I have a couple of reactions to this news. First, there are effective treatments for emotional disorders such as depression, anxiety, Obsessive Compulsive Disorder, Post Traumatic Stress Disorder, and Borderline Personality Disorder. In fact, we regularly write about these treatments in this blog. If your therapist can’t identify what he or she is going to do to help you, find another therapist.

Imagine going to a medical doctor for severe headaches who tells you that she plans on meeting with you once a week, talking about your headaches and giving you lots of attention. For that, you’ll hand her some money and your headaches should improve. You’d likely run from her office. A psychologist, like a medical provider, should be able to describe a way to diagnose and treat your symptoms. Of course, in order to benefit from the plan, you must participate in the treatment.

Second, beginning with my bachelor’s and master’s degree at Wayne State University I was trained in the theory and principles of cognitive behavioral therapy. In fact, I can remember the professors making fun of penis envy in my introduction to psychology class (circa 1970). This training continued for another master’s and Ph.D. in clinical psychology at Fielding Graduate University. Like all licensed psychologists, I update my skills through continuing education. Most of the offerings I have attended over the years are focused on evidence based treatments. I often attend workshops given by the Association of Behavioral and Cognitive Therapies, a national organization that advances training and research related to cognitive behavioral practices. Again, not all of treatments that work are necessarily cognitive behavioral, but the majority of them are. My point is not that cognitive behavioral strategies are the only ones that work, but if your psychotherapist has not been trained in using empirically based methods, I wonder where the heck his head has been for the last 40 years!

We’re hanging out in the San Francisco airport waiting for our flight back home to New Mexico, reflecting on the unique conference that just wrapped up. Actually, it was an unconference, meaning that it was designed to be interactive and collaborative rather than a series of lectures. In addition, the participants were all proud to call themselves Dummies. That’s because we all have written one or more books in the For Dummies series.

What an interesting collection of people! The authors came from both coasts and all walks of life. The group included professors, computer geeks (umm, actually wizards!), business consultants, mathematicians, medical doctors, web designers, psychologists, a photography guru, and a very funny cartoonist. Our purpose was to collaborate on how to spread the word about the quality of the For Dummies series of books and the people who write them.

The weekend began with a cocktail party on Friday evening at the home of Diabetes, High Blood Pressure, and Thyroid For Dummies. We hitched a ride with Acne For Dummies. We were a little nervous about our own reception given our moniker, Borderline Personality Disorder, Obsessive Compulsive Disorder, Anxiety, Seasonal Affective Disorder, and Depression For Dummies (after all, who would want to talk with two people carrying so much emotional baggage?).

Nonetheless, we were warmly welcomed by LinkedIn, Starting an Online Businesses For Dummies, and Starting an iPhone Application Business For Dummies. We were engrossed in a surprisingly interesting conversation with Algebra I, Algebra II and Business Math For Dummies. Java For Dummies was delightful, though we never did quite figure out what Ruby on Rails For Dummies was all about. Accounting For Dummies talked about the old days of former publishers of the For Dummies series-Hungry Minds and IDG as well as his dreams for the future. Speaking of dreams, Dreamweaver & Creating Family Websites For Dummies arrived late accompanied by the 5th Wave (cartoonist). Those two perked up the evening so much that everyone chatted for hours longer than expected.

We collaborated over the next two days and were joined by Home Based Business For Dummies and Photoshop Elements For Dummies. We walked away with some thoughts and our minds buzzing.

• We spend too much time on our computers-face to face meetings still matter.
• Linking through Social Media has great promise.
• Although our backgrounds have little in common, our shared experiences as writers bring us together.
• We now feel a commitment to collaborate and help each other.
• Everyone is interested in connecting with their readers.
• We’re thankful to Wiley for all the great chotskies!

A real advantage of taking a Mindful approach to experience is that relatively few present moment experiences are truly “awful” or intolerable. In fact, the vast majority of things that gravely upset people have to do with imagined, future catastrophes or guilt, shame, and self loathing over past actions.

One of our favorite discussions was about me learning the value of mindfulness in our earlier book, Depression For Dummies and it goes as follows:

Charles never feels as grounded and at peace as when he takes our dogs on a long jog three or four times each week. He heads out the door and in just a few minutes makes it to the West Mesa overlooking Albuquerque. You can see the entire city laid out at the footstep of a majestic mountain range. The view is stunning and you can see many miles out to the horizon.

The mesa is laced with dirt roads and gullies created by occasional downpours that blow through the otherwise parched land. Rabbits routinely dart across the running path. And once in a while, you can spot a coyote in the distance. Charles connects with the experience by noticing the rhythm of his running, the obvious joy the dogs exhibit, the quiet, and the (usually) gentle breezes.

Because he runs a long way, sometimes predicting a sudden downpour is impossible. The first few times rain started to drizzle, Charles cursed his fate and picked up the pace to return home as quickly as possible. But frequently Charles got soaked before he arrived home, and he felt distressed at his soaked condition. After all, everyone knows it’s awful to get drenched in the rain.

But he noticed that the dogs never seemed to mind the rain. They occasionally shook off the excess water and continued to enjoy the run as much as ever. Charles wondered how they could continue to connect with their experience unfazed and undaunted. Then it hit him. Their minds are unfettered by thoughts of how awful it is to get soaked. They merely connect with their joyful experience, nothing else.

And could he not do the same? Yes. He then realized that the sensation of the rain feels not much different from his usual morning shower. What does “getting soaked” matter? The experience of running in the beautiful setting, rain notwithstanding, felt wonderful if he let the thoughts go and simply existed.
Of course, you could wonder, but what about lightning, wouldn’t that be dangerous and indicate a need for action? Yes, that’s one way thoughts can be useful.

This last point about lightening raises an issue that is often neglected in many discussions we’ve seen about mindfulness. Specifically, we’re talking about the fact that although a focus on the present is invaluable, it’s not enough. One still must maintain a perspective on the past and the future.

Thus, when looking back on your life, it’s important to learn from mistakes, yet take the same non-evaluative, nonjudgmental, open perspective. Try to accept your past actions as having been the result of the best you knew how to do at the time. And in looking ahead, you need to remember the past and realistically and objectively forecast what actions today need to be taken to maximize your overall life satisfaction in the future. Taking shelter from lightening just makes sense even though nothing in the present would suggest any particular problem (unless the lightening actually strikes and then of course it’s too late).

The take home message is that we highly recommend training yourself to focus on the present with openness, acceptance, and without judgment or evaluation. Then take that same attitude in maintaining a perspective on the past and the future. Live your life in the present, but remain aware of where it comes from and where it’s going.

OCD also involves thoughts. For some people with OCD their obsessions and compulsions are more in their heads than in their guts. Consider a woman who feels a compulsive urge to arrange her canned goods in a “certain, perfect” order. She doesn’t report feeling particularly anxious at all. It’s just that she feels things aren’t “right” if she doesn’t have everything in a just so order.

OCD can also show up primarily in behaviors. For example, a man might feel a driven need to go through doorways in a particular manner. Until he gets it “right,” he can’t let himself continue on his way. He can’t come up with any particular thoughts about why he needs to go through doors in this way; he just feels he must.

As these examples illustrate, OCD manifests itself in many widely differing forms. The prominent feature(s) may involve anxiety, thoughts, behaviors, urges, or distress. Although OCD is currently considered a type of Anxiety Disorder, many professionals believe it deserves its own separate diagnostic category.

The take home message is that this is a fascinating, yet quite complex disorder. If you “think” you may have it, consider seeking professional consultation. This is one problem that you don’t want to self diagnose. The good news is that usually treatments work very well for OCD.

We tell those asking this question that people with Borderline Personality Disorder (BPD) indeed engage in a wide variety of behaviors and states of mind. Not surprisingly, people who care about those who have BPD often ask which of these various states represent the “real” person–the difficult states or the endearing ones? In order to answer that question, let’s first take a look at some of the disagreeable states as well as what may cause them. Then we’ll review the positive behaviors and the causes for those. We’ll conclude by filling you in on which ones reflect the “true” person at the core. And most importantly, we’ll give you a few issues that may help guide you in making this difficult relationship decision.

Negative Behaviors and States of Mind
People with BPD often inflict harm on those they love (sometimes quite intentionally; other times without conscious intent at all). They can say and do things that are perceived as astonishingly hurtful. Furthermore, people with BPD often fail to understand appropriate limits and boundaries of those they care about. Thus, a man with BPD might attempt to control his partner by demanding that she cut herself off from her family because they don’t “like him.”

In addition, those with BPD often criticize their partners for not “doing enough or earning enough” for them or their family. They may burst into rage, anger, or impulsive actions with seemingly little provocation. Often their partners who don’t have BPD find that their self-esteem suffers and they begin to question their own sanity, thinking that their partner is right–they really aren’t doing enough or they’re doing things the wrong way.

What causes such distressing, yet inappropriate behaviors in those with BPD? All too often, people with BPD completely fail to understand the nature of their behavior and how it affects those they care about. In addition, people with BPD typically have deep seated fears and insecurities that drive them to their impulsive, destructive behaviors. In other words, although their behaviors can seem quite dreadful, their fears and failure to understand other people’s perspectives lead them to act poorly. For example, if they fear abandonment, they may respond to their partners’ unexpected late arrival as proof positive that their partner is planning to leave them for someone else. Their fear then turns to rage.

Positive Behaviors and States of Mind
On the other hand, people with BPD quite often appear to be some of the most wonderful people you’ve ever known. They will go out of their way to demonstrate caring and concern. They praise their partners’ appearance, send unusually thoughtful gifts, offer backrubs, and run errands just to please their partners.

What causes these delightful behaviors? Often it’s because of the same fears and insecurities that drive dreadful behaviors. For example, fear of abandonment will cause them to work very hard at being utterly irresistible. At times like these, their partners often report feeling on top of the world and adored in ways they have never felt before or since.

Which is the Real Person?
When people ask this question, they’re really hoping that the answer is the wonderful, endearing side of their partner. Unfortunately, the real answer is “both.” Yes, those with BPD are often caring, considerate, and kind. No question about it. On the other hand, if they have exhibited negative, atrocious behaviors over and over again, that’s part of their “real” self as well.

Making the Decision to Stay or Go
Thus, the decision to remain in the relationship or not is complicated. We have some questions and issues for you to consider in making this decision next:

1. If you have no idea whether your partner has BPD or not (and most people wouldn’t know), see a therapist for guidance and consider reading our book Borderline Personality Disorder For Dummies.

2. Don’t stay if you’re expecting the negative behaviors to disappear. They won’t go away on their own. Sometimes people with BPD manage to control their outbursts for a couple of weeks or even a few months, but they always return unless the person has worked very hard in therapy and made good, solid progress over time. Successful therapy for BPD typically takes one or more years of treatment at least once or twice each week–and usually includes both group and individual work.

3. If you’re staying because you have low self-esteem and find the praise and caring addictively irresistible, you’ll probably need therapy for yourself in order to develop confidence in your ability to take care of yourself.

4. Although family and friends aren’t exactly always right, they usually have your best interests at heart and often can see your situation more objectively than you can. If everyone in your world is advising you that you’re in a self destructive relationship, at the very least we strongly recommend you listen to them and see a therapist (for yourself only) for guidance in figuring it out. For that matter, if you find yourself lying to family and friends about the relationship, know that something is wrong.

5. You may wish to consider remaining in the relationship if the negative behaviors are quite infrequent, not too intense, and have been showing clear signs of improvement over a period of months or years. Don’t trust temporary changes of less than a few months. But those with BPD do change and they do improve. Improvements are far more likely if the person has been working hard in their own, individual as well as group therapy for quite a while.

Last week, I attended a well orchestrated day long conference on treating people with Post Traumatic Stress Disorder (PTSD). Organized by Dr. Rex Swanda from the New Mexico VA, the content of the conference primarily focused on therapeutic practices that have been studied and found to be effective in treating those who suffer from this disorder. Treatments that are considered evidence based have been subjected to at least several independent research studies, compared to other types of treatment, or to no treatment. Here is an abbreviated description of PTSD.

PTSD can occur when people suffer or witness a traumatic event in which they are threatened with death, injury, or physical violation. During the time of the trauma these people respond with horror, fear, or helplessness. The symptoms of PTSD include some of the following:

• Re-experiencing the trauma: through dreams, flashbacks, unwanted thoughts, or distress when reminded of the trauma.
• Numbing or avoiding: attempts to avoid situations, triggers, or thoughts about the trauma, feelings of detachment from others, loss of interest in activities, beliefs that their lives will be short, and restricted emotions.
• Hyperarousal: problems with sleep, easily irritated or angry, problems concentrating, and jumpiness.

If you have concerns that you or someone you care about has PTSD, please consult with a mental health professional for a diagnosis and treatment plan.

Now, back to the conference. There were multiple sessions that mostly reviewed the effective treatments for PTSD. Not surprisingly the therapies that work are based on mixtures of cognitive and behavioral therapies. These approaches have stood the test of time and science. Cognitive Behavioral Therapy (CBT) has been used to successfully treat a wide range of emotional and behavioral problems.

It’s fun when the conference planners inject a bit of controversy to keep the audience awake, especially after lunch. So I looked forward to the speaker, a psychologist well known for his narrative ability, humor, and intelligence. I was riveted by his stories, but disappointed when he slid into the sad old tale of how empirically validated therapies are woefully insufficient for those with severe trauma. His arguments were dated and dismissive. This same argument has been made for the past several decades. Ostensibly, cognitive behavioral therapies don’t address critically important culture differences, early developmental issues, individual differences, and fail to include warmth, empathy, and concern for clients.

It was too bad that the speaker did not stay at the conference to hear Dr. Evelyn Sandeen, also from the VA, discuss the difference between evidence based treatments and evidence based practice. In her talk she described how in practice, we tailor the treatment to the individual. Therefore, good practice requires a warm, nonjudgmental, supportive therapeutic relationship along with close attention to the client’s background, personality, and individual needs. A good cognitive behavioral therapist takes all of these factors into consideration while delivering validated treatments in an individualized, sensitive, and skillful manner.

I truly appreciate interesting conferences and all of the work that goes into organizing and producing them. Thanks to the New Mexico Psychological Association for consistently delivering quality continuing education!

For us, one significant change has been our assignment to the older generation. For many baby boomers, this new status is largely unanticipated and surprising. Where did all that time go? Our transfer to elder status comes with the gain of grandchildren, the joy and pain of watching our children love, learn, and leave. It also comes with the dissipation of dreams, the creation of new dreams, the loss of our own parents, new aches and pains, technological challenges, and the wonderful perspective of experience. Of course, that wonderful perspective derived from experience isn’t always sought out or appreciated. Sigh.

Family members change. Children are born, or adopted. Adults join families through new ties or partnerships. People leave families. Some die, others move on, some lose connections by choice, some by circumstance.

Getting together with family evokes lots of feelings. Okay family-Chuck and I are both clinical psychologists and it’s true, we really are analyzing everything you say or don’t say. And we know exactly what you’re really thinking (well, that’s not true-we still can’t read minds, but we’re working on that).

On the long (delayed) flight back to New Mexico, we had time to reflect on our family. And we both concluded that the people in our family–like those in most families–do the best they can do given the time and context of their births, childhoods, biology, learning, luck, and fate. We’re good people, for the most part, and we plod ahead, not always really sure of where we’re going.

So, does this hopelessly egocentric rambling have a point? Yes, one way to improve mental health and happiness is acceptance. So family, we have analyzed you completely by now and want you to know the outcome. You’re all okay. And it’s even okay when you don’t agree with the inestimable value of our wonderful perspective!

• Blunt force trauma: This type of self harm includes banging one’s head on a hard surface, punching oneself, and using a hammer or other tool to inflict damage and pain to the body.
• Cutting: This is one of the most common and widely known types of self harm that those with BPD engage in. Cutters use a variety of tools such as scissors, razor blades, knives, needles, and broken glass. Scars often result and many people who cut try to cover up their injuries while some people actually try to put them on display.
• Burning: People resorting to this tactic use cigarettes, matches, lighters, and hot objects to burn themselves. They usually only burn a small area each time, but the resulting scars can often occur over a large part of the body.
• Intentional accidents: Folks who set themselves up for accidents may not look like they’re trying to hurt themselves, but their failure to take even the most basic, reasonable precautions tips you off to their true motives. These people often end up in far more than their share of mishaps and investigation often reveals that they set ladders on obviously unstable ground or fail to use essential safety equipment.
• Miscellaneous self injurious behaviors: These include swallowing harmful objects, inserting objects into body cavities, hair pulling, consuming harmful chemicals, pushing one’s eyeballs, or biting one’s body.

You’re probably wondering what the motivation is for these various acts of self harm that seemingly would result in no gains for the person who does them. The answer to your question is that there is no single motivation for self harm. Both mental health professionals and those with BPD have suggested a variety of possible motivations including:

• To distract from emotional pain: You can’t underestimate the unbearable nature of inner pain experienced by those with BPD. Although the pain from self injurious acts rarely matches the internal, emotional pain, it does pull one’s attention away from the overwhelming emotions for a little while.
• To meet other needs: In most cases, it’s not so much a need for attention as it is a need for basic nurturance and support from others. In some cases, it appears that people engage in self harming acts in order to obtain care and concern when they lack the skills or knowledge for obtaining those needs in healthier ways.
• To punish themselves: Sometimes people with BPD appear to harm themselves out of a profound feeling or belief that they deserve punishment and abuse. Sometimes this belief appears to be related to the fact that they were abused as children and believed they deserved the abuse. Thus, they continue the pattern of abuse on themselves, thereby reenacting the abuse over and over again.
• To get back at someone: Many people with BPD have trouble expressing anger in healthy ways. Thus, they will hurt themselves to make other people feel badly for something they did or said.
• To feel better: When the body is injured, the brain releases a type of pain killer known as endorphins. Endorphins are similar to morphine and reduce pain and distress. Thus paradoxically, one may engage in self harm in order to regulate emotions and feel better. If that motivation sounds bizarre, consider the fact that many of us in New Mexico report loving to consume hot to really hot chili peppers in abundance. Why? It seems chili peppers causes a release of endorphins.
• To feel almost anything other than numbness and emptiness: Many of those with BPD say that they have a constant feeling of “unrealness.” They say they feel out of it and/or dissociate. Pain feels “real” and allows them to connect to the world for a while.

Again, motivations vary from person to person and some people no doubt have several motivations from the above list. Still others may have motives we have not covered. Fortunately, there are treatments for self harm that appear to work for many people. These take time and professional help. Although it’s interesting and often productive to sort out a person’s motivations for self harm, it may not be necessary in all cases to fully understand the motivations for the behavior in order to change it.

• First, think about some activities that you might enjoy outside this winter. If it is a sport, consider taking a class or joining a group so that you can combine going outside with socializing.
• People with SAD tend to hibernate in the winter. Try to arrange some activities to do during the winter months in the early evenings.
• Find an exercise routine that you enjoy. Again try to make this a social time as well.
• Weight gain is also common in the winter for people with SAD. If you struggle with weight consider a support group to get you through the dark times.

If you have had severe problems with SAD, we suggest that you discuss this with your medical provider or a mental health professional experienced with this particular problem. Some people take a certain antidepressant as prevention for SAD. If you want more information about SAD, we have a great book (you can buy it new or used on Amazon) Seasonal Affective Disorder For Dummies.

My first inclination, like many people, is to fluff up the pillows, reposition myself, and will sleep to overtake me. Sometimes that works, but usually sleep remains evasive. So, instead of counting sheep for hours, here are a few tips to manage sleepless nights:

• Get up. Yup, put on your robe and slippers and get out of bed. If you can’t sleep, you don’t want to stay in bed. That’s because you want your brain to associate your bed with sleep, not with insomnia. So, go check your email, read a book, or watch TV in another room for a while. When you start to really get tired, go back to bed.
• Don’t catastrophize. Realize that you will likely sleep better tomorrow and that you can get through the day without your regular sleep. The more you get upset about not falling asleep, the more your brain will keep you awake. Worrying just doesn’t work.
• Have a very small snack. It doesn’t have to be raw broccoli. A glass of milk or a cup of tea and a biscuit or piece of toast will do.
• Talk to your doctor. No, don’t call her at 3 am when you can’t sleep, but if your sleep problems become chronic make an appointment with a health care professional. In addition, consider a short stint of cognitive behavioral therapy with a mental health professional. CBT has been shown to be effective for the treatment of insomnia for many adults.

Sweet dreams…………