Monday, October 25, 2010

BPD and Visit Days

Today is Monday and like I have for the last month, I've gotten my LO up, dressed and ready for a visit to see her birth mom.  I never know if the visit is going to happen.  Sometimes I find out 5 minutes before the pick up time that the visit is canceled.  Sometimes my LO goes on the visit and they call me an hour later and say they are bring the LO back.  But the flexibility of the visitation isn't what bothers me the most...

What bothers me most is the fact that my LO is being taken to someone who has Borderline Personality Disorder (BPD) and that person is not getting the help that she needs to manage her disease.

The mental health community isn't quite sure how to manage BPD.  People who are diagnosed with BPD are usually placed on some sort of psychiatric medicine that is used to help control the symptoms of Bi-Polar Depression like Lithium or Zoloft.  Since the problem of BPD isn't a chemical one, its an attachment issue, these drugs do nothing really to help the underline disease of BPD.
There is one therapy that seems to be effective its called Dialectical Behavior Therapy (DBT).  DBT is a therapy that teaches people with BPD how to regulate their emotions by using distress tolerance, acceptance, and mindful awareness. (A la Buddhism)  Though it doesn't "cure" the disease of Borderline Personality Disorder, it helps people who suffer from the illness to overcome the fear of loss of attachment.  (To read more about DBT you can read Cognitive-Behavioral Treatment of Borderline Personality Disorder by Marsha Linehan the developer of the therapy)

DBT requires a long-term commitment from the Borderline Personality sufferer and, if still intact, the family members.  I say the family if its still intact because living with a BPD sufferer is difficult. 
Here is an example of what we have lived with...

     The BPD sufferer wants a family member to bring them something, this something could be as little as she wants a sweater, the family member who has other plans says no, the sufferer becomes dysregulated and loses control, she throws a fit, she says mean things, she may get physical.  In her mind the family member has failed to live up to their end of the attachment bargain.  The sufferer, who is in pain, feels that her world is ending.  

Because these fits of dysregulation tend to be vicious and irrational to others its is hard for the family members to remain attached.  On top of these fits of dysregulation, there are other issues, BPD sufferers are trying to stop the pain so they tend to drink or use drugs.  They tend to be promiscuous because all they want is to attach to someone.  These choices can be tough on families and any attempt at helping the BPD sufferer can be seen as a negative in the BPD sufferer's eyes.

So if the DBT therapy is helpful, you'd think that the mental health community would be all over it, right?  It's not.  Since BPD is a difficult illness to manage, most therapists avoid treating these people.  Another reason is that there aren't a lot of therapist who are trained in the DBT technique.  The technique requires the therapist to do a lot of follow-up and follow through.  It requires the therapist and the BPD sufferer to commit to a long term commitment, and finally if DBT technique fails the blame is placed on the therapist not the patient. 

Again, this is an attachment issue.  Somewhere along the way the BPD sufferer either didn't attach to their caregiver properly or that attachment was broken.  This is why it is so important that we as parents work hard to ensure our infants attach to us properly and that we learn how to work through our own attachment issues.  There are a lot of us who were raised during the time of Dr. Spock and our parents were told to allow us to CIO.  A good book to read about attachment focused parenting is Attachment-Focused Parenting: Effective Strategies to Care for Children  by Daniel Hughes.  It is kind of technical but it has several chapters on how to deal with your own attachment issues. 

So where does this leave us?  I have asked if there is the possibility of enrolling the birth mom in DBT, but the closest therapist is 2 hours away and there is a waiting list.  So, my LO's birth mother is being treated with prescriptions that don't really work and is left unable to deal with her fear of lose of attachment unaided.  This causes a variety of issues...There are false accusations about the care I give my LO.  There are fits, yelling and the threat of physical aggression.
And there is a LO that is dropped off at my house who is dysregulated and confused.  It takes hours for me to get her regulated again so she realizes that we are still attached.  Visit days require lots of babywearing!

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