CLOSED to new questions AMA 7-22-20 [Ask Me Anything] with the therapist, Shareen Birges and Rory Boutilier answering your questions

@resourcefulLunch7113

Anyone of any age or background can be affected by mental health, and living in an environment where you do not feel comfortable or safe talking about your mental health can feel isolating. Children, teens, young adults, and elderly people have mental health issues, and there are even therapists who have special training to work with people in certain age groups. Some therapists only work with children or teens because they have unique needs compared to other age groups.

If you are struggling with talking to your family about mental health, a good starting point may be to talk to your doctor or a teacher about what you are struggling with. This can open the door to getting the help you need and having someone in your corner with you to talk to your parents about mental health and how it is affecting you can go a long way in feeling more comfortable.

Depending where you live, mental health treatment may be accessible without your parent's permission. In some countries there are laws that state if a person is able to make informed consent and they fully understand what is involved in therapy, they can attend therapy without asking their parents for permission.

Talking with your doctor is a good first step because they might be able to help you right there in their office, or they can make a recommendation for you to talk to someone.

@amusingPlace6317

I am unable to answer your question directly but I hope I can give some insight into finding the right answers. Without knowing your history, how your daughter handles this kind of information, and the relationship dynamic between you and your partner, it is difficult to give an answer because I do not have enough information.

The first question you asked about in the event you pass away, what happens to your daughter's care, that is a question which should be discussed in your family and come to agreement about the situation should it ever arise. Keep in mind depending where you live there may be laws in place that could override a verbal agreement. It is best to speak with a family lawyer about this.

Telling your daughter about her father is another question which should be discussed within your family unit. Depending on the age of your daughter, her understanding of the situation, how she has handles news of similar nature in the past, and how her perspective may on her family may change (or not), are all things to consider.

There is not really a standard age to tell children about their family dynamic, and many families do not discuss it until much later in their child's life. This is all individual choice. If you are worried that her biological father may tell her before your family unit has a chance to talk to her about the situation, it is worth talking with your partner about how you want to approach the topic. If you are unsure about the best way to go about it, a family therapist could help with offering more guidance in this area.

@FrozenGhost

This is a great question and I am sure many people are wondering the same thing. Here is a bit more information about how 7 Cups work with a therapist.

When you reigster for therapy you have a username which you either pick or is assigned to you. When you are matched with your therapist there is an intake system called Sophia; Sophia asks you to tell your therapist about yourself and what brought you to 7 Cups, talk about your goals, and anything else you feel is important for your therapist to know. The information you enter into the registration form on 7 Cups is not visible to the therapist, to keep things as anonymous as possible.

All therapists are legally and ethically required to adhere to a duty to report and duty to protect. What this means is if in the course of therapy your therapists has reasonable suspicion that someone who is a vulnerable person (child, elderly person, someone who has an intellectual impairment) is at risk of being harmed (abuse, neglect, being taken advantage of), or there is reasonable suspicion you are a safety risk to yoursef or someone else (suicide or homicide), your therapist is ethically and legally required to intervene. In the case of 7 Cups, this means your therapist can access your information with the permission of the 7 Cups staff to intervene and protect the public. This is the only way your therapist can access your information, they cannot do so for any other reason.

7 Cups also has a very strict policy against sharing personal information such as emails, social media handles, and contact information. In the course of therapy if your therapist and you work on getting you in contact with someone in your area, you may choose to tell your therapist the city you live in. This will allow your therapist to contact service providers in your area and give you information about what is available. You will not speak to your therapist on the phone, they will not email you, and they will not contact you on social media. The 7 Cups platform is the only way therapists and clients are permitted to communicate.

To answer the second part of your question, yes therapy can help. Each person is different and we all have different needs, so finding the right therapist for you might take some time. The best predictor of a good therapeutic outcome is the relationship you have with your therapist; the better the working relationship, the better outcome you can expect.

Being open and honest in therapy is definitely encouraged, because as therapists we can only help if we know what is going on in your life. I cannot speak for other therapists but here is what I usually ask and the reason I ask these questions.

1. How old are you? (Age matters; is this a problem you have been dealing with for a little while, a long time, 20 years? 3 months?)
2. Where are you from? (country/state/province is fine, there is no need to specify the city. This is important because there are large cultural variations even within a country, and between countries and around the world there are massive differences and attitudes toward mental health, personal problems, and different personal dynamics. Knowing where someone is from is a quick way of getting a snapshot of their cultural background and the societal challenges you are facing.)
3. What is your preferred name? (First name basis. Knowing who we are talking to as therapists helps us make therapy more personal. Think of if I were to say 'It sounds like you are really struggle, pleasantBubblegum6405. Let's talk about how I can help.' or if I said 'It sounds like you are really struggling, Jack. Let's talk about how I can help.'

Ultimately your therapist (whether on 7 Cups or in person) is bound by ethical obligations to keep their work life and personal life separate, and we are not allowed to find out information from other sources other than you. That means your therapist cannot look at your Facebook profile, check out your instagram, or read your Tumblr posts. Even if you give your therapist your full name, address, email, and date of birth, they cannot look at your house on Google Maps, or email you without your permission. The reason for this is because therapists are bound by ethical codes of conduct and we have to work in the best interest of the client. At the end of the day, what you post on social media or what you do in your spare time is largely irrelevant to therapy. Your therapist cares more about helping you work through what you are struggling with than they do about what you share on Facebook. Your therapist is also not allowed to be your Facebook friend, connect with you on Linkedin, or anything like that. This is to keep professional boundaries.

The main goal of knowing about our clients is to know who we are helping and develop a working relationship with them. There is some information that is needed (what problem you are facing), some information that is good to know as a therapist on 7 Cups (name, age, sex, cultural factors, relationship status, social status - do you have lots of support, or very little support?), and there is information that is not needed (Facebook profile, email address, etc.). Any information your therapist has about you should be clinically relevant.

Hope this helps.

Hi @Invisibility101 and thank you for your question.

The stigma around mental ill-health is very real in all communities, however some are worse than others. Many people don't understand mental ill-health and so choose to either disbelieve it, ignore it, ridicule it or a combination of this. Its very isolating and its one of the major contributors to suicide and self-harm. This is why I don't beleive you should do this alone. Having supportive people around you, people you can share your ups and downs with, people who are able to understand and accept you is both very important and, unfortunately, often difficult. This is one of the major reasons people get very good at "hiding" and "masking" their mental health issues.

It is a real shame that your friends are unable to hear the pain you are in the and the struggles you are facing with your mental ill-health. If you find that your friends are unsupportive, you can try looking up some online support groups for people with social anxiety and anxiety panic disorder. This can provide you with a sense of community and help you to feel less isolated.

With your friends its about making a decision around what you want to do. If you friends are unable to support you, then maybe you need to think about what it is about their friendships that is important to you and is it worth you having to hide what is happening for you. I am not saying you need to find new friends, or end friendships, I'm encouraging you to look at what is important to you about friendship and your friends and think about how that does/doesn't impact your decisions around who your friends are.

I hope this is helpful and that you are able to find supports and a support network that helps you live your life the way you want to.

Thanks

Shareen

Hi @admaiorasemper and thank you for holidng me to account! its important that we own our experiences of mental ill-health and be able to communicate this when they are different to others'.

I should have phrased my answer better and I apologise for the confusion. I was responding to the informaotin in the post, which discussed that the person in question was unable to see they had an issue and refused to seek support because of this. BPD can present in this way, with as person being unable to admit fault because their sense of self is so fragile.

For others, like yourself, the unhelpful self-talk causes them to feel always at fault. I think the best way to characterise it is that BPD is a condition of extremes, and can be very "black and white" this or that, however there are also people with BPD who find that they flip from one extreme to the other, at times unable to accept fault and at others always feeling at fault. I apologise again in case you ever felt that I was minimising your experience with my experience.

Thanks again for your question

Shareen

Hi @Glossytears, I'm so sorry to hear how lost and alone you are feeling. Its sounds like to me there may be an element of depression going on and definitely some grief and loss.

I would suggest you speak with a professional, a counsellor, a GP or a psychiatrist. They should be able to support you to find out what is happening for you and find a way to support you through it.

Thank you for your question and for sharing your situation.

Shareen.

@cyanPlatypus6370

I might be able to answer some of your questions about this.

BPD, or any personality disorder, are diagnosed because there is an 'enduring pattern of maladaptive traits which are consistent over time' (or similar wording used in clinical literature). Your first question was does BPD go away? The answer to that is 'sort of, but not really'. Treatment for borderline personality disorder is a huge predictor of positive outcomes for people with the illness. We also know that BPD tends to get better with age, to a certain degree. There is no 'cure' or 'fix' for BPD in the same way there is a cure for pneumonia or a virus, because BPD is the result of different wiring in the brain. Think of it like is there a cure for diabetes; not really a 'cure' because someone who has diabetes will always have it, but they can manage it with lifestyle changes, medication, monitoring their symptoms, and over time it can even go into remission. The same sort of thing can be said for people who struggle with BPD; with lifestyle changes, treatment, monitoring symptoms, etc., BPD can be managed and even go into remission. Medication does not treat BPD directly but rather treats the symptoms fo BPD, most often depression.

If you feel you are struggling with BPD and the symptoms associated with it, speak with a therapist who can help. Over time you may come to notice that BPD is less central to your every day life and more of a background noise. It's a process though, so take things one day at a time. Focus on the present moment.

The second question is more complex, much life many things in mental health. To give you a straight answer to where does BPD come from: we don't know. However, we do know that there are many environmental factors which can increase the likelihood of someone developing BPD later in life. Some of the most commonly cited events in people's lives who have BPD are: a history of trauma at a relatively young age (abuse, sexual assault), lack of or broken attachments to primary caregivers (broken attachments to parents, for example), and unable to regulate emotions (distress intolerance). These are usually observable relatively early in someone's life, early teenage years even.

Now, just because someone has experienced these things does not guarantee they will develop borderline personality disorder. Similarly, not all people who have borderline personality disorder have experienced these things. (This is the 'correlation is not causation' argument). BPD has a family component, so if you have a family member with borderline personality disorder you are at an increased risk of developing the disorder.

The second part of your question is how can a personality be disordered. This is a great question actually and what you said about someone just being who they are is true. A personality disorder is a set of personality traits or patterns (someone's way of thinking and behaving) which are maladaptive (meaning they interfere with the person's life), enduring (mean it does not go away, or the person has little relief from it), and consistent over time (meaning the symptoms have been mostly the same for the whole time). As with any mental illness or diagnosed mental disorder, the key defining feature is what we call a marked negative impact on the individual's functioning in multiple domains. This is a fancy way of saying 'a noticeable bad way of coping or behaving in most situations'. 'Bad way' is not necessarily bad behavior, in this context 'bad' refers to the thoughts you have or experience about your symptoms. Would you prefer to not feel that way? If so, then that is the 'bad way'.

Personality disorders are diagnosed because the symptoms that someone faces create challenges for them in their daily lives. When we talk about borderline personality disorder, one of the core features of BPD is related to the fear of abandonment to the extent that the fear causes the individual to actually act in a way that causes abandonment. When we talk about this as a symptom we usually refer to it as 'history of unstable relationships'.

In my opinion, one of the reasons there is so much stigma and negative self-talk about mental health in general, but especially BPD, is because there is a prevailing myth that people with mental illness are flawed in some way. If that is the case, then people with diabetes, angina, cirrhosis, and astigmatism are all flawed too. Of course, we know that's not the case. The brain is an organ that can malfunction the same as any other organ we have. When out pancreas doesn't work properly it's called diabetes, when the heart doesn't work properly it's called angina or a murmur, and when the liver fails it is cirrhosis. But when the brain doesn't work properly it can be called 'difficult' or 'too much to deal with'.

You're not flawed. You have a unique set of personal challenges, much like many others do. Speaking about those challenges is a huge step in the recovery process, and talking to others who can help is a big step too. You are more than your diagnosis.

You can always speak with a therapist, a support group, or ask someone you trust for resources to learn more about BPD and personality. Be careful roaming the internet for information because there is a lot of incorrect information out there, particularly about personality disorders, and it can do more harm than good.

Kim L. Gratz used to have a number of books and information articles on BPD and related conditions. She is a psychologist and researcher specializing in BPD, if my memory serves correctly. A quick Google search will turn up results about her.

Quick tip: try changing your wording. Rather than 'I have BPD' or 'I'm the one with BPD', try 'I struggle with BPD' or 'I was diagnosed with BPD'. Try to create a clear distinction between you the vibrant individual, and the set of symptoms you struggle with. You're more than your diagnosis.

Hope this helps.

Hi @joyfulWaterfall7622, I can't tell you if you have BPD either, as I am not a diagnostician. What I can say is if you have the symptoms, its probably likely you have the condition.

If you connect with a counsellor, psycholgoist or psychiatrist, and discuss your specific situation and symptoms, they will be better able to answer this question.

I hop you get the support you need.

Shareen

@Hydrangea03

Great question.

Personality disorders cannot be formally diagnosed before age 18 because of the way personality develops over time. In young people (minors, teenagers), they are still forming and still growing and the brain is still changing, so a personality disorder is not diagnosed because it might not be 'fair' at such a young age. When someone receives a diagnosis for a personality disorder there are usually many life changes that happen; therapy, medication, group therapy, etc.

In the case of a minor, it could be a rough patch in life or other circumstances that are causing the same symptoms of a personality disorder to develop. A personality disorder is a set of personality traits which are maladaptive, enduring, and consistent over time.

That being said, if someone has a personality disorder it is not uncommon for them to have symptoms before age 18. By the time they turn 18, someone who has a personality disorder, chances are they now meet the criteria for an enduring pattern of maladaptive traits which are consistent over time.

Another way to think of it is we don't want to risk diagnosing someone who has severe depression with a personality disorder by accident, so it is a cautious approach to diagnosis. Again, it is not uncommon for someone who has a personality disorder to have the traits of the disorder in their teen years, but a diagnosis cannot be made without meeting all of the criteria.