Movie: “Back From the Edge” – Borderline Personality Disorder

I just recently watched this video on Youtube. I highly recommend it to everyone: other clinicians who work with BPD or who want to learn more about it, people with BPD, people with loved ones with BPD, and those who know nothing about it.

The good news is that there is finally scientific evidence that Borderline Personality Disorder is actually a biological even hereditary illness not that different from diabetes or bipolar disorder. Those suffering from it are relieved to find out what is “wrong” with them and that it is not their fault that they suffer so much, that there is a name for and description of what they struggle with and they are not alone with it. I am especially glad to see them cover the whole issue of diagnosis and show how people who find out they have BPD are so relieved and also feel that they are understood and that they now know what is going on with them and because it can be explained very precisely and all their “symptoms” are mentioned and described in a way that they resonate with the whole diagnosis, there is great hope for them to recover fully and lead happier, more satisfying lives and have better relationships and hope for love with others.

I think this is a great example of the usefulness of diagnosis and the DSM 5 (the diagnostic tool for people in the mental health and substance disease field). It argues against people’s beliefs that some diagnoses are not good and make a person feel worse or sentenced or that having BPD and being told you have it means you are “one of those crazy sick people”. It also helps people encountering BPD in themselves and others have more patience and understanding of the terrible self harm behaviors and very extreme amount of suicidal thoughts, wishes and attempts.

In terms of treatment and hopes for recovery, the movie shows how people benefit greatly from the most documented and researched treatment: DBT, Dialectical Behavior Therapy, founded and invented by Dr. Marsha Linehan. There is also brief discussion of other treatments, especially psychodynamic, however, they leave out a newer treatment called “Mentalization”, maybe because it wasn’t well known when the movie was made. I still don’t understand much about Mentalization, except that it was founded by a psychoanalyst but is not psychoanalysis. I believe it focuses on cognition and accessing the reasoning part of the brain to get the patient out of the amygdala, which is the “fight or flight” response; people with BPD have different brain chemistry from people with “normal” brains. The reason they are so highly reactive, sensitive and emotional in response to interactions with others that other people do not react to or receive as hostile and dangerous is that their brains are wired differently and thus, while ill, people with BPD spend a lot more time trapped in the amygdala. With mentalization, I believe there is some emphasis on learning about responses of other people to the patient’s behavior or reactions and learning to look more neutrally at interactions with others.

Anyway the basic principles of DBT therapy are explained and patients describe how it helped them to learn to self regulate and decrease their extreme symptoms. The movie is not an exhaustive description of DBT as it empasizes the experiences of people with BPD, before effective treatment and after as well as their family’s experiences before and after.

New Book on Depression; Check out this link!

New Book on Depression; Check out this link!

I subscribe to “Brain Pickings Weekly”. Last week they had a great post about this book called: “The Unaddressed Business of Filling Our Souls: Mood Science and the Evolutionary Origins of Depression”
by Maria Popova

She discusses the book by Jonathan Rottenberg “The Depths: The Evolutionary Origins of the Depression Epidemic” and provides really great images of drawings about depression.

Please check out this link for more info!

I disagree; I have parts! A Short Teaser of One of My Favorite Topics…

This is a short post about a big topic, but I will start it going, as I was very annoyed by the following:

In an interview, Mark Epstein, psychotherapist and Buddhist, who has written numerous books about those subjects said,

“In a third example, I was speaking to my therapist about how ‘”part of me” was angry and “part of me” understood that I didn’t need to be angry. He looked at me with barely disguised disdain and said, “Mark, you don’t have parts.” This has served as a koan for me over the years. “I don’t have parts? What am I, then?”

I disagree. I don’t know about him but I have lots of parts. There’s a difference between being split and in conflict with yourself, and parts of yourself, and having different parts of yourself that are all aware of each other’s existence. Carl Jung thought the parts were the Shadow, the Persona, and the Anima/Animus, but I think we all have our own personal parts. 

Katy Perry wrote a great song called “Part of Me”. I remember first hearing it not in her voice but from my seven year old patient who was singing it while we made art, “This is a part of me that you’re never gonna ever take away from me…” It was great to hear her sing this in the session, and see her strong part getting stronger. When I hear someone say, “Part of me wants to do such and such,” and then dismiss it, I say, “Wait a second. What is that part saying to your?” I think we need to dialogue more with our parts and be more comfortable with all our parts and they are definitely not an illusion. Maybe the murderous part in me is part of my shadow, but it is not all of my shadow, which consists of many parts, and once that part comes into the light, it is not part of my Shadow, not anymore. We have parts that are other genders, and parts that are not gendered. Some of us have animal parts. I think I have a spider part of me that likes to weave webs.

In a dream, all your parts show up in the form of different people, objects and other beings. If you dream about holding a knife, you are also the knife. If you view the knife as a part of you, you may have a dialogue with it and find out what it wants to do for you or what kind of energy it is inside of you…

Legos and Love

At the end of a post from last month I said, “The philosophy of playing legos, contributed by a five year old, to be explored in another post.” That old post was about a death but more about life.

The legos come from a parent’s story: He had to tell his five year old about a death of a loved one, and there was no right time to do it. With his partner they decided to do it before a play date, just in case she would need to distract herself, forgetting that children have a built in healthy “time proportion to topic’s seriousness”.  (This is true of any conversation when the child says very directly, “Ok. let’s talk about something else. THink of something totally different,” direct communication that she has had enough of  it. Actually great teaching for adult relationships, knowing when to stop “talking” about a subject and just drop it, and if it’s serious, change to something fun. She was playing with a legos set and they told her that the person had died. For a moment, he said, her face was the saddest he had ever seen and his heart broke. It lasted about a second and then she said “let’s play legos.” and proceeded to continue with her legos, completely engaged in the new moment.

This is a great lesson for young and old about the balance between sadness and darkness in life and the beauty of play, flow and being in the moment, fully connected to the here and now. Children naturally are better at this than adults. We need to learn both important skills — to shift to the legos more fully and to feel our feelings more fully.

A long time ago, at a job long far away at the beginning of my journey as a therapist, I worked at a CDT for adults with chronic mental illness. I had a caseload of patients and one of the groups I had to do was called “Primary Group”. It was at the end of the day and involved all of the people on my caseload having it in their schedule to come to a room and have a group with me, their “primary therapist”, a group that was not very defined or specified. I probably had between 25 and 30 patients, and usually around 15 or so showed up; I could never predict who or how many would be there. I had a music player and music and the options of doing anything with them.

For some reason this group caused me a great deal of anxiety, even though I was quite experienced with running all kinds of groups that had nothing to do with art therapy, from “Smoking Cessation” to “Walking” to “Music Appreciation”, “MICA” etc. as well as many other talking or activity oriented groups. Anyway, I don’t remember what I did in my primary group at the beginning, but I remember being totally stumped by it. What to do with these people sitting around a table in a room besides play some music and figure out who wants to hear what. I thought I was supposed to come up with something, as they looked at me like people sitting in a restaurant waiting to hear what’s on the menu, but the waiter is not a stranger, it’s their therapist. Very stressful! Giant expectations (my own) of doing the “right thing”…

I talked to my supervisor a lot about this group, and I remember one thing she said that stuck with me and echoed something another supervisor said in much different kind of group I was in at another time in my life. “You are working too hard. Just show up. That’s all you need to do.” Huh? Ok. Worth a try. So I made an effort to throw everything in my head out the window, try to keep my mind open and myself grounded and just “showed up” to the group and did nothing. It worked. The group felt less uncomfortable and more enjoyable. I don’t remember doing anything much or what happened, but it made sense.

Now, thinking back on it, as a parent, I realize the wisdom of those words “Just show up. Don’t do anything. Stop working. Really just be PRESENT.” The number one thing children and adults say about their experiences growing up is that they were happy when their parent was there with them and really “present”, and they always missed their parent when they were at home and the parent was not in the home, as all kids are aware of when their parent is in the room but not really there. There have been many studies done with very upsetting film footage of parents with their kids, engaging with the child, and then what happens when they are told to ignore the child. In just one minute, your heart breaks watching it. (I was shown one of these at the Trauma Conference I attended recently, and the whole five minutes was torturous and traumatizing to watch… I really wanted to run out of the room.

This is the most important thing a parent can do. Being in the here and now with your child, playing with him/her, listening, responding, giving physical affection, doing legos. That is really all they want. Because it involves the true acts of love that matter: affirmation and validation of the child’s existence and separate Self, and of his/her feelings, physical affection, quality time, giving and receiving.

I had been thinking about this concept when I saw a great Facebook post from a mother that sums this up:

“Taking your kid to ice skating lessons on a beautiful day in Central Park sure does beat working!”

I am sure the child, whatever age he is, would say the same thing in his own words, that he wants his mommy or daddy to be there and to stop working as much as possible. Not that working is inherently bad or good, as long as parents spend real quality time with their kids; however, I have yet to see a child complain about their parent doing things with them instead of working at whatever job or project. I have seen six year olds at birthday parties where most of the parents stayed at the event, and the kid whose parent dropped her off is sitting in the corner, with a heartbroken face, not wanting to join in any of the other kids’ activities. When asked what’s wrong, this kid always says, “I want my daddy (or mommy) to come back.” They eventually manage to mellow out a little if the party is long enough, but watching the “reunion” is always so touching and every parent who was there sees the child run to their parent and get scooped up, feels a great feeling of relief. At one party, there were many therapists in the room and one of them said to me, “There is nothing we can do to help her except let her feel upset and wait.” It was true. Children want their parents to be there with them, even when they don’t want the parent to join in their play or activity. They want the security of knowing their parent or parents are there, engaged, witnessing or joining in when appropriate.

I have adult patients who say that now that s/he has become a parent, s/he doesn’t want to “miss” their child’s passage from baby to toddler to school age child. “My parents were never around, and when they were, they were always busy or preoccupied. I remember wanting them so much. When I take my daughter to the park, I am so happy to be there, there is no place on earth I would rather be, and nothing I would rather be doing.” That really summed it up; what is really important in life when you choose to have a family of your own, and why there are more daddies in playgrounds and at school pickups now than ever before, not to value one gendered parent over the other, but it seems like society is trying to strike a balance, and it has only just begun as these dads are a small percentage of all dads. These are people choosing to play legos with their children, not in an office without them. They are the unsung heroes of our busy success oriented society, the parents that want quality time with their kids but also quantity. They want to show up and be with their child, to come to the events at school, to take their child to a class and pick her up and spend the whole day with her, who always choose being with the child over doing something “grown up”, when possible.

A patient of mine quoted to me that she found a definition of love as five acts, just do these five things and you are really loving to the other person or animal; to paraphrase her, it was:

1. Affirmation/Validation (to me that means being with the child you have, not the child you want to have or who you wish you were or anything but this particular unique and wonderful being.) And validating all emotions, not separating them into positive and negative, ie. “It’s ok that you are angry right now.” How many therapists can agree that this one sentence can take years of work if the patient was not taught that their feelings and range of feelings and intensity of feelings were all ok.

2. Quality Time: of course, you cannot love anybody, dog, cat or human, if you don’t spend quality time with them — this is where the assignment is the same as what my supervisor said, to show up and engage in the here and now, to let go of judgments, preoccupations, worries, even your own troubles and anxieties, just show up and, as meditators say, “Do nothing”. “Be with”.

3. physical affection: this is of course true in any love relationship from parent/child to human/dog/or cat. Especially with furry animal companions, most of the love is conveyed through touch…It is pretty simple, but I have heard of many brilliant people who have failed at this simple act of love. “My parent didn’t ever hug me or show affection to my other parent in their marriage.” or “My parent hugged  and touched me, but it wasn’t a warm loving kind of touch — I felt like my life was getting sucked out of me  and I couldn’t breathe.” Holding hands with your child as s/he falls asleep, one of the best feelings there is…

4. Giving and Receiving: this can be in all kinds of contexts, real loving acts of giving and receiving. I posted about the Valentine’s cards. It was very special for me to give some of my patients Valentines’ cards I made in the session with them while they made their own card.

5. Acts of service: sort of similar to number 4, I would translate this not as volunteering at an animal shelter, although that is a wonderful thing to do, but simple things like picking up pizza for your family on your way home to work, or baking with a loved one or for a loved one. Taking someone home from the hospital or visiting someone in the hospital. Going to your child’s school dance/music performance or to their school project or bringing cupcakes in to your child’s class to celebrate his/her birthday with the class. Participating in the “cooking” lessons, when the teacher asks for parents to come in and cook something, or coming on school field trips…

That’s it. Love is really that simple. Be Here Now With the Other and Connect Fully. We all have the rest of our lives to try to do it, to keep working at it and improving, as it is not easy. The simplest things or truths of life never are. But they are worth the effort and constant process…

Boxes, BOXES, boxes! Always Great for Art Therapy!

The box is one of the oldest and most used “art therapy” activities and can be used with just about anyone, age 3 to 103, groups, individuals, families, couples, supervision groups, in any setting, including challenging settings like home visits…

I reblogged a great post about “safety” boxes which gives some great ideas and info for using a box in a healing and therapeutic way that can be even life saving… I happened to see this post recently while in the middle of making boxes with many different patients and art therapy group as well…

One of the most common box projects involves utilizing the box as a kind of “self-portrait”; on the outside and top and bottom of the box, choose images or other materials that express who you are on the outside, and on the inside of the box, who you are on the inside. This can mean so many different things to different people, but it allows for hiding and the idea of having privacy and a space that only you know. There is always the option of doing things inside the box and then closing the box so there is no access to the inside. Otherwise, the top of the box can have a multiplicity of meanings and ways it is connected to the bottom of the box.

I have found the above idea to be somewhat limited and sometimes too personal more recently, as I noticed that making “Affirmation” boxes seems to appeal to lots of people and can help with self care and increasing self worth, confidence, pride and creative productive thinking and combat destructive thinking and urges. The idea is to decorate the box and then write down affirmations or other positive thoughts or even quotes you find inspiring and put them in the box, to use the box on a daily basis to remind yourself of whatever you have chosen to put in your box. It makes the box have a feeling of specialness and also gives it a use and interactive quality that some other kinds of box directives don’t have. The “WISH” box below is one of my patient’s interpretations of this idea. You can mix wishes, affirmations, goals and things you enjoy into one box. The possibilities are limitless…

Boxes come in all shapes and sizes, and I like to have a variety available to allow for a lot of different options: shoe box, rectangular and square kleenex boxes (these have some interesting history, as the person choosing one knows on some level that probably the kleenex in this box was used by other patients and themselves as well as the therapist), jewelry boxes and typical store boxes of all sizes, boxes with tops attached that can be folded to become a box. There are all kinds of boxes that items come in like camera boxes and others. Food boxes like cereal bar boxes and other such boxes can be used as well. I also always have on hand very small “papier mache” boxes, cardboard boxes that I purchase in shapes of a heart, square, hexagon, circle and oval: ( They also come in larger sizes.

In the photos below I have included different boxes in various stages of creation. The majority are ones done by me in session with different patients, and the box with the word “WISH” on it decorated with decorative duct tape was done (not finished) so far over 2 sessions by an adult female patient.

As you can see, all sorts of materials can be used to decorate the box. Like the altered book project the box often presents as an object you are drawn to “cover” to begin with to have something to add to and to kind of transform the box into a new kind of box, especially if it is an obviously recycled box like a kleenex box.

Some great materials for boxes include: fabric and felt, yarn, magazine photos cut out of various types of magazines, words taken from my “Word Box”, decorative and colored paper, foam pieces, old drawings or paintings, etc. Masking tape and duct tape and other decorative tape have become commonplace items that are great for covering boxes, as shown by the box below with the duct tape on it and the one with only masking tape on it. To embellish the box you can use so many kinds of materials from rhinestones and jewels to pom poms, little mirrors, wood pieces, buttons, beads, glass pieces, rocks etc.

Other materials for the box include materials to put inside the box on the bottom if you want your box to be some kind of nest or “place”: sand, rocks, fake fur, feathers, twigs, glitter, old flowers, paper that has been cut into tiny slivers in different colors. I found some of this paper at starbucks, it also comes with some gifts, I don’t even know what it’s called but it gives a feeling of a nest right away…You can put such items in the bottom of the box and also hide objects in these nest like things.

I will be posting more about boxes as they are so fascinating; they also lend themselves to parallel creating in the therapy session. I often make boxes alongside patients with whom I might normally not make any art…










How to create a self-harm safety box…

I found this great post a while ago from this wonderful blog, and I have been meaning to repost it here for a while, as I am making a lot of boxes with people lately, mostly “affirmation” boxes, which could be considered “safe space”, as well as boxes that are more directly like the one in this post, boxes to have at your workplace when you need to feel calmer, or have a quick escape, more like “5 senses” boxes. All these kinds of boxes are great, and as an art therapist, I always welcome new ideas for decorating and using boxes in a healing manner…

All that I am, all that I ever was...

Once upon a time, when I was much a much younger (and sexier) man than I am today, I used to own a box. On a purely aesthetic level, there was nothing special about this box. It was just a run-of-the-mill shoebox decorated with Doctor Who stickers, newspaper cuttings and images of the great Australian actress, Toni Pearen.

What was special about this box was on the inside, for I’d filled it with colouring pencils, rubber bands, bath salts, candy, a mini-colouring book, a couple of novels, a DVD and some (slightly more) risqué images of the great Australian actress, Toni Pearen.

For this box was my safety box; a box I could turn to when my self-harm urges grew so intense that I needed some serious distraction to stop me from injuring myself.

Over the years I owned this box I lost track of how many times it prevented…

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NY School of Visual Arts Art Therapy Exhibition: Let Grow

On Friday the 28th, I was at SVA (NY School of Visual Arts) campus for their annual conference “29th Annual Art Therapy Conference, Trauma, Art & Social Constructs”. A post could be written about the conference and the speakers, but this one is about the student show. I went over to the exhibition in another campus building to see the annual art therapy show, a group show of student and client artwork, entitled, “Let Grow”. The department describes their annual exhibitions in the context of the graduate art therapy program curriculum as “Exhibition: Internship coursework includes participation in a client/student art exhibition held each spring at an SVA gallery in the Chelsea neighborhood of NYC. Applying social action theory within an art therapy framework, students consider therapeutic goals and the role of art and the artist in a community context. Students and clients develop their identity as artists and examine the limitations of socially constructed labels and the impact of institutional policies.” This exhibition luckily did not tackle the last part about socially constructed labels etc., and was more personal and focused on the relationship with art therapist, student, client and art making process.

The title of the show was an obvious play on words, “Let Go”, which I think meant to engender exploration of the idea that you “let go” in the art making art therapy process, you also thus “grow”, and the student or art therapist facilitates the client’s process of letting go and growing. This concept also brings up the idea of “letting” grow, allowing oneself to grow with, I think, the question of, do you let yourself grow or do you sometimes get in the way of growth by not letting go? which is an interesting concept or question for the therapy and art therapy process. Also, in looking at the show, I wondered whether art therapy has the power sometimes or even often to allow the client to “let go” and “let grow” more easily with less resistance, due to the art making art therapy process itself of allowing the materials to engender movement beyond rigidity and opening up to the messy and not fully controlled creative process with the art therapist present as a safe container for the chaos of letting go and growth in the individual or group…

I enjoyed the wide range of materials at the exhibition especially. I wasn’t there long enough to really take in each piece and make sure I took photos of all the work, but I am providing my photos of a majority of the work it seemed to be a mixture individual or group client artwork, and student art work in response. The pieces could have been arranged in a better way so the big 3D ones did not get in the way of the smaller 2D ones, but it was easy to walk around the room and get a look at each piece anyway. Also, I am pretty sure the department did not include direct description of what the setting was for each client(s) piece and what more about the clients, even whether they were children or adults, which might have been good to see and connect more with the artwork. Client’s names with last initial were supplied, so you could pretty accurately guess the gender, but I did not include names of clients or students in this post. I took photos of a lot of the work, which I am sharing on this post. This lovely exhibition serves as an example of how art therapy inspires such a range of images and media and topics. I photographed some of the descriptions of the process but not in such a way that I am sure of all of them what goes with which image, so I can copy the quotes to inspire and engender further exploration.

This student’s quote below in particular one addresses the theme of the show, “Let Grow”: It goes with the photo of the multi media piece with cups and paint dripping down to a flat kind of board container that has crayons in it. The image seems to address the theme, with the containers maybe representing group members and the paint splattering down onto a tray with crayons expressing the “messy feelings” that get contained in the safe space she describes.
Student: “Structures take time to build, but once established they can provide safe, containing spaces for letting go. With the right support, we can allow ourselves to melt, mix, explore messy feelings and ultimately grow.” This pretty much sums up what I was pondering above and states it in a succinct way that addresses the art making, the art materials and the idea of structure.
There is another description that goes with the balloon piece and the silver oxygen tank on the floor which was placed next to the balloon pieces on the wall, of which I have shown a few photos. This quote is from the client:

These balloons represent
My daughter
My anxiety
My anger
My Father

They keep me down, but I’m ready to rise.

The student art therapist writes in response about her piece, the oxygen tank looking piece painted silver:

The pieces signify listening, empathizing, guiding and encouraging.
Together they become the air tank that supplies growth.

This was a very interesting juxtaposition of the student art therapist representing her relationship with the client through a very direct response to the client’s artwork, and brings up an interesting image of the “air tank” supplying growth. Actually I am confused as to whether the entire piece is some kind of symbol of growth, or perhaps the student made the air tank piece with the client which would give more clarity to the artist statements…

The following is a student quote which goes with the white container piece, whose materials I am not sure about:

“When I let go of what I am, I become what I might be.” –Lao Tzu

After multiple attempts and setbacks, through the frustration, we can find what works. This place offers flexibility, durability, and support. Through the process, we can grow and leave this place feeling more resilient.

These quotes below accompany the box with the eye and the piece with the string and words in the case underneath the box. The client art work is entitled “Visual Clarity”:

Besides visually seeing more clearly, there is a mental clarity seen also. I’m trying to represent stages from one place to another (bad place to good place). This piece was done in a short period of time, which made it more spontaneous. I surprised myself with how well I was able to express myself.

The art work below the box is the student work, with the threads and words spelled out in the piece with the thread that looks a little like dental floss, is entitled “Common Threads”. Some of the words in the piece are support, limits, structure, communication. Here is the student’s statement:

The unfurling reveals opportunity and support, not only within, but also around us. You find new joys and surprises by embracing the unknown and exploring your creativity. From vulnerability comes strength. From honesty comes clarity. We realize this and can take the next step.

The student work, the piece that looks like a fish tank with multi media, entitled “Swim” seems to be expressing the client’s feelings and perhaps the way the client can feel safe in the supportive relationship with the art therapy student through the symbol of the tank holding the fish inside:

He can stare at a fish tank for hours.
The fish don’t bother each other. They don’t fight. They are not afraid.
They don’t hold onto the past.
They don’t worry about the future.
They remain present
And swim, and swim
And swim.

An Untitled Student work, probably the piece that looks like a paper woven container, very beautifully put together:

With patience and love comes progress
Piece by piece, layer by layer
The observer becomes the teacher
With the skills to reflect on life’s patterns
And what it means to build from the scraps.

Quote that goes with the title “Stand Back, Universal Swirl of Worlds!” made by an art therapy group; I think it is the picture with blue and yellow in it and the frame is wrapped in yarn. Even if it goes with a different piece, it is a nice and clear statement of community and the healing power of group art therapy, as well as the idea of the whole exhibition representing “What we leave behind” which connects the students, internships, clients, professors, and art therapy program together:

Working together we each bring our own color into group. Wrapping yards of yarn offer containment and safety. What we leave behind ties us together as a community.






















Memento Mori… Or, The Importance Of Thinking On Death

Another great post from a blog I follow. As I often post on here about this topic, especially our society’s ungealthy attitude towards death and dying….

We're All Mad Inhere

Does this offend your sensibilities?

Lately I read an article in my local paper about how a butcher’s display window had started to garner protest, as the villagers found the hanging carcasses and skinned animals in it distasteful. I didn’t know if I had to be amused or worried.

Another incident was on Facebook, where a girl offered a coffin for sale, in “mint condition with only slight wear from repeated use”. Apparently she had gotten it from her parents, who were performance artists. The reactions on it were incredible; people called this girl without empathy and morals, they literally cursed her to hell, said she had no respect for anyone’s feelings… Only because she was using a public forum to sell a theatrical decor piece (it was a real coffin, but still) related to death.

Or this?

We are humans. We live. We die. We rot and decay. That is simply the way of things. It…

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