THE BPD TOOL

A PICTORIAL FRAMEWORK

for clients and clinicians managing Borderline Personality Disorder

by Michelle Ayres

Borderline personality disorder is hard to understand. This booklet gives clients and clinicians a manageable tool that rationalises a complex presentation and its resulting overwhelming impact in a pictorial form. Together with a solid therapeutic relationship, a working formulation and treatment plan, it is a useful aid to communication and understanding. The framework is particularly useful when a client calls in distress. It is a tool that can be used easily. By using the picture nearest to how the clients feel (1-7), a mutual understanding and starting point can be quickly reached to move things forward mindfully and with compassion. The back of each page has been left blank for clients own notes. Michelle Ayres is a cognitive behavioural psychotherapist. Her background is mental health nursing and management. She lives and works in Guernsey.

Try not to merely act in the moment Pull back from the situation Take a wider view Compose yourself Epictetus

Introducing:

ME

I feel empty, out of control, powerless and angry a lot of the time. I have mood swings. I have no real sense of self. I am emotionally driven. Other people are often frustrated and angry towards me but I dont understand why. I fear abandonment, rejection, betrayal and domination by others. I am needy. I have a history of unstable or abusive relationships. Sometimes I self harm or have suicidal thoughts; I make threats and behave badly. I am impulsive (binge eating, reckless driving, sex, spending, substance misuse) I feel guilty I have brief paranoid ideas or severe dissociative symptoms related to stress. I experience repeated crisis in my life. Things I might believe about myself: I am all over the place, I am bad, I am unlovable, I do not fit in, I am different, I cannot cope alone, I need someone to rely on, I deserve to be punished, nobody understands me SOUND FAMILIAR? PLEASE KEEP READING.

Introducing:

DOOM and GLOOM aka THE WORLD AND OTHER PEOPLE

How I generally see the world The world is a bad place. I do not understand it and it does not understand me. It is threatening. It is dangerous. Things I generally believe about others Either they are powerful, loving, perfect, better than me. They understand and can play the game of life! Or they are rejecting, judgmental, controlling, betraying, abandoning. I cannot trust them. They will let me down. HOW ELSE DO I SEE THE WORLD AND OTHER PEOPLE?

Introducing:

ROCK

This is where I cling to make me feel safe: Partner, family, friends, therapists, doctors, self harm, old ways of doing things WHAT ELSE DO I CLING ON TO?

Introducing:

LIFE JACKET
This contains the skills, strategies and knowledge I have to keep me afloat in the stormy sea of life. So: STOP. Dont act immediately. Take a breath. Notice what is happening. Choose the most helpful and effective skill from those that you have learned. These may include: Cognitive behavioural or dialectical behavioural therapy skills Change your thinking (think about something else, notice how you are thinking, is there another way to look at this? Positive self talk, positive affirmations) Change your behaviour (do something different, enjoyable, fun, energetic) Relax, breathe slowly, notice things around you Talk to someone, get support from friends, family or your therapist WHAT OTHER SKILLS HELP KEEP ME AFLOAT?

Introducing:

WEIGHT
It seems that I am weighed down by something I do not understand and cannot make sense of. I am struggling. Despite what other people say about me and my behavior I am doing the best I can. Things that keep me weighed down include: the negative way I think, feel and behave. Childhood and adolescent significant experiences, schemas, core beliefs, environmental factors, unhelpful assumptions, confusion about what to do next, emotional responses, impulsiveness, temper. making the same mistakes. Over developed and under developed behaviours. WHAT ELSE WEIGHS ME DOWN?

Introducing:

SUN
When things start to make sense! FINALLY! AT LAST!

Introducing:

STORM

When things dont make sense! When I am struggling, when I dont know what to do, when I forget all the strategies, skills and knowledge I have gained.

Introducing:

SAILING

All around me people seem to be sailing through life. Sailing is what other people seem to know how to do naturally. I dont get it. I dont understand how they do it. It is all so confusing. They make it look so easy.

1. I AM ALL AT SEA

2. CLINGING TO MY ROCK IN A STORMY SEA

3. ATTACHED TOO MUCHBUT BEGINNING TO INFLATE MY LIFEJACKET

4. LEARNING TO FLOAT ALONE

5. SAILING ALONE

6. SOMETIMES SAILING WITH OTHERS

7. SURVIVING ALONE WHEN THINGS GO WRONG

A POCKET GUIDE TO USE FOR REFLECTION - ASK YOURSELF WHERE AM I NOW? WHERE WOULD I LIKE TO BE HOW CAN I GET THERE? WHAT CAN I DO? WHAT SKILLS CAN I USE FROM MY LIFEJACKET?

For CBT resources and links see:

www.get.gg

Feedback and enquiries welcome bpdtool@cwgsy.net Further copies www.bpdtool.co.uk Illustrations by Mathew Chesters
Michelle Ayres

ISBN: