Supporting Someone in Crisis

From Spectrum Personality Disorder Service, Victoria

How to help when your family and friends are emotionally distressed? 

In times of stress, people with BPD may become easily overwhelmed. They want ‘something’ from us, but they may not know what they ‘need’ — and the only way they may know how to communicate is through anger or other challenging emotionally-driven behaviours.

Often, this anger or challenging behaviour expresses a need to feel heard, feel understood, and to make some sense of their intense emotions. They also need to feel that someone really cares. Providing calm empathy and support is helpful. It’s also important to remember that during these times, the person experiencing extreme distress is not able to think or act logically, no matter how obvious a solution may seem to others.

Stay calm and compassionate
When distressed, people with BPD often try to push their overwhelming emotions onto others — usually those they feel closest to, or whom they believe will not abandon them. If we respond by allowing ourselves to also become distressed, the person with BPD can easily become even more distressed, and an already difficult situation may become worse.

Try to avoid becoming defensive
If the person accuses or blames you, admit to what is true about their accusations, or acknowledge that they believe they are speaking the truth. Arguing and justifying your position will only make things worse.

Acknowledge their distress
You don’t need to agree with the person or think that their behaviour is appropriate. However, aim to actively listen to what they are saying (i.e. the meaning behind their words/actions). To determine you understand what they’re saying, ask clarifying questions (e.g. ’I’m not sure if I understood you properly and I need some help here. Do you mean………?’ or ’I notice that………… Is that how it feels for you?’).

Take some ‘time out’
You may need time to consider what the person has said before responding. Sometimes, shifting the focus is helpful (e.g. move outside, or ask if the person would like a cup of tea). The focus needs to stay on the other person and their needs, not on the ‘doing’.

In some instances, it may not be useful to continue a conversation when both of you are upset. If this is the case, tell the person you will leave the room / go for a walk / a drive around the block and come back, or ring in 5-10 minutes. Encourage the person with BPD to use some strategies to calm themselves down whilst you are gone. Make sure that you return, or ring within the time frame you state; otherwise you may inadvertently reinforce the concept of abandonment.

Have a support person you can ring
During a crisis, you’re likely to be feeling quite distressed and uncertain about what may happen in your absence, particularly as it’s possible the person with BPD may self-harm as a way of managing their distress. It may be helpful for you to have a support person that you can ring to help you to debrief and to support you. It might also be a good idea to have another place to stay, if it becomes necessary.

Develop a plan
For you: It’s just as important for you to learn strategies to calm yourself in times of stress as it is for the person with BPD. Try deep breathing, counting backwards, visualisation, or whatever works for you. When you’ve calmed down, return to talk to the person as you promised.

For the person with BPD: Having a crisis management plan can be extremely useful. This plan should be developed when the person with BPD is calm and peaceful. It should include input and feedback from a mental health professional/s, as well as the main support network (family and/or friends), and an extended support network where possible. Developing the crisis plan should include discussion about appropriate and inappropriate behaviours, and the consequences of these. The plan also needs to be clear, so all carers and supporters understand what’s expected of them.

Sitting down and discussing the triggers for distress will help others to understand what is happening for the person with BPD. This may also highlight ways to minimise or avoid these triggers.

Be consistent
If you’ve previously agreed to some boundaries, be consistent with them. However, avoid making new boundaries during a crisis. Boundaries should be around your own behaviours (what you will/won’t do), rather than a punishment or an attempt to control another person’s actions.

Self-care
In order for us to care for others, we need to care for ourselves. Making sure we have enough sleep, regular exercise, good nutrition, and engage in activities we enjoy, will help us remain as calm and as focused as possible in times of stress and to manage difficult situations more effectively.

However, sometimes we may inadvertently get emotionally involved in the crisis and respond inappropriately before we know it. If this happens, don’t be hard on yourself. Recognise that you’re doing the best you can at this particular time. It’s always possible to come back and apologise, admit you could have managed it differently, and start over.

Personal safety
Staying safe is essential for everyone during a crisis.

When faced with verbal and/or physical abuse, reinforce that although you can see the person is distressed/angry/upset, it’s not okay for them to yell or rage at you. Nor is it appropriate for them to threaten, throw things around, slam doors when they’re angry. Be prepared to (calmly) stand your ground, and maintain your self-respect if you feel unfairly attacked.

If you become concerned for your own or another person’s (especially children’s) safety, leave the scene immediately and dial 000.

Have crisis phone numbers readily available — on your phone, on a piece of paper in the car, or with a friend — so that you always have access to this information.

If the person admits (or you believe) they have taken an overdose, engaged in other potentially lethal self-harm, or are suicidal, call 000. A situation-by-situation decision will need to be made concerning non-lethal self-harm.

Image by Felix Mittermeier on Unsplash