At the Feet of Jesus: Article for the Christian Counselor’s of Texas Summer Newsletter- June 2015

I don’t think there is any diagnosis that evokes stronger emotional reactions and judgments from counselors than that of Borderline Personality Disorder. I have been consistently surprised by the number of therapists I have seen rolling their eyes and throwing up their hands, dismissing these clients saying, “She’s Borderline.” I have not seen these types of strong responses with any other diagnosis or problem.

I can’t help but think that when we dismiss these clients as hopeless and incurable, this must grieve the heart of God.

According to the DSM-V, Borderline Personality Disorder is defined as, a pervasive disorder of the emotion regulation system. It is characterized by profound instability in interpersonal relationships, self-image, and affects, and marked impulsivity (DSM-V, 2013).

In the therapist’s office, individual’s struggling with these vulnerabilities tend to display extreme emotional deregulation, therapy-interfering behaviors, co-occurring substance abuse problems, eating disorders and other high-risk behaviors (like suicidal ideation, suicide attempts and self-mutilating behavior such as cutting).

It is true that clients with these types of difficulties often present in a way that challenges the therapist. They are frequently given the title, “bad patient” or “treatment resistant”.   I wonder if this is precisely the reason why we are tempted to dismiss them. They challenge us and therefore it can bring out our own frustrations, vulnerabilities, defenses and weaknesses as individuals. I would like to suggest that this is a great place for us to be…out of our comfort zone and in need of help!

But he said to me, “My grace is sufficient for you, for my power is made perfect in weakness.  Therefore I will boast all the more gladly about my weaknesses, so that Christ’s power may rest on me.”  2 Corinthians 12:9

 In our own power, we are incapable of moving our clients with Borderline Personality Disorder forward toward true healing and wholeness. It is God who does the work and we are but a vessel. We need to have the Holy Spirit help us to bring the love and compassion of Jesus to relieve and heal the physical, emotional and spiritual suffering in our clients.

It is true that some of our clients are easy to love and some of our clients are more difficult to love. Yet, aren’t we called to love those who are difficult to love?

“If you love those who love you, what reward will you get? Are not even the tax collectors doing that?”  Matthew 5:46

God wants us to love our Borderline clients and do our best to help them find healing. This often takes humility, patience and a willingness to draw God down into the therapy session when we may feel weak and powerless to move these clients toward true healing and wholeness.

When I think of the deep suffering that clients with Borderline Personality often endure, it makes me think of Mark 5: 25-34. In this passage, we read the story of how Jesus brings healing and wholeness to a woman who had been suffering for a very long time. Many people had given up on her dismissing her as irredeemable. She had struggled for 12 painful years with hemorrhaging and was unable to find any relief. Although this appears to be a physical illness, it is not hard to imagine that she must have suffered socially, emotionally and spiritually too as her bleeding would have made her unfit for the company of others. She would have been someone that others avoided, as she was an outcast and one who was considered ‘unclean’.

This woman had looked for healing, and ended up going to see many, many doctors and spending all that she had. We are told:

“She had suffered a great deal under the care of many doctors and had spent all she had, yet instead of getting better she grew worse.”  Mark 5:26

At some point, even the doctors had given up on her, seeing her as incurable. She must have felt isolated, alone, ashamed and perhaps even dejected, depressed and nearly hopeless….

Until she heard that Jesus was nearby, and then everything changed…

She moved swiftly and desperately, pressing herself toward Jesus in the crowd. She thought to herself, “If I just touch his clothes, I will be healed” (Verse 29). When she reached Him she touched the tip of His robe. Immediately, she felt in her body that she was freed from her deep suffering. Jesus then asked who had touched Him and He looked for her. She came to Him trembling and fell at his feet. Jesus commended her for her faith saying, “Daughter, your faith has healed you. Go in peace and be freed from your suffering”.

In my work as a counselor, the majority of my clients struggle with Substance Use Disorders, Eating Disorders, Mood Disorders, Trauma and Personality Disorders. I have personally seen a look in the eyes of many of my clients that I imagine the woman in this passage of Scripture must have had with each doctor she went to see. After seeing many other therapists before me, theirs is the gaze that seems to inquire, ‘Will you be the one who can help me? Will you be the one that can free me from this physical and mental prison? ‘

In the United States alone, it is estimated that 18 million individuals suffer from Borderline Personality Disorder (NIMH website, 2015).   Unfortunately, it is often underdiagnosed or misdiagnosed. Borderline clients often endure great suffering on a daily basis and receive constant messages from their body and brain that their inner state is aversive or painful.

Borderline clients are typically not helped by psycho-dynamically oriented therapists and tend to have been treated by 5-10 therapists, on average, yet to no avail (Dimeff, 2010). These clients often incur great expense as they seek healing, like the woman in Mark, and often require long-term solutions for care.

It may be useful for us to remember that research suggests that Borderline Personality Disorder is due, at least in part, to several brain abnormalities that result in cognitive impairment as well as problems regulating emotional responses. There is also evidence to suggest that problems with emotion regulation can be due to differences in the Central Nervous System in some patients due to genetics and events that occurred during fetal development or early life trauma (Dimeff, 2010).

In other words, individuals struggling with Borderline are not really “bad people with a bad personality”. Most often they are biologically vulnerable individuals who have deep-seated trauma and a history of growing up in an invalidating environment. Of course there is often great variability in clients with Borderline Personality Disorder and, as is true with other mental health diagnoses, there exists a continuum of behavioral and emotional deregulation.

We also need to remember that research suggests there is healing for Borderline Personality disorder. In fact, there is evidence to suggest an 84% remission rate over time for the illness (NIMH, 2015). With advances in neuroscience we now know that brain neuroplasticity profoundly effects the outcomes of treatment for individuals struggling with mental illness. Treatment can actually change the brain and this is certainly true for individual’s struggling with Borderline Personality Disorder symptomology.

One of my favorite therapies to use with individual’s experiencing deep emotional pain and deregulation is Dialectical Behavior Therapy (DBT). It is efficacious for treating Borderline Personality Disorder as well as treatment-resistant depression, substance use disorders, eating disorders and suicidal or at-risk adolescent clients (Linehan, 2015). I think it is also interesting to note that DBT is also now used in the treatment of complex PTSD, according to trauma experts (Dimeff & Koerner, 2007). In fact, our existing understanding of Complex PTSD actually comes from a reframing of the diagnosis of Borderline Personality Disorder where many, but certainly not all have experienced some type of trauma or are part of a history of intergenerational trauma or disorganized/disoriented attachment (Linda Curran in Dimeff & Koerner, 2007).

DBT is a therapy that balances the client’s need for acceptance and the client’s need for change. Part of this therapy is skills training where the therapist teaches the client; 1) Mindfulness to decrease identity confusion, emptiness and cognitive deregulation; 2) Interpersonal effectiveness to address interpersonal chaos and fears of abandonment 3) Emotion Regulation and Self-management to reduce changing affect and excessive anger; and 4) Distress Tolerance to help reduce impulsive behaviors, suicide threats and intentional self-injury.   Often these skills give real-time relief from the inner turmoil experienced by these clients.

In terms of the therapist’s stance, these clients need us to offer them a compassionate, non-judgmental attitude of acceptance and validation. When we sit with them, we must attempt to enter in to the client’s reality and deep suffering. When we do, we realize that our Borderline client is really doing the best that he or she can with what she has been given. The behaviors the client is exhibiting are very often a maladaptive attempt at meeting unmet needs. We want to balance this out, however, and believe in the client’s desire and inherent ability and capacity to grow and change.

As someone who sits with those who are suffering day in and day out, I realize that true compassion is not seeing myself as ‘well ‘and the client as the one in need of healing. It is really a relationship between equals. Only when we know our own suffering and need for a Savior well can we have true compassion for the pain and suffering in others. Compassion becomes real when we acknowledge our own brokenness.

“Praise be to God, the Father of our Lord Jesus Christ and the God of all compassion, who comforts us in our distress so that we might comfort others with the same comfort God has given us”.  2 Corinthians 1: 3-5

Let us reach out our hands then and offer that comfort and hope for healing to all of our clients.  We want to lead them to the feet of Jesus where they can touch His robe and be made fully whole. Yet, we do not want to leave them there alone. This is ultimately where we too should be sitting, trembling with thanksgiving. Indeed, it is the blood of Christ that cleanses us from all of our sin and leads us to true wholeness and freedom ourselves.

May God richly bless you and fill you with love and compassion as you minister to those who are hurting.

 References

Dimeff, L. A. (2010). Overcoming Borderline Personality Disorder: A Family Guide for Healing and Change. Oxford: University Press.

Dimeff, L. A. and Koerner, K. (2007). Dialectical Behavior Therapy in Clinical Practice: Applications Across Disorders and Settings. New York: The Guilford Press.

American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders Fifth Edition, (DSM-5). Washington, DC: American Psychiatric Publishing.

Holy Bible, New International Version (2006). Michigan: Zondervan.

Linehan, M. M. (2015). DBT Skills Training Handouts and Worksheets: Second Edition. London: The Guilford Press.

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It’s a New Year: Time to Clean out that Junk Drawer

new-year-organization

Every year as the New Year approaches, I seem to get this overwhelming urge to run out to the container store and buy some new storage bins and containers in an attempt to get in control of some of the clutter that has accumulated in our household!   In fact, we normally spend a few weekends each January cleaning, organizing and giving things away to Goodwill.  Yet, a strange thing seems to happen every year.  As soon as I feel I am getting somewhat organized, school starts up again and the kids come home with beautiful fridge-worthy creations, technological gadgets and plugs suddenly appear on the countertops and a variety of other books and miscelaneous items seem to leave a trail as long as it is wide.  Suddenly, I don’t feel so organized anymore, and even wonder if my organizing efforts were in vain.  It is normally at this point that I hear my physics teacher in High School in the back of my mind reminding me that everything heads towards entropy (chaos and disorder).  So true!  This organizing thing is going to be a constant battle.

One of the messiest places in our house is a drawer hidden away under the kitchen countertop (in fact, I think we may have two)!  The infamous junk drawer…  I think most of us have one.  You know…the place where we throw all of the odds and ends during a busy day when we don’t have time to find a proper home for them.

Junk drawers can be kind of messy just like life can be kind of messy.  In fact, there came a time in my life when I realized it is also possible to have an emotional junk drawer… a place where we put hurts and disappointments throughout the years because we are too busy to deal with them.  For me, I was busy getting a degree, getting married, having children and taking care of those children as well as running a busy household, trying to keep up with family and friends and keep a budding career growing.  Each time I felt pain or hurt, I would attempt to throw those feelings to the side thinking “I will be fine” or
I’ll put that away later” and then I would just keep on going.  But eventually, the drawer started to overflow with so much stuff…so many unhealed, unresolved emotions; things deep within me that were old and broken.  So, I set forth on my emotional de-clutter project thankful that God is a God of order and peace (1 Corinthians 14:33) and knowing full well that it was possible to find healing with His help.

As we begin a New Year, I wonder if you have taken a look in your junk drawer?  If you have, I would love to hear about it…Perhaps we can clean them out together!

Until next time…

Blessings for your Journey,

Stacy Vollands

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Just Keep Running

dog-running-with-owner

“Therefore, since we are surrounded by such a great cloud of witnesses, let us throw off everything that hinders and the sin that so easily entangles, and let us run with perseverance the race marked out for us” (Hebrews 12: 1.) 

Last weekend my husband and I went on a long training run for the half-marathon with our dog, Max. As we were running past the “bark park” in our neighborhood, there were other dogs getting out of their owner’s cars to go and play. Max is so curious, especially when other dogs are around and he was distracted. Unfortunately, he ran in front of my husband who then accidentally stepped on his back hind paw. We heard a loud yelp from Max and we stopped abruptly to see if he was okay. We were so surprised that Max appeared to be fine and that he even wanted to continue running. It wasn’t long before we noticed that Max was only using three legs to run!! He was holding his foot up and was determined to compensate with the other three. We were amazed that Max was so focused on the task at hand that he wanted to finish the run, even when he was injured.

There are a lot of parallels between running a physical race and running the race of life with faith. Many things can happen to us that may wound us and cause us to limp. Yet, with focus and determination, fixing our eyes on Jesus, we can rise above even our worst challenges, hurts and hang-ups. We may feel tired or even like giving up sometimes under the weight of these, but we must remember to persevere on the special path marked out for us.

One of my favorite parts in running a race is when I see the finish line. When I am tired and at the end of myself, I look forward to that finish line so that I can rest. Whatever you are going through today, remember that Jesus is with you in this race cheering you on! He is the One that can help you to persevere through trials and pain. He is also the One who can sustain you during your race (even when you may be limping) and the One who will be there waiting for you at the finish line! So, “let your eyes look straight ahead; fix your gaze directly before you” (Proverbs 4:25) and keep on running!

Blessings for your journey,

Stacy Vollands

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The “New Normal”: Adjusting when a Child Moves Away to College

Stolaf1

We just arrived home a few weeks ago from a trip that marked a monumental milestone in the life of our family. We dropped our oldest daughter off at an out of state school to begin her freshman year in college. When we arrived home, the house was a little bit quieter, her room a bit too tidy and our hearts a little bit heavy as we realized it was going to take some time to adjust to our “new normal”.

Having a child leave home to attend college is a momentous occasion in the life of a family. It is exciting and joyful but at the same time it is an emotional process that can present unique challenges. For parents, it is a new experience to ‘let go’ of a child. After all, we have had them at home and we have been responsible for them for 18 years. When they leave home our role changes and we need to adjust. We cannot hold them too tightly. We need to allow them to spread their wings so they can begin a time of more independent discovery and learning.

There aren’t a lot of people talking about this process. It seems that as we raise our children, there is an abundance of information to guide us in navigating our parenting responsibilities from the time we are expecting all the way through the High School years. Yet, there are fewer resources when it comes to preparing for and actually launching our children into college.

As a counselor, I work with clients who are trying to navigate through all types of loss. Grief is the process in which we work through our losses. I have found this college launching experience to be a grieving process of sorts; not a traditional grief as in a permanent loss but rather a grieving over the way things used to be. This “launching grief” can evoke many and varied emotions in a parent as well as any younger siblings that still live at home.

In walking through this experience, I would say that it is useful to:

1. Prepare Yourself for Change
The process of launching children is a journey that involves a lot of change. This change is exciting but it can also be upsetting. One can start preparing for this change by realizing that transitioning our children into the world is a part of life and is, in fact, a natural and important rite of passage in our lives and in the lives of our children.

The process of adapting to change actually begins in our hearts when our children are very small. One of the first transitions is often separating from our children when they go to school or day care for the first time. I still vividly remember dropping our daughter off on the first day of all-day Kindergarten. I was all equipped with my small packet of Puffs and ready for a tearful goodbye. Much to my amazement, she walked into the class only glancing back briefly to say, “Bye Mom” quite confidently. It was a similar story as we parted at the leaver’s assembly during freshman orientation week. We had been told that we would need to say our goodbye’s at the end of the ceremony. The parents were to exit to the right and the students to the left. Again, she said goodbye with a glint of excitement and adventure in her eyes. This time, she lingered though….she wanted to make sure I was going to be okay.

2. Acknowledge and Understand your Feelings of Loss (as well as your Joy, Relief etc. that may also be there) and Process these Feelings
It is important to acknowledge and understand our sometimes contrasting emotions and allow ourselves the space to work through them. Although I didn’t cry when we parted, I have had my share of emotional moments and have found that the tears will come at the strangest of times. I have always heard that the ultimate emotion is one in which you cry and laugh at the same time. This has been my experience of “letting go”.

Leaving a child on a college campus can be one of the most joyful events as well as one of the most difficult in the life of a parent. We raise our children with the hope they will one day be healthy, functioning adult members of society. When we see that they are ready to “leave the nest” and that they are happy and excited about the new adventure that awaits them, that is indeed joyful! Yet, at the same time, even when we do this successfully we still have to navigate our own emotions and feelings of loss. In addition, we often need to help younger siblings navigate these emotions as well.

3. Feel Free to Grieve in your Own Unique Way.
One thing to remember is that all members of the family may not grieve in the same way. It is important that we know this and anticipate it so that we are better equipped to be compassionate with ourselves and other family members who may grieve differently than we do. In our family, I did my grieving throughout the summer prior to our daughter’s departure. My husband found it more difficult after we returned home from the college drop off trip.

The night after we returned home from that trip, our two younger daughters ended up comforting one another as they cried themselves to sleep. Just last week, our youngest daughter mentioned to me that she misses her sister and she asked me, “When will it stop hurting?” I responded, “I don’t know, Sweetie. I can’t answer that”.

Grieving a loss is unique to each individual. We just need to allow ourselves to process these feelings as they emerge and eventually, with time, we will feel better.

4. Allow your Grief to be Recognized but Don’t Make it your Child’s Responsibility
It is okay to let our children see us cry and let them know that we love them and will miss them but we don’t want them to feel responsible for our grief. As I watch our daughter’s freshman orientation video online I can well up with emotion. One of the most meaningful sections of the video for me is when the parents say goodbye to their sons and daughters. The responses are so different. Most of the students are so excited and ready for a new adventure whereas the parents are trying hard to let go and muster enough strength to just walk away. It is like a role reversal of sorts. The parents are tearful and clinging to their children with the most heartfelt of hugs while the students are there smiling and comforting Mom and Dad saying, “It’s okay”. “It will be okay”.

Our daughter was concerned about how the transition would be for us, but especially for me, truth be told. She had heard stories about other mothers who had come home from dropping their children off at college who had run straight to their child’s room upon arriving home only to flop on the bed in a flood of tears. And, if that happens to us, it is okay. Our daughter, though, did not want to hear that I had done that. She had tried to prepare me for the return home by pleading with me not to go into her room. When I went home, I did go in her room and I was okay! When I told her this, she said that she had been praying for me! All I can say is, Wow! The power of prayer!

As we drop our older teens off at college they are about to begin a huge adventure and they have their own mixture of emotions to deal with. We don’t want them to have to worry whether or not we are going to be strong enough to take care of ourselves or if we will be okay without them at home. It is therefore important for us to process our emotions with other people who understand us and love us. I would recommend your spouse, a trusted friend, a counselor or a pastor.

5. Learn Life’s Lessons through your Loss
The day before we flew out to get our daughter settled in at her new college, I went out for a run around our suburban neighborhood. As I was running and listening to my music, I experienced such a mixture of emotions. On the one hand I was so excited for my daughter and the adventures that lie in front of her, and on the other hand, I felt a pit in my stomach sadness that life was about to change. At that very moment, I felt that “Still Small Voice” remind me that He will be my strength when I am missing her. He will be my strength when I am lonesome and when I am reminded of how far away she is.

bible-verse-2-corinthians-my-grace-is-sufficient-for-you-for-my-power-is-made-perfect-in-weakness1
2 Corinthians 12:9

God’s Grace Is Sufficient

But he said to me, “My grace is sufficient for you, for my power is made perfect in weakness.” Therefore I will boast all the more gladly about my weaknesses, so that Christ’s power may rest on me”.

One of the most important things that I have learned during this whole transition is that I need God’s help to navigate through the different season’s of life. I am thankful that I have a God who can help me through this transition! I am confident that when I turn to Him, I can successfully adapt and get used to our “new normal”.

6. Grieve with Hope and Focus on the Excitement and Discovery that is Ahead for your Son/Daughter
When I miss our daughter I like to try to balance out the emotional side of the mind with the rational side by focusing on good things.

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Philippians 4:8
“Whatever is true, whatever is noble, whatever is right, whatever is pure, whatever is lovely, whatever is admirable-if anything is excellent or praiseworthy-think about such things”.

When I focus on the good things about our daughter being away at college, it really helps me. I often remind myself that our daughter is happy and that she is adjusting well. The college she has chosen is a perfect fit for her and for her personality and interests. We could not be more happy for her.

One of the most poignant memories for me, apart from saying goodbye to my daughter, was when the Dean of Students commissioned the eager, yet anxious freshman faces in front of her, saying:

“Today you join this community and commit to pursuing knowledge of the world, of others, and of yourself. This is an exciting moment. Know that you are here to grow and that your job now is to invest in those of us here with you. We know that you are truly capable of bringing yourself to this pursuit and we know that the most beautiful thing you will produce here is you”. (Dean of Students at our daughter’s college).

It is hard, but it is good. She is creating something BEAUTIFUL!

We can commit to this journey and we can grieve. At the same time, we can also live with optimism and hope, holding on to the One that created us and our precious daughter.

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