It can be like a destination you reach and beyond that point the world is at your feet. It can be measured by the signposts you pass in the journey towards the life you want to lead.
We prefer to think not of an endpoint, a destination but we choose the metaphor of the journey because it describes the slow change in our lives and ourselves as we move from being unwell to being well.
Recovery is a realistic possibility.
5 Domains of Regulation:
If BPD has five domains of dysregulation: emotional, behavioural, relational, cognitive and self-identity, it makes sense that we can describe recovery as having 5 domains of regulation: emotional, behavioural, relational, cognitive and self-identity.
We can also identify a few key indicators to determine recovery. One might be the ability to contribute productively to community life, usually measured by employment. Another might be having at least two close long term relationships, usually the family you are born into and/or the family you create. Being able to live an independent life, with or without support. Here we recognise that being independent means living with the support and encouragement of others and some people may need more than usual support.
A definition from NSW:
Recovery is: ‘a deeply personal, unique process of changing one’s attitudes, values, feelings, goals, skills, and/or roles. It is a way of living a satisfying, hopeful, and contributing life even with limitations caused by illness’
( Ng,F.Y.Y., Bourke, M.,E., Grenyer. B.F.S., & Schmahl, C. (2016). Recovery from Borderline personality disorder: A systematic review of the perspectives of consumers, clinicians, family and carers. PLUS ONE, 11(8), e0160515. https://doi.org/10.1371/journal.pone.0160515)
three essential supports:
To achieve recovery we require support.
This is the greatest challenge for people with BPD. Having the support we need, when we need it so we can manage our journey to recovery.
Relational supports can be simply described as having a minimum of three close, long-term, personal relationships.
When we consider relational support, we recognise that it often involves friends; however, it usually falls to families. Sometimes families feel they need to withdraw from contact with their loved ones, sometimes families are so dysfunctional they cannot offer support, sometimes people with BPD reject the support of families.
For recovery, a person with BPD needs to be supported by those they love and those who love them. This cannot be assumed to happen given the nature of BPD.
Relational Support is what BPD Community does: we create community to support recovery.
Some aspects of the 'social element' include employment/education, housing, financial, recreation/fitness and general health (e.g. exercise, sport, activities, etc.). This is basically all the things that mean a person can live an independent life, achieve their potential and be an active, involved member of their community.
It is difficult to quantify how many people with BPD have access to 'social supports'. Some of those who are homeless may get some support, as may some who experience isolation or some women in domestic violence situations. People can access social supports without a diagnosis for example through their Council Services or their local Community Health Centre.
Treatment supports in the medical model typically involves medication, while for BPD, psychotherapy is the preferred treatment. Treatment is concerned with limiting the symptoms of BPD. Treatment options is Victoria are very limited and in the public sector usually reserved for the seriously unwell. Psychotherapy is the preferred treatment for people with BPD. The Clinical Guidelines identify many treatment types, the most common available in Victoria are: Dialectical Behaviour Therapy, Schema Therapy, Acceptance and Commitment Therapy, Cognitive Behaviour Therapy and Cognitive Analytical Therapy. Most importantly the treatment must be BPD informed.
Currently, families and friends are usually automatically excluded from the treatment process. Given the nature of relational dysregulation in BPD and that people with BPD often depend on their families for support, this alienates families further and undermines their ability to support their loved ones.
HOW TO BEGIN YOUR JOURNEY TO RECOVERY
Your journey to recovery begins when you decide that you want to recover and do what is necessary to start that journey and then continue even when it gets hard.
Peer Group supports are great. Community training programs might be helpful. Sadly there are not enough to meet the need. You can however join our BPD Community, its free and this way you can keep up with the latest news on BPD. It is great to be a part of a community. As a subscribed member of BPD Community you can have access to a voice working for you to create a compassionate community, where stigma and discrimination is replaced by the hope and optimism of recovery.
Recovery is more than ‘a cure’, it is about living a full life where you can achieve your potential. Consider:
1. Living independently might be hard. It pays to have a job. This is important not just for the money it brings. A job gives you contact with the world. It gives you a structure to your life. It brings you the opportunity to develop relationships. It extends you and challenges you. It gives you status.
2. You might have had problems with money. You may need to get support to help you manage any debts you have and to budget. You can ask for someone to help you with this. Perhaps your local council knows the local resources for financial support, they would also know at Centrelink.
3. Your physical health may have suffered. You might need dental work, physiotherapy, and other allied health professional support. Ask for what you can have, visit your local Community Health Centre.
4. Accommodation might have been problematic. Do you need help in your living arrangements? Ask for it. Perhaps your local council knows the local resources for housing.
Are you eligible for the NDIS?
If you are, you are in control of what you need to support your recovery. Think about all that is available and make wise choices; consider the advice available to you.
Below is an example of the steps that could be taken to help you get treatment support:
1. A good GP is where we can start. Go to your GP and let them know you have a diagnosis or that you think you have BPD and that you want a mental health plan. The GP will ask you quite a few questions which you should answer as best you can.
The GP can refer you to a ‘specialist’ a psychiatrist or psychologist or a Mental Health Service in a hospital or a Mental Health Organisation. It might be private or it can be public. If you cannot afford a private clinician, ask for a referral to the public system.
2. If you have ever felt suicidal, or if things get way out of hand, prepare a Crisis Plan (see link). Please let your GP and family members know. If you are suicidal, reach out, call 000.
3. Avoid surfing the internet where there is some very cruel and hurtful misinformation.
If you are under 18, do not surf the internet alone, think about the benefit of having a responsible adult with you when you surf the net about BPD and only consider reputable websites.
4. It might take a while to get an appointment with your ‘specialist’. Make sure you get there about 10 minutes ahead of time. You can then fill out any forms that are needed. It helps to have someone you trust with you. It helps if that person has known you for a long time, and knows you well and loves you: a parent or partner/spouse.
5. From there all should plan out, but be aware of your rights. For example, you can ask for a second opinion.
6. You need a person to work with who you can trust and a planned approach to treatment.
be prepared for the long haul, but you also want to notice some changes;
be prepared to implement what you learn and practice and practice what you are taught (practice makes perfect);
The therapy is based on an explicit and integrated theoretical approach, to which the therapist (and other members of the treatment team, if applicable) adheres, and which is shared with the person undergoing therapy.
The therapy is provided by a trained therapist who is suitably supported and supervised.
The therapist pays attention to the person’s emotions.
Therapy is focussed on achieving change.
There is a focus on the relationship between the person receiving treatment and the clinician.
Therapy sessions occur regularly over the planned course of treatment. At least one session per week is generally considered necessary.
Structured psychological therapies are effective when delivered as individual therapy or as group therapy.
9. How long, you ask? Your treatment may take a few months or a couple of years. It depends on you and the people who work with you.