during those times that are flat, without meaning, knowing that it won't always be this way.  That meaning can and will return.  That, in fact, my creative spirit will find a way to achieve meaning, as that is what I most desire.  That is why I live.

Creative Recovery II - Risks: Biological/Environmental

The Risks of Creativity

"And then the day came when the risk to remain tight in a bud was more painful than the risk it took to blossom"                                         Anais Nin


We are all aware of the biological and developmental/environmental aspects for any mental illness, as well as addiction.

The new light Maisle and Raeburn shed on these risk factors for me, is that creative individuals, due to their individualism, may be at greater risk due to the feeling of alienation and a sense of "swimming against the current".


"These are not people who just see that the emperor has no clothes; they offer their own brand of attire for him to wear. The feel obliged to speak out, do what they believe is right, and pursue their own goals, even when they may be punished for doing so."
                                                                       Arnold Ludwig The Price of Greatness


Creative people have a compulsion to create.  We are often anxious at any point in the process of creating; and if we are somehow stymied in creating, become very depressed.

"A person with vitality, passion, and energy--a person who is really alive--possesses roiling thoughts, big ideas and insistent desires. These inevitably lead to obsessions and compulsions."

These obsessions and compulsions can be constructive, or destructive, depending on how they are channeled.

There is also the well established historical link between creative people and substance abuse.  Including the fact, that creative people are often performing in environments such as bars and clubs, or environments where alcohol is regularly served, such as vernissages at art galleries.

We have an entire culture or mythology linking creativity with exploring alternate realities accessed via substances.

But to live and create authentically, we need to face life and our emotions, without our "crutches".

Creative Recovery I - Introduction

Creative Recovery by Eric Maisel and Susan Raeburn, seeks to engage creative people from all walks of life, both scientific and artistic.

Much in this book speaks to me and I wish something like this was available to read earlier in my life.  I'd like to see this book required reading in secondary school Humanities or Social Studies courses, as it would serve to forewarn and alert young people to what may be going on in their lives or in the lives of others close to them, while they are still in the early stages of potential risk or substance abuse.

Creative Recovery is an excellent source of information and awarenesses.  I like it, because it provides an intellectual step-by-step approach in how to think about and assess addiction; as well as exercises designed to tap into the creative spirit, moving one away from the self-harm of substance abuse.

As with many recovery self-healing books, Creative Recovery advocates keeping a journal as one works through the exercises.  At the end of each chapter, there are a series of activities from which one can choose, depending on your creative "bent".

Maisel and Raeburn cover many of the well-established ideas regarding addiction, as well as some of the latest research and thinking about recovery.  The new elements they add to the mix are the special challenges creative people may face regarding addiction. 

Many of the "basics" of addiction and recovery are so well-covered in other books and in treatment programs many of us have attended, I don't want to re-address those topics here.

However, I do find some of the manifestations and symptoms of BPD concurrent with those of addiction.  Additionally, the authors highlight for me, some of the compulsions and rewards of creative endeavours.  In other words, creativity is a two-edged sword: there are some elements which have the potential to destroy us; and some elements which can heal us.

                                                                         to be continued...

Creativity - Road map

I have a stack of books about creativity on my desk.  Books with titles like, The Creative Cure and Creative Recovery.

These sound like books which might have the answers or approaches I'm looking for.

Over the next few weeks, I will be reading through these books to see if I can find ideas and techniques that speak to me; and hopefully, will be helpful for  us all, in coping with life.

In coming posts, I plan to tackle these books one at a time, review them and summarize what I find.

Creativity - Introduction

I've always thought of creativity as a "spark of the Divine" in all of us.  I believe we all have creativity in us, and that, in fact, we need to express ourselves and our unique take on the world in order to embrace happiness; in order to be healthy.

Creativity has such a broader spectrum than the world of fine arts and entertainment.  It's how we put ourselves together: our style.  How we decorate our homes, make a meal, or a garden.  How we build things.  How we solve problems.  The impulse to create is in every aspect of our being.

Looking at early archeology, it appears that each person in a tribe had their own style or variation in decoration, their "mark".  Everyone personalized their dwellings, their clothing, their daily utensils--even their bodies, with tattoos.

When we began to organize ourselves along the lines of "division of labour" much of that individual expression got lost, and handed over to those "who could do it best". (Or, more quickly, more functionally, at a lower cost, etc.)

So much so, that during my lifetime, at least, very few of us felt we were "talented"; or felt confident enough to express the creative impulse. During times of hardship, the arts are cut back and seen as frivolous.  When, in fact, studies show that times of economic severity is when we most need new ideas and approaches.  That the brain needs to play and rest, as much as it needs to work.
                                                      ~~~   

For those of us with mental illness, I wonder if creative acts could play a role in healing. Integrating.  Helping us be less broken; more whole.  Feel more fulfilled.

As someone with BPD, perhaps some form of creative activity will help me form/define my identity?  That illusive core self that I don't seem to have, or that I seem unable to enclose in a permeable boundary necessary for healthy relationships.

Will creative activity help me integrate my sensory inputs?  Help me give things different weights and meanings, so that I don't get so overwhelmed?

What is the therapeutic value of creative expression, and can it help with BPD?

Mentalization Therapy Conclusion, cont.

As I have mentioned before, Bateman and Fonagy's research and treatment come the closest to anything I've read that explains BPD, and provides two essential elements to work on as therapy goals:

1) Transference used to create attachment and validation lacking in the BPD person's formation.

2) Teaching and encouraging alternative perspectives/interpretations of events.

However, I feel their approach is just the beginning in treating a person with BPD.  An important element I feel is missing is identity formation.

Their focus appears to be treating two of the underlying conditions present in BPD vis a vis relationships.

If the BPD person can learn to trust one person (the therapist) and be heard, validated; then, perhaps, that trust can be extended to others

If the BPD person can learn to have alternative perspectives and ways of interpreting their world, it may help with misreading human interactions and responding negatively.  Thereby improving relationships.

At the same time, without being able to form a solid core of self (rather than the alien self described in my last posting) how can we with BPD avoid the relationship patterns shown in the graphic diagrams earlier in this segment of the blog?

Is it thought that if we get better at trusting and not jumping to conclusions along the lines of old rigid thought patterns, we will do better in our relationships, and thereby develop a healthy core identity?  I don't know, and wish I could ask the researchers.

For myself, I've always felt like a chameleon.  That I could take on and fit into anyone's life, and often did.  Living my life through others, trying to control things.  Whether that was through over-involvement or detachment.

I've felt like a "site where things happen".  Usually bad things.  Like a catalyst.  I enter a situation and with my crazy energy things start to happen.  Sometimes good things.  But often bad--and that is when I would leave.

Bateman and Fonagy suggest that due to lack of emotional regulation, people with BPD also have problems with attention control.

I can see this in myself.  When things don't "pan out" or something "goes wrong" I'm on to something else.  I don't stay at any one thing for very long.  I discard people and situations like toilet tissue.  I flush them away and start over.

In the end, while I think this therapeutic research team are definitely on to something that will help; they leave me with as many questions as answers.

I believe their ideas constitute a good beginning.  But it seems to me the next steps on the BPD treatment road map are missing.

Mentalization Therapy Conclusion

In concluding this segment on mentalization therapy, I want to quote something from Bateman and Fonagy that describes fairly accurately the experience of someone suffering with BPD:

"If someone was causing you pain or simply tormenting you, perhaps not everyday for the whole day, parts of a day, or for days and weeks on end; You could, if you were brave or desperate enough, defend yourself, by perhaps attacking (and eliminating) your persecutor.

But what if this thing you hate, was inhabiting your head? You can’t exactly say please leave my body, you can’t do anything to get it to just pack up and leave because technically, physically that isn’t possible.

You can say fuck you. I hate you. You can self-harm with the hugest force your body can withstand, with all you can muster.

You can do that. You can be very very angry and show them who’s boss, you won’t stand for it, you won’t take it lying down. You want to be heard, you want to say right, you think you can hurt me? I’ll show you, I’ll show you how much I can hurt you!

But you and this thing, you are inhabiting one body. You attack this thing; you attack yourself. You don’t have a choice though. That’s a sacrifice you make over and over.

Eventually, you realise the only way to get rid of this thing, once and for all is getting rid of yourself. What choice do you really have?

No doctor can specify the problem. No medication can fix the problem that can’t be specified. You fail to understand yourself. You can’t explain to your family and docs, they can’t help you because you do not talk.

You doubt yourself : Do I even have a problem?  People in real life often treat you like you don’t have a real problem. They talk to you stupidly, you complain that they don’t understand, you look a fool.

Perhaps that is why you don’t talk to them anymore. Maybe you don’t have a problem anyway. You are a child, quite possibly you are just making this up for some attention, finding an excuse for why you can’t stay in college or get a job. Maybe you don’t have an excuse, you are just a stubborn little child.

From what everyone tells you perhaps that is true. You have doubt. You are willing to listen to someone else.

For now that is the only reason why you are not, at this moment, trying to do it. [kill oneself]."

                                                                  ~~~

I imagine a patient of theirs wrote the above, or perhaps it is a composite of what their patients have told them.  In any case, with a few slight variations, this is how I've felt all my life.

Except in my case, I often intellectualized and externalized the problem.  Even though I knew there was something wrong inside me, I often blamed things and people in my environment.  And my response was to leave, to run.

I would tear up/cut up the fabric of the life I had created and watch it bleed out.  I would start over again, some place new.

I destroyed myself and my life, over and over again.

To be continued...

Components of MBT - Alternative Perspectives

Generating Alternative Perspectives

The second component of MBT therapy is encouraging the person with BPD to generate alternative explanations for the behaviours of others.

Part of the problem with BPD is rigid thought patterns causing incorrect interpretation of events.  Faulty assumptions are made.  There may be a "one size fits all" interpretation of the motivations and intentions of others--usually negative.

From my own experience, I would suggest that if something negative has happened in the past, that experience gets generalized to anything that "looks like" that old experience.  Then, evidence and "facts" begin to be gathered to support that old negative view.  Without recourse to any objectivity or possibility of exploring alternative explanations.

For example: "She didn't say hello to me in the hall this morning.  She must hate me, reject me.  Just like all the others, she doesn't think I'm good enough/she thinks she's too good/I'm a bad person."...etc. etc.  Due to the experience of rejection as an infant, the person with BPD tends to see rejection everywhere, even when it doesn't exist.

In MBT, the person is encouraged to think of other possible explanations of why the person didn't say hello.  It is an effort to try to "hold the mind of the other, in one's own mind." 

For example, the person may not have said hello because they were preoccupied with something else: they may have lost their keys that morning; their dog may have died; they may have a big meeting coming up.  There are many reasons why someone may have neglected to say hello, other than hating or rejecting the person with BPD.

Additionally, why should whether someone says hello or not have such a huge profound impact on the person with BPD?  I think it is because someone like me looks for validation everywhere and in every little thing.  I want to "attach" so I look for attachment everywhere...much as a child might.  The emotional need is primitive and primary.  There is no "skin", no boundary between myself and others.

Reflections on Alternative Perspectives

This has been an important part of every therapy I've been involved in since being diagnosed, and it is helpful.

I've begun to realize that my emotional needs and demands on others, my expectations, are far too high.  There are probably, more like that of an infant than an adult.

I have approached every situation, looking for a place to belong.  To attach.  Seeking the unconditional love that one hopes to receive from one's parents.  I have "tested" people with unrealistic demands; inappropriate behaviour.

I have made incorrect assumptions and acted on them.  No matter how I attempt to intellectualize or justify my take on things, I'm beginning to see the underlying pattern of a child trying get what I didn't get and need; whilst lacking the trust or belief that will ever happen.

It is a maladaptive cycle of relating to others which can only end in failure.  I have the needs of a child in an adult body, in an adult world.  Defeat is inevitable and repetitive.

Generating alternative perspectives has been very important in challenging limited negative patterns of interpretation and the feeling that I am "right".

At the same time, it knocks off kilter, what little structure I had created in my life, in my mind.  My explanation of the way the world is.

However, part of treating this illness is to deconstruct that self and my maladaptive way  of relating.  To try to see my world from different points of view.

It is hard work; and I'm grateful for the trained professionals in my life who help me see the world differently.  Who provide a safe environment for me to expose my internal "chat"; my negative mind frame.  People who validate my pain; while also suggesting other ways to interpret events and cope from my adult mind, rather than the neediness and constant angry demands of an unnurtured child.

It is very hard to give one's self what one didn't have as a child.  I believe it is only through therapy I can begin to develop the affirmation, trust, nurturing I didn't receive and haven't been able to give myself.

Components of MBT - Attachment & Transference

Secure Attachment through Transference

Transference is a well-known dynamic in therapeutic situations where the patient transfers feelings (largely unconscious) from past interactions or experiences onto the therapist.

In Mentalization Therapy, this transference is utilized as a tool to build a relationship of trust with the person having BPD, so as to provide that "secure attachment" missing in the person's childhood development.

The therapist creates a positive open nonjudging environment permitting the patient with BPD to develop trust and a safe attachment.

This is an important first step in the treatment of BPD.

Reflections on Secure Attachment through Therapy

I can very much relate to the need I have had for the development of secure attachment in a therapeutic environment.  So often, I have wished I had someone with whom I could speak on a regular basis, regarding what was going on inside me.  Someone trained to help me process these feelings and experiences.

However, so often in my experience, when I have gone for help; I felt the therapist didn't truly understand what was going on with me.  Or, I didn't feel comfortable enough to be honest about my internal dialogue.  The therapist tended to look for immediate, episodic reasons for my "take on life".

Add to this, the tendency of nearly every therapeutic situation I have been in, to limit the number of sessions I was allowed (by policy)...my devastation and sense of abandonment when therapy ended is completely understandable.

The one secure place I had tried to develop, to be honest and reveal myself was no more, and I was no further ahead in terms of treatment.  I have so often walked away feeling I was given a band aid to treat a gaping wound. That I was alone and no one would ever understand me.  Hopeless.

I am so incredibly grateful that the one-on-one therapist I am currently seeing has somehow overcome this limitation in the number of sessions we can have and the continuity of treatment.  She also is willing to explore my background experiences and history, and doesn't see what is currently happening in my life as episodic; but rather, as a life long pattern of behaviour and response which we can examine: In terms of real causes that have impacted and formed me.  In terms of possible ways of rethinking and reprocessing what happened to me with my "adult" mind.

I believe it is only through the possibility of long-term, on going therapy, will I begin to develop the ability to "see" myself and what I am doing clearly enough to change it.  In a secure attachment therapeutic environment.

If I can develop trust with my therapist, perhaps that can extend, eventually, to others.

Having the very clear relationship graphic visuals provided by Bateman and Fogany (which I have reproduced in this blog) help me see how I have been operating in the world and why that doesn't work.  I clearly understand now, why I haven't been able to connect or succeed at life, and the origin of the horrible incapacitating feelings from which I have suffered.

What is Mentalization Based Therapy (MBT)?

What then, are the components of MBT used to treat someone with BPD?  What indeed is meant by the word "mentalization"?

Mentalization

Mentalization is a term coming from research and discussion regarding Theory of the Mind.  The word itself means the ability to understand the mental state of oneself and others, underlying our behaviours.  It is recognizing "my mind" in the mind of others and that there are differences between the two.

Mentalization is imaginative mental activity allowing individuals to perceive and interpret human behaviour; in terms of intentional mental states such as needs, desires, feelings, beliefs, goals, purposes or reasons.

Individuals without secure attachment have greater difficulties in mentalization and therefore, in social/relationship interactions.

In some cases the disconnect is so strong or the mentalization so inaccurate, such people cannot hold down jobs, complete their educations, or form relationships of any duration.  Consequently, their lives become very unstable.

This results in a huge sense of failure, disconnection, alienation, emptiness and depression, all of which lead to self-destructive behaviours.

The Components of MBT

So what then, can be done to treat this inability to "mentalize" prevalent in those of us with BPD?

Bateman and Fonagy suggest the following:

1) Creation of the secure attachment undeveloped in childhood, through therapy transference.

2) Encouraging the ability to generate multiple perspectives regarding any situation, freeing the person from getting stuck in the "reality" of one's own view; the rigidity of one thought pattern, assumption, or explanation.

I will explore these two prongs of Mentalization Therapy in my next posts.

Reflection on the Causes of BPD

Secure Attachment Disruption

In anything I've read about BPD thus far, the cause put forward by Bateman and Fonagy (that of a lack of secure attachment) rings true to me.

I can see any number of circumstances contributing to a disruption in the circuit of secure attachment. i.e. It may not necessarily be due to intentional neglect on the part of the parent. 

For example, a more demanding child born into the family while the child is still an infant. A disruption in the household configuration, such as a breakdown in the parents' relationship.  A preoccupation on the part of the parent due to external factors such as their job; or, a loss of income or a change in housing.

Internal factors such as the state of mind of the care-taker in the first two years of childhood: things such as various forms of mental illness, depression, post-partum depression.  Even emulating poor parenting models of the preceding generation, where parents were cautioned against spoiling their children with too much attention, could result in "benign neglect".

In everything I've read previously, the research mentioned that BPD can occur equally in children with traumatic childhoods and those with "normal" childhoods.  However, if one looks closely, even at "good" families, there may have been some event or occurrence during the infancy of the person with BPD that interfered with the child's development of secure attachment and triggered the disorder.

Care in becoming a parent

Something that is close to my heart, and I wouldn't be true to myself if I didn't mention it:

Take care in choosing to become a parent.  I think those of us with mental illness need to be especially careful.  We need to consider the genetic inheritance we bring to offspring; the patterns of behaviour we may be passing on.  Our inability, due to illness, to consistently "be there" for our children.

For anyone, the stability of one's life; the material resources and parenting skills one brings to the table, are important to the welfare of children born.

If we don't consider that we have a choice in becoming a parent, or not; we may continue the cycle from which we have so suffered, ourselves.  And speaking for myself, I would never want anyone else to go through what I have gone through, living with this inability to cope with the world around me.

MBT - Causes of BPD

Causes - Secure Attachment

While recognizing a genetic component to BPD, according to Bateman and Fonagy, BPD is a kind of "mind blindness" caused by lack of secure attachment.

Lack of secure attachment occurs when an infant's primary caregiver doesn't spend enough time or there is a paucity of interaction between the child and the person looking after them.  There is not enough "face time" between the child and the mother, for example, for the child to learn how to read emotional expressions.

The child isn't able to find herself as an intentional being and may internalize the other (primary caregiver) into the self.  There is a lack of basic trust, sometimes due to the unpredictability of response from a parent.  The BPD person experiences the world as hostile and persecuting.

Outcomes

The child without secure attachment develops an "alien" self.  There is a deficit in reading facial expressions; an inability to perceive the mental states of others accurately.

The attachment system of someone with BPD is triggered too readily.  Identity formation is damaged.  There appears to be an inhibition of the prefrontal cortex, the area of the brain responsible for executive functioning/decision-making.  This results in lack of emotional regulation, impulsivity, risk-taking.

There is a lack of boundaries between self and others, and a consequent instability of relationships; or, the inability to form meaningful or lasting relationships.  There is a tendency to become overwhelmed or over stimulated.

People with BPD tend to make faulty or incorrect assumptions regarding the thoughts and intentions of others leading to behaviours and communications which are inappropriate, or inaccurate, given the situation.

Because we with this disorder have difficulty in accepting the "good and the bad" in others (exemplified in the tendency to idealize or demonize); we also cannot accept the bad in ourselves and suffer from self-depreciating internal chants.  Feeling at times, very "bad"; unworthy to live or that we need to punish ourselves.

At the same time, at the other end of the scale, we have the conviction of being "right".  There is often grandiosity and idealization present.  Our thoughts and thought patterns are rigid and often negative; with an intolerance of alternative perspectives.

In truth, we are decoupled from actual external reality, and feel emptiness, meaninglessness, disassociation=extreme intense unbearable pain.

MBT - Relationships, cont.

Normal Relationships

Before leaving the diagrams and observation of BPD relationship modalities, I think it would be constructive to see a similar diagram of how "normal" humans conduct their relationships.

 Source: MBT Training Workshop, Bateman & Fonagy, 2009

In this diagram we see how humans without BPD, construct and live their lives.

Different emotional weights, distinction of self and others; and the ability to reasonably negotiate the various divides.

What happens in BPD, is that there is no distinction.  Others are either: Nothing that I am.  Or... All that I am.

In both scenarios, "I am the centre of the Universe" apply.

In the detached mode, I am the centre of the Universe, stay away.  I control this pain.  Which, while effective in controlling the possibility of interactions which could result in rejection, leaves one disconnected, alone and empty.

In the emotionally enmeshed mode, everything and everyone is me.  Which is an overwhelming, exhausting way to live.  For me, it resulted in numerous breakdowns and emotional pain.  The inability to complete things or last at almost anything I took on.

I can see why some researchers and therapists see narcissism and BPD as related.  In both disorders, there is an imbalance or distortion between self and others.

Mentalization Based Therapy - Relationships

Continuing from the previous post regarding BPD modes of relationship functioning.

Emotionally Enmeshed Mode

In this mode of BPD relationships, there is no division between self and others.  Everyone/everything has the same weight, meaning and intense involvement in the mind of the person and their life.

                                                       Source: MBT Training Workshop, Bateman & Fonagy, 2009

A person having this form of relationship structure will find themselves over involved in all of their relationships and the details of every context, as an extension of self.  It is an "I am the centre of the Universe" way of being.

As every interaction is exceptionally intense and involved, having the same emotional/affective meaning, it is a volatile and exhausting way to live.  Emotional regulation is nearly impossible.  Life is overwhelming.

There are no boundaries between self and others.  Expectations of others are unreasonably high.  Due to intense attachments and unrealistic demands, rejection is easily perceived everywhere.  There is a lot of "idealization and demonization" of others.  Relationships move rapidly from acquaintance to intimacy to "dump or be dumped".

One's identity is lost in an other's, repeatedly.  Thoughts are rigid and inflexible.  It is difficult to accept the "bad and the good" in oneself and others.

Such a life is living hell.  A roller coaster of emotional ups and downs, and inevitable relationship failure; which extends not only to partners and family; but to jobs, school and community.  Huge deep depressions and anxiety.  Feeling useless and incapable of living.

This is where I used to live.