We Can All Learn From BPD Treatments | LOIS CHOI-KAIN
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- čas přidán 5. 09. 2024
- What do the various personality disorder treatment approaches have in common, and how can this wisdom be conveyed to a wider public? Dr. Lois Choi-Kain describes her efforts to make mental health treatment more accessible and affordable to clients, and more sustainable for the field.
Most people could benefit from psychotherapy in one way or another, but does everyone really need a specialized, expensive treatment? Do we even need in-person therapy, or just a good healing myth?
Dr. Choi-Kain is a powerhouse in the BPD treatment world. Her short bio:
"Dr. Choi-Kain is a leader in the Good or General Psychiatric Management (GPM) approach developed by her mentor John Gunderson, M.D. with his long-time collaborator Paul Links, M.D. GPM aims to be a generic form of BPD centered care that is more accessible and just plain good treatment.
Lois W. Choi-Kain, MEd, MD, is the director of the Gunderson Personality Disorders Institute. The institute provides training and supervision for numerous proven treatments, including mentalization-based treatment (MBT), dialectical behavioral therapy for post-traumatic stress disorder (DBT-PTSD), transference focused psychotherapy (TFP), and general psychiatric management (GPM). She works nationally and internationally to expand teaching efforts on borderline personality disorder and its evidence-based treatments and engages in research to study resources for training clinicians who need direction and patients who need access to informed care. With her mentor, John Gunderson, Dr. Choi-Kain developed a training program for GPM and has been expanding its applications.
In 2009, Dr. Choi-Kain developed the Gunderson Residence, a specialized residential program for adult women with severe personality disorders. In 2013, she founded the BPD Training Institute, a major center for proliferating awareness of and evidence-based care for severe personality disorders. Dr. Choi-Kain has also developed training clinics in McLean’s Adult Outpatient Services for treatment approaches such as MBT and DBT-PTSD."
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I appreciate these videos so much, partly because actual treatment for personality disorders is SO hard to come by. It seems like a lot of clinicians aren't even trained to diagnose BPD at this point in the United States, let alone treat it.
I know that I get more out of real in person "therapy" or "work" or whatever you call it, but I tend to be so isolated now due to a combo of life circumstances (thanks covid) and my avoidant tendencies, that I'm really really grateful for the resources that are available, like this channel itself..I've gleaned a lot of wisdom from this channel really, and I'm super encouraged to hear Dr. Choi-Kain speak of her work to make helpful resources available on-line
Yes! This seems more important in these times than ever. You're not alone in feeling isolated. Thanks as always. -P
The therapists on this channel are truly phenomenal.
This therapist is such a great communicator and so able to explain. More constructive myth-making about ourselves. I love this.
The success of the treatments may be based upon the interaction and building of value with the therapist rather that the actual type of therapy. Reminds me of a time a motion study carried out in a manufacturing plant which bought about an improvement in the production levels, when the study finished the production levels dropped off again. The reason for this was that the workers felt encouraged and valued by the fact that somebody was actually taking notice of their efforts.
Thanks very much for the thoughtful comment. -P
Hawthorne effect
I think the whole interpersonal hypersensitivity narrative distorts what bpd is, as its about splitting. Its not that the person is hypersensitive, its that these aspects are not integrated in the core personality. But are split off and dissociated. When you are angry, the other "timelines" do not exists, so you feel totally entitled to your rage because the person is all bad. There is a discontinuity in the experience. What appears as hypersensitivity is simply that there is no other way to react, but the absolute polarities of overly needy self and rejected self.
Hypersensitivity simply does not explain the memory issues, and entitled rage. It does not explain why they deliberately seek out horrible fantasy relationships that usually include mutual abuse. If you were truly hypersensitive, why would you seek out bad relationships? Splitting can turn horrible abusive relationships into good ones, just cut out the bad parts, hypersensitivity definitely cant. I think this is the issue in trying to simplify things, you lose things. Things stop making any sense. They no longer explain the cause & effect.
Understanding splitting, is to way to understand all personality disorders. A child dissociates all the bad experiences, in order to keep the parent as a good loving parent.
I think Fairbairn explained splitting best. The exciting/disappointing object relating to the vulnerable needy self and the rejecting/attacking object relating to the rejected self. These are the relational pairs that are dissociated & split off from the core self.
Borderlines seek out exciting but disappointing relationships.
If these split off parts are not integrated, and you simply learn techniques to avoid these parts of you. You lose these parts of yourself.
If you start to believe that you are hypersensitive, then you also believe that you were born like this. And that it was your fault, that you were simply too needy as a child. And now, your environment needs to support your hypersensitive personality. It turns your issues into an identity.
I don't agree that hypersensitivity is something we're necessarily born with; it can be part of a trauma response, like hypervigilance, no? Those with BPD perceive changes in facial expression expression accurately- they just misinterpret what it means and react according to that misinterpretation.
Yes... And because of misperception, so-called hypersensitivity is a mis-use of the term. If you are perceiving something as threat that is actually not - in other words, you are misperceiving - you are NOT per se hypersensitive, but "correctly" reacting to an incorrect perception. I personally find the hypersensitive route a back-pat for those with BPD type reactivity to give themselves props for being exceptional in this sensing way, at the expense of owning the problem reactions of this so-called "hypersensitivity." Some may be extremely sensitive to shifts in expression, but may be able to sublimate their feelings in ways that are productive and thus might not externally appear "hypersensitive." -R
@@beccaklein2194 Hypervigilance is a result of being paranoid, and paranoia is the result of splitting.
"A more positive aspect of selectively abstracting and splitting is that it helps organize one's thinking-however much the organization comes at the ex pense of correct perception of reality. As Millon and Davis (1996) suggest, individuals who selectively abstract narrow "the natural complexities of [the] social world... to signify one or two persistent and all-embracing ideas [so that they] can effectively deal with ... . problems... by 'knowing' that every thing represents basically one or two variants of the same thing" (p. 709).
In overgeneralization, a companion process to selective abstraction and splitting, patients, disregarding the qualifier some, expand some to become all, so that a few things become everything. Persecutory ideas and delusions of persecution are often the product of the distortive belief that the normal animosity people hold even to those they basically love is necessarily representative of their true feelings in entirety, and therefore constitutes their firm, unyielding, and unalloyed negative interpersonal positional statement. Grandiose delusions can be the result of the same process in reverse: a failure to recognize negative feedback when it exists, leading to the belief that no one is against me, overlooking how in fact almost everyone has at least some detractors, if not enemies, who at the very least see them in a negative light, and at worst hate them completely."
Understanding Paranoia: A Guide for Professionals, Families, and Sufferers
By Martin Kantor
Splitting is a way to simplify the complex world. Its not like a hypervigilant person is scanning for good things? No, the baseline assumption is that the world is inherently hostile. This is the result of splitting.
Nancy McWilliams describes it quite well in this interview "Nancy McWilliams Interview - on Life, Psychoanalysis and Spirituality
" at around 5:30 she speaks about how all personality disorders have these polarities.
Like how the paranoid person is also extremely trusting. You can see this especially now, because of the pandemic. Paranoid people distrust the government, institutions but at the same time, completely trust youtube videos.
Much like on the included text, it describes how narcissistic grandiosity is based on splitting. Its well know, that narcissist are quite gullible. Because they believe that only good things will happen to them. Again, splitting.
So its not that borderlines are hypersensitive, they simply use a lot of splitting to simplify the world. To manage it.
Borderlines also use dissociation, they split and then dissociate these parts. This was what originally created the issues in childhood, as so much was dissociated that there were not enough left to build a personality on. The good parent, good object is like a seed of the growing personality. A child will do everything it can, to have that.
Trough understanding splitting, you can learn a lot. Not only about yourself, but about the world. Its universal, everyone split to some degree. And i think its the key thing humanity should start to understand. As its splitting, that fuels racism, perverted religions, wars etc.
@@Nobody-Nowhere "No, the baseline assumption is that the world is inherently hostile. This is the result of splitting."
??
Splitting is rather the result of assuming the world is inherently hostile because of own experiences.
Not the other way round.
The baseline assumption of all so called personality disorders is "I'm not good enough, I'm not worthy, I have to work for receiving love, I deserve to be punished etc."
A false believe about onself through developmental traumas and abuse.
Wich leads to the believe that the world is inherently hostile.
"Borderlines seek out exciting but disappointing relationships."
Because they observed uncertain partnerships as a child.
They "learned" it this way. Or better said they did not learn what healthy relationships are like or love is.
That is then there unconscious imagination of relationships and they attract the "wrong" people as long as they do not become conscious of it.
The evil intention part stems from the church etc.
It is just the human need for vengeneance after beeing abused for years...
@@Nobody-Nowhere thank you
OMG I found DBT to be too hard to even understand. Not simple enough. This Dr. Just amazing. My PSYCHIATRIST Seems to think DBT is the only therapy. I’m so obsessed with the fact I have no friends I can’t function. Obsessed about it. Like what she says about have goals. I can barely keep a job down but sure I have ADHD too!
This makes me feel like some one out there is working very hard to help us :-)
Couldnt agree more. One problem I almost always encounter with listening to therapies is the enormous amount of details that are involved. Having bare bones is helpful as a sort of heuristic to help me see through all the fluff and get to the big picture. Anyone can get mired into a quagmire of details and lose the big picture, like, 'what is happening here'.
Rabbie! Your documentary was intriguing. I’ve watched it a few times now. I hope you continue to make more documentaries. I also love your channel and these interviews that you’re doing with these therapists. Especially this therapist in particular. She is so great to listen to. Borderline is such a fascinating topic with all the mystery and stigma surrounding it. I think it is easy for many people who are far from being diagnosed with this personality disorder two identify with at least some of the characteristics and struggles people with this diagnosis deal with - at least on minimal level.
Thanks so much for the awesome feedback. I tend to agree that the information contained with in BPD treatments could and is useful to a more general population. Appreciate your commenting and being here! -R
dr. choi-kain is really amazing
She's such an empayhetic person! I wish I could find a therapist like her...
Ps just finished watching. Absolutely loved this one and esp when she spoke about the healing myth!!
Cos I can sort of relate to that thru my faith. I was able to get somehow better control over myself and my thinking thru it.
But then there was still what she mentioned in another clip "that pain" . Plus emotional outburst every now and then ....
Dear BorderlineNotes team thank you from bottom of the heart for sich great work! Xxx
Priceless information in regards to encouraging openness about an array of treatment interventions for BPD; this creates unlimited opportunities for additional and possibly more impactful treatments in the future, thus improving functions for individuals who suffer from these disorders. Bravo!!!!
How can I find immediate care? Is there a such thing considering I’m not homicidal nor am I suicidal?
This channel is my best resource. I’m so grateful for these videos! I need one on one! It’s seemingly impossible here in Arkansas! I’m desperate. Can anyone help point me in a productive direction? Please!?
I wish wish wish we could ourselves offer up resources. I wish your request was more the exception than the rule. Are you near a big city or university? If university, it might make sense to dig into their psych department and professors and see if anyone there is versed in personality disorders as a first step to help you find people who can help. Have you looked to see if there are local DBT groups? God, I'm sorry, I wish we could be more helpful in this way. I know there is a HUGE problem with access to treatment, let alone access to good treatment. - R
@@BorderlinerNotes thanks for your response. I’ll keep digging 🥺
@@bethanynelson4254 I'm from a different country and was very lucky to receive free care from a professional who knew about BPD and treatments. It's not the same as getting one-on-one treatment but Dr. Daniel Fox's youtube channel helped me a lot, too. His videos are pragmatic, simple, positive, and without attaching any stigmas to BPD. He also has some worksheets available. You can also try Mindfulness, it's hard at the beginning but in time it helps a lot. There are some videos on CZcams (one of my favourites is the "mountain" meditation). There should be more on the internet. Excercise, things like cleaning, organizing stuff is also useful. Hope you can get access to one-on-one treatment. Wish you the best!
@@sureyyak someone I know and trust in the field of psychology sensed my urgency and though he works as a child psychologist, he was able to get me a session with someone TODAY & I am so grateful!
I think it’s gonna be a good fit…I always do but in just one session I have learned new skills to practice until we dive deeper. Core breathing, color switching…I didn’t know of these basic mindfulness skills and/or that they could be helpful and effective quite quickly.
The color switching was so easy the first time but it was like I knew the trick afterwards so it was more difficult the second, third, & fourth time but I’m sure it will take practice. Perhaps it won’t be a skill I use often but I was excited to learn new grounding tools!
I am also very appreciative of your response and your suggestions! Thank you!
#hopefulagain
#peoplelikeyou❤️
Thank you, for real!
@@bethanynelson4254 That's great to hear, yay! 💜🌞
Fascinating. She is just a fascinating woman.
Charlotte brought me here .. Dr Lois you are so wise.
Thank you, thank you, thank you
Thank you Dr Lois Choi-Kain
I like making it accessible. It allows me to help myself slowly at my own pace. Self discovery and self treatment. Doesnt work for everyone ofc
Can Dr. Lois just talk all the time? Thanks!
Brilliant! Thank you so much for this video. ❤👍🏻
And thank you for being here! -P
that's just what i was going to say.
that´s true empathy
Hopefully such packaging of general wisdom principles can eventually translate into people in the general population having that wisdom. And if enough people in the population has that then it can really spread, and not be some specialized thing you have to go out of your way to learn and not necessarily have a lot of people to talk about it with.
I know before the internet became so ubiquitous, perhaps even before the world wide web people tend to have that kind of conversation online. I think a big factor is we just took things way slower, you might have a one on one conversation with someone online for hours on end over and over (yes I was young and didn't have a job either) but that did get to a place where there's that kind of understanding sometimes. It might be that we didn't necessarily have great wisdom specific to mental health, but it inevitably led to that kind of rapport, even if it is largely in a one off type of real-time penpal relationship. (I do think real-time is an important factor) Maybe that in itself is largely a healing myth, but if it's about the possibility that a peer in the general population can be helpful and we just need to be open and spend enough time and attention to find one online then maybe that's constructive and helpful.
Lois should use the term "models" rather than "myths" because it is not a myth unless it is something akin to what Joseph Campbell describe where stories of mythical figures are used as metaphors for principles and strategies in life. Teaching skills might be through passing along myths, but most therapy is not a mythology as the narratives are a description of actual events as interpreted by the patient on the basis of their internalized model of how the world works with themselves as the central actor. Most times the patient is expressing their perspective based on their internalized model of how things work that they use to interpret their experience and the therapist is attempting to broaden that model to include a way of interpreting those situations and this revision of the perspective provides reasons for applying alternative strategies to those circumstances which are hoped to achieve a more optimal result in terms of the patient's goals.
I don't know where I fall in this spectrum of borderline/narcissism, but for me specifically, relationship trauma is a big problem. Having one at least somewhat healthy relationship has helped me see myself more clearly. I suspect relationship trauma might require this at some point.
If you live in Massachussets it may be possible to get into a clinical trial for metallization or another modality at Macclean
Is there a way to have an online diagnosis or therapy?
Here where I live I’ve always been left unsatisfied and disappointed whenever I courage to visit a doctor. They only give you ten, fifteen minutes from their time and let you go with no diagnosis and three meds prescription!
Dr. Choi-Kain mentioned they were offering, or working on offering online resources. Does anyone know where to find this format of assistance from her treatment center?
why not benefiting from the high level of emotional drive of BPD patient ?
If the patient yells at you , that means you triggered his/her defense mechanism , not that they care about what you said , as much as they care about their self-image to be destroyed , I guess ! .
Well-trained, capable therapists may know this and be able to harness the energy for the benefit of the treatment. Many therapists aren't quite there yet, unfortunately! See Yeomans interview pieces for more -- he's an specialist with this. -P
Just a suggestion: I think the original color of the recording would look so much better than how it's currently edited.
She did this project for film school, so she probably was experimenting with different techniques. I like the black and white, makes it easier for me to concentrate somehow.
Becca, this is no longer a film school project. Alas, that ship sailed 6 years ago. Our color choices are as they are and as they were while in film school. We are aesthetically minded. Not everyone will agree with our aesthetic choices, and I am very comfortable with our material not being universally liked in certain ways. But, I stand behind these choices. That said, feedback and opinions are forever welcome on our material, so thank you Sterling, for sharing your thoughts. -R
The life goal she speaks about at the end of the video... living more constructively and being more satisfied while doing good things for the people around us.... I wonder how far we should take it? Does she suggest we go out of our way to do do good things for EVERYBODY out there or is it ok to concentrate on our family and a friend or two? It just seems a bit melodramatic/ euphoric, undirected(?) EVEN lost to be thinking about helping the entire world? It would be putting the cart in front of the horse. Could be a temptation for anybody who wants to be social worker. I don't think it can be as easy as it seems to be.
Where can we find the online resources?
would love to know if there are any clinical trials accepting patients
that are testing tele treatment for BPD
It just gets worse. It’s like an auto immune disorder.
Lois should be careful using terms like "wisdom" without explaining what she specifically means as she may find herself making a circular argument. Wisdom is a word like love where people always think they know what is being said, but the term may mean different things to different people and different things within different contexts. Wisdom is a term much like the idea of "right action" is in zen. It is not about something frozen in the terms like some insect in amber. So much of therapy involves saying the right thing at the right time and even not saying anything sometimes. It is in the quality of engagement with an individual that helps that individual to integrate thoughts, ideas, concepts... something which could not achieve integration before this essential communication. All individuals have their own language of experience and the therapist must learn each individual's language of experience to help the patient make those bridges between the pieces of the model to achieve new integration.
Healing myth sounds like schema.