Suicidal Ideation and Self Harm

Q1: How to deal with unrelenting negative thinking?

A: It’s about shaping behaviour. Do what you can to ignore it, and praise everything that is good. Model ignoring. Validate if it goes on and on. We are driven to look at the negative stuff – put effort into looking at the positive.

Q2: Should we take the same approach as in Q1 with passive suicidal ideation?  Our son aged 29 doesn’t like us to be involved in his medical appointments. He goes doctor shopping, spends his days at home or at medical appointments. Says “they don’t know what they’re talking about”. He thinks he has long covid. Does not accept our validation.

A: No, not the same approach (as for negative thinking.) Validate if you can, for example “that sounds like…” or “I’m listening…”

There must be something to get up for each day. (He has a dog.) Does he walk it? (He recognises that he doesn’t have the strength to walk the dog every day.) Is this the time to withdraw your involvement? He’s an adult. He must take carriage of his life. If you don’t help out with the dog walking, would he do it? (He has the capacity to do short walks. He says “don’t you think I haven’ tried that? It doesn’t work”.)

Consider…that BPD has become part of who he is. He may be thinking “Who am I without BPD? What happens if I get well? I will lose these things.” This can be cyclic. Use incremental steps.

“I care for and love you. I can do everything in my power to keep you alive, but I can’t keep you alive. That’s on you.”

Some people need longitudinal therapy.

Q3: What if we refuse to give her money?

A: What behaviour do you want? If you give it, will it enrich her life in some way OR is it solving a problem she’s created? Ask yourself what behaviour you want to shape her.

Q4: I can name many of my daughter’s interests. How do we get her to the point where she can use her skills? Is it about verbalising it more?

A: If she says she didn’t do something well, she is really saying is ‘Validate me so I know I can do it.’ 

Think about the meaning behind what she is trying to elicit from you, that she can do for herself. 

You want her to generate her own self-validation. We all need to self-soothe, self-validate. Negative self-statements serve a purpose – look for it. We all need to get something out of what we do and say.

Q5: Why is this common in people with BPD?

A: Being protective is great, but if too much, they can become fearful of the outside world.

Q6: You need to build a relationship with the person you are trying to help. If they say they don’t want it, what can we do?

A: It’s a choice to be with me, see me. My deal is you have to participate.

Q7: I manage to get them there (to appointments) but not through the door. What should I do?

A: Ask the psychologist to do a phone consult instead, so that your person can see and hear them without having to go out.

Q8: My daughter blames me a lot. She says she feels not loved enough. She also says this to her psychologist. How do I deal with the blame?

A: Blaming you, or internalised? The psychologist can say “I think your parents did the best they could with what they knew.”

In hindsight, sometimes we do need to apologise. No-one’s perfect – we do the best we can. Try to think about what she really wants instead of saying that. She avoids. Say “ I really feel that there are times you blame us. The only person who can change that is you. How can we help you?”

Q9: My granddaughter has always been anxious, and the anxiety has grown over time. How much should we tolerate, and when should we step back?

A: Say “I’ve noticed that when we go to the supermarket, you are anxious. How about you do the x aisle and I’ll do the y aisle?” 

Sometimes we try to do too much. It is overwhelming, almost like an attack – ask what’s happened today.

Q10: How to respond to “These people are judging me”

A: Ask what is making them feel like that. To be able to access her thinking is a real skill.

Q11: I organised a great weekend but since then she has not been back in the house. What she said about the event wasn’t true at all. She’s lying. It feels like a real slap in the face.

A: You felt hurt, disappointed. We often try to avoid saying so. Say “You really hurt me, I was looking forward to….I’m so disappointed.” Look for the reason behind the behaviour. The expectation would have been to have fun, and be connected. That may have been too much for her right now. It’s easier to bail than to say this.

Q12: How to approach where there’s coercive control and an eating disorder – they’re trying to regain control.

A: Eating disorders are all about control. Can be seen as self-harm. They have a sense of powerlessness.

Q13: Sometimes he gets overwhelmed when he can’t get the basics done during the day. As much as I day it doesn’t matter, he picks up that I’m upset, then he gets more upset. How do I manage this?

A: You are not responsible for his comfort – he’s responsible for that. He needs to work out his own self-soothing strategies, that help him self-regulate. There are lots of suggestions for this online. Is he using his DBT skills? (He gets very distressed in some situations – gets very angry.) Look for the trigger. Is in his own thinking. He needs to use his DBT skills. He might need to do a DBT refresher course. Yes, he has significant trauma to make him think the world is a terrible place. You’re doing all you can to help him go out and enjoy himself. All clients with BPD that Deb has seen have had significant trauma. Treat the trauma first, to free people up, then treat the BPD.

Q14: Why is SA so short of psychologists?

A: Not enough university places available to fill the gaps. Our population has grown exponentially. Public psychologists are paid much less than private. Private psychologists have better conditions. SAPA needs media coverage to put pressure on the government – increase training places and look at conditions. If things don’t improve public sector psychology won’t exist at some point in the future. If no better deal, there will be a mass exodus of public psychologists.

Caution: these notes were taken by an audience member, based on their understanding of Deb’s presentation.