This guest blog is by Blaise Aguirre, MD. and Gillian Galen, PsyD. They are coauthors of Mindfulness for Borderline Personality Disorder: Relieve Your Suffering Using the Core Skill of Dialectical Behavior Therapy
Even though Catherine has been in therapy for three months, her parents have just come to terms with the fact that she has borderline personality disorder. Although they are relieved that she finally has a diagnosis that makes sense, they still struggle with her behaviors and their reactions to what she does.
They feel at a loss when she tells them that they don’t understand, that they don’t care about her, and that they are always leaving her when she most needs them. Carl, her father, says he thinks that she takes advantage of their uncertainty about what to do, and he usually gives in because she threatens to kill herself when she doesn’t get her way. Carl and his wife Barbara in fear that she will actually go through with it because the risk of suicide in BPD approaches one in 10.
Fortunately, accurate diagnosis means more targeted treatment choices. Catherine is in Dialectical Behavioral Therapy (DBT), a type of cognitive behavioral therapy. One of the core components of DBT is mindfulness, and it's something we can all benefit from.
What Is Mindfulness?
The practice of mindfulness is the practice of learning how to pay attention. Some call mindfulness “being present,” “staying in this moment,” “becoming aware of what’s going on around you or within you,” and “being in the here and now.”
Biologist Jon Kabat-Zinn provides the most commonly used definition of mindfulness: “Paying attention in a particular way: on purpose, in the present moment, and non-judgmentally.” He believes mindfulness to be fundamental and attainable through practice, and describes it as “a way of being.”
For example, you may be mindful of reading this blog right now. That is, you are paying attention with an open mind to what you are reading, and when you get distracted by thoughts, feelings, or things going on around you, you purposefully return your attention to the words on the page. When you bring your attention back, you are strengthening your “mindfulness muscle,” which is the capacity to catch your mind when it wanders and bring it back to the task at hand.
Awareness Of the Present Moment
At the core of mindfulness is the practice of awareness to the present moment. All too often, families fall into the trap of clinging to the past or the future, not the present moment. They think about injustices they’ve experienced in the past or worry about things that have not happened yet.
The Past: In Catherine’s case, they are still angry at her having stolen her grandmother’s credit card a year ago and charging over $900 on it. They insist that she pay off the debt as the first part to reconciliation. Their anger at Catherine makes them suffer and makes the relationship harder to repair.
The Future: On the other hand, they are constantly worried that she is going to hook up with a boyfriend who is going to introduce her to drugs, which could kill her. Their fear of all the terrible things that could happen keep them stuck in the painful emotions of events that their minds have created. This is not to say that these things won’t happen, but acting as if they already have is neither helpful to the parent nor to their loved one with BPD.
The Present Moment: Parents suffer when they live with the strong emotions of the past and future. Certainly Catherine may well need to pay up her debt. But she is not abusing the credit card now. When parents live in the moment without fears and worries, they can more easily find solutions.
Mindfullness asks family members:
- To observe what is actually going on by simply noticing the events unfolding
- To describe these events by putting words to what they notice
- To fully participate in the moment by acting with full awareness in the moment. Our lives are so busy that it is easy to get distracted.
The way to do so is by doing one thing in the moment without multi-tasking and by being effective by doing what the situation needs.
The Benefits of Being Present
Everything about us is impermanent. Everything! The moment we are in is constantly changing. We are aging, leaves are blowing, the sun is rising, atoms are vibrating, and neurons are connecting. It is impossible to be aware of it all because the universe is vast.
And yet many of us act as if things were permanent. Try to think of one thing that has been exactly the same as it was in the past. Did you come up with anything? Probably not. The process of change is constant and enduring—especially your emotions and actions. Being present and noticing the changing nature of things is also a way to be more compassionate for yourself and the people you love.
Getting Rid of Judgments
Part of mindfulness is being nonjudgmental and avoiding labeling things. Judgments are short-cut ways of describing something. You might say: “That was an awful movie.” But this does not really convey much. It really means, “In my experience that is not a movie that I liked because it had too much violence and ended in a predictable way.” Perhaps someone else might have enjoyed the movie (it might be a classic like The Godfather").
Describing without judging is firstly simply describing. “The movie had a lot of violence and a lot of people were shot. Since I don’t like violent movies, I thought it was awful.” This leaves people room to have their own interpretation.
In the clinic, we sometimes see parents talk about the “disgusting” tattoos they see on their loved ones with BPD. Yet often we see that their peers think that the tattoos are the coolest things ever. Both “disgusting” and “coolest” are judgments. The practice of being non-judgmental is simply saying something like, “My daughter has a tattoo of a phoenix rising on her back and I don’t like it.”
Many people feel they are not judgmental. So here is a practice. If you are a conservative, spend 30 minutes a day watching MSNBC and notice your judgments. If you are liberal, watch a Fox talk show and notice your judgments. We all have them!
The Benefits of Being Non-Judgmental
Judgments only enhance the very emotion you find uncomfortable. Examples of nonjudgmental labeling are “I feel sadness,” “I feel tears running down my cheeks,” “My stomach feels hollow,” “My shoulders are tense.” These labels are all facts that are difficult to argue.
Labeling allows us to categorize our experiences and communicate them with others and ourselves and do so without enhancing the very emotion that is causing discomfort. Put into words only that which you notice in the moment. Stick to the facts, do not add your own commentary or judgments to the experience. Practicing labeling the next time you experience an intense emotion.
Here is another exercise that shows you what you get out of not making judgments. For two minutes, sit mindfully and label an emotion. Begin by identifying the judgments that you have about this emotion. Next, replace your judgments with nonjudgmental labels. Imagine what that emotion tends to feel like in your body and how you could describe it.
Try this with multiple emotions and write them down if you find that helpful. Do this same practice with the same emotion the next time you feel it. When you label the experience, notice whether the emotion lasts as long as you remember.
Feelings and Thoughts Are Not Facts
Many people with BPD struggle with the ability to separate thoughts, feelings, and facts. They think or feel “I am a terrible person,” and believe it to be true. They may say “I am really stupid,” and then believe it's a fact. This is terribly limiting; it leaves no room for growth or recovery.
However, if this person says, “I did a stupid thing,” then they can work on ensuring that they don't act that way in the future.
Families can get stuck with these thoughts, too. They may think, “I am a terrible parent.” Instead, they should notice they have a thought that their parenting was not good. See, there is a difference between non-judgmentally observing a thought and accepting it as the ultimate truth.
Now, it may be true that as a parent you were not as effective as you may have wanted to be, but then again no parent would ever want their child to suffer. Beating yourself up for things in the past and then saying that you are to blame is rarely helpful.
Mindfulness Practices your Family can do Right Now
As the medical director of McLean's Adolescent Dialectical Behavior Therapy Program, I work with the families of young people with BPD every day. The type of mindfulness practice that works varies from family to family. Anything that you can do mindlessly, you can do mindfully. Focus awareness on attending to the practice at hand without judgment.
Here are three practices that your family may enjoy:
An observe practice: Someone in the group rings a bell and the group then sits and simply observes the sound until it fades away. The focus is just on the sound. Notice the sound from the strike of the bell until the sound is no longer audible.
A describe practice: Get a magazine and find an advertisement. Pass it around one person at a time and the person simply describes what they see in the advertisement, without adding judgments, opinions or interpretations.
A participate practice: Laugh club. Everyone simply starts to laugh. Each group member throws themselves into laughing. Do so for 10 minutes.
In each case after the practice, ask individual members to share what they noticed during the practice. Remember it is impossible for your mind not to wander. Our brain produces thoughts, which is what it is designed to do. The act of mindfulness is choosing, with intention, to return your mind to the task you set out to do. Each time your mind wanders and you intentionally bring it back, you are being mindful.
Do One Thing At a Time
The next skill that is fundamental to how you practice mindfulness is learning to do one thing in the moment. When you are reading, just read; when you are talking with a friend, focus only on the conversation; when you are eating, eat; when you are walking, just walk.
This includes letting go of all the thoughts racing around in your mind and putting your mind and body to the task you are doing. At first, doing one thing in the moment may feel as if you are slowing down too much and won’t get anything done. However, studies show that while people think they're good at multittasking, they're actually losing up to 40% of their productivity. Whatever you choose to do, in the end you will get it done more effectively and efficiently.
Doing one thing in the moment works best if you practice throwing yourself completely into what it is that you are doing. Full participation in something often quiets the mind, and many people find that fully participating in an activity brings joy and some peace.
Summary
The practice of mindfulness is a way to reduce suffering, not just for the individual with borderline personality disorder but for the family as well.
Catherine's family can work on being more present by practicing open curiosity about her experience and she in turn can be present by practicing open curiosity about theirs. Open curiosity is questioning without judgment and explaining without editing. Being present is describing the experience of an event to a person and having the other hear and listen and be curious without pre-conception or interpretation.
Being present allows for the idea that rather than perceiving someone as simply “manipulative” in their behavior that, you are curious about it and try to understand the motivation behind it. Families often feel beat up by BPD behaviors. Staying present and open can help change that.
Blaise Aguirre is an expert in child, adolescent and adult psychotherapy, including dialectical behavior therapy (DBT), and psychopharmacology. He is the founding medical director of 3East at Harvard--affiliated McLean Hospital, a unique, residential DBT program for young women exhibiting self-endangering behaviors and borderline personality traits. Dr. Aguirre has been a staff psychiatrist at McLean since 2000. He is widely recognized for his extensive work in the treatment of mood and personality disorders in adolescents. He is also the author of several books, including Borderline Personality Disorder in Adolescents: A Complete Guide to Understanding and Coping When Your Adolescent Has BPD.
Gillian Galen is the assistant director of training and senior psychologist at 3East at the Harvard-affiliated McLean Hospital. 3East is a unique, residential DBT program for young women exhibiting self-endangering behaviors and borderline personality traits. She is also an instructor in psychology at Harvard Medical School. She specializes in adolescent psychotherapy, including DBT. She has a particular interest in using mindfulness and yoga in the treatment of BPD and other psychiatric illnesses.