Practical Tips on How to Run a Successful
Borderline Personality Disorder Support Group
Borderline Personality Disorder (BPD) affects 2-3% of the population and is a devastating mental illness causing much suffering for both the individuals and family members and others who have an established relationship with the BPD person, including friends and significant others. The disorder itself causes rapid mood swings and difficulty controlling self-destructive impulses; emotion dysderegulation is at the core of this illness. Despite the seriousness of the disorder, recent research indicates that treatment can lead to considerable improvement over time, and that there is hope for recovery! Nevertheless, it is often difficult for individuals and families to find the support and treatment they so badly need due to stigma and lack of general awareness about the disorder.
Support Groups for other mental health conditions such as Schizophrenia, Bipolar Disorder, Major Depression and Anxiety Disorders are common. However, the idea of support groups for people with BPD and their family members is relatively new. Over the last few years, a small number of offline support groups have formed. One of these groups is the Borderline Personality Support Group (Victoria, BC Canada) run by Elizabeth Bogod and co facilitators. We would like to share some practical advice on forming a BPD support group in your area. Here is what we recommend:
1) Assess Your Wellness
Are you far enough along in your recovery to start a support group and effectively lead it? It is very important to be honest with yourself about this. Facilitating a support group is never easy and there are special challenges to facilitating a BPD support Group. If your emotions are often overwhelming, you engage in impulsive behavior on a regular basis or you are only half way through treatment you might not be ready. Ask yourself if you are up for a challenge and are prepared to follow through with it in the long term.
2) Assess your facilitation skills
Have you ever facilitated a group before? Group facilitation requires a fine balance between using leadership skills to control the flow of conversation and letting conversation evolve naturally. If you want further training consider contacting NAIMI – take the Peer-to-Peer: NAMI’s Recovery Curriculum to learn more about peer support and mental illness. Also consider contacting the Canadian Mental Health Association or learn from a peer support manual . You can also work through the Shared Leadership Workbook. It is important that you not only share your journey with members of the group, but you must also provide amble opportunity for them to do the same. You will need use reflective listening skills to ensure everyone feels welcome and is able share based on their individual comfort level with disclosure.
3) Build a Team
If at all possible, partner with someone to help facilitate the group. There is nothing quite like having a co-facilitator to debrief with after the meeting or help you out when you are not sure what to say. Ideally we recommend you find one other person with BPD. Look for somebody who is well into their recovery like you are. It is not uncommon for family members including parents and partners to attend meetings. So we recommend that, in addition to having a second person with BPD, you have a family member on your team. The Borderline Personality Support Group is made up of two people with BPD and two moms. If you are just starting out and don’t know anybody with BPD or supporting family members, put out your feelers. Let mental health organizations know what you are trying to do. If you ultimately choose to start the group alone, keep your eyes out for good
co-facilitators.
4) Build a set of group guidelines for the group or a “Comfort Agreement”. Your guidelines might include:
- Confidentiality – What is said in the room stays in the room
- Be gentle and supportive with each other
- Share the air and be mindful of how much you’re sharing/speaking during meetings (Allow others to speak who are less extroverted)
- We do not discuss other group members when they are not present (even out of concern). This guideline ensure privacy of group members and avoid gossiping.
- Respect diversity (this includes ethnic, cultural, religious, sexual preference/identity and differences in ability)
- Respect differences of opinion
- Be Non-judgmental and keep an open mind
- Be gentle if offering advice, and offer only if asked – Say something similar to “When I experienced something similar to your experience I tried this_________________. Do you think that might help?”
- Own your Experiences “Use I language” Remember that while we share this disorder, each one of us has dealt with it differently and have used different coping skills and management styles to deal with this issue
- Avoid side talk and be respectful when others are speaking
- Participation is voluntary and you should never feel obligated to share
- If you are late, please sit down quietly and join the current conversation when it is appropriate
- Avoid graphic details about self-harm or other destructive behaviors that may trigger yourself or others
5) Consider how you will deal with special BPD issues in advance of meetings
a) Splitting – Splitting is the tendency for people with BPD to see themselves and other people as either good or bad. It is “all or nothing thinking”. As a facilitator you need to be very aware of the probability that this may happen in your group. A difficult splitting situation may present itself if a participant decides to pit one facilitator against another or speak ill of another participant or facilitator. How can you handle this? First your “Comfort Agreement” will cover treating people with respect. Second, if you need to, you can simply ask to talk to the person in private, find out what is going on, state your own feelings of respect for the other person involved and remind them of the comfort agreement. Some people with BPD have insight into their splitting behavior and may appreciate your help with bringing them to a more balanced perspective.
b) Disturbing self-harm discussion – Many people with BPD self-injure or engage in impulsive, dangerous behaviors (usually self-destructive). These discussions can be very triggering for both the participant discussing the topic and other group members. How can you handle this? First your “Comfort Agreement” asks participants stay away from graphic detail about self-injury. If a participant is going into too much detail, you can always gently remind them of the guideline and what it is there for. You might say, “I am sensing the level of detail that ___________________(name) is going into about his/her self-harm is making others uncomfortable. What do others think? Shall we stop here?”. If the discussion continues, you may want to talk in private with the individual about what acceptable limits are for this type of disclosure. This is a touchy issue so you will need to make sure you are sensitive to the participant. It is important that he/she feels like they can share their struggles with the group while still maintaining a safe and supportive environment for all.
c) Suicide threats – People with BPD often feel suicidal. Although this issue is rare in support groups, it can happen and you need to be prepared. All suicidal threats need to be taken seriously. If you have more than one facilitator (recommended) you will be able to handle this more effectively. Ideally the facilitator speaks to the suicidal individual in private. If you are that facilitator, you need to find out how immediate the danger is to the person. In other words, “Do they have a plan, and if so what is it?”. If they have a concrete plan most states and cities have crisis lines you can call to get emergency support. If the person has a weapon on hand, phone 911. In this case, do not deal with the crisis yourself. If the danger is not immediate, or they do not have a plan, ask them about their support systems .Do they have family or friends who can help them? Can they stay with someone? Help them arrange this, if possible. You will need to use your judgment. If you are unsure what to do, talk to your co-facilitators, contact a crisis line or talk to a mental health non-profit organization. After dealing with the situation, take some time to look after yourself. Suicide is a difficult issue. Debrief with another co-facilitator and/or take some “me time”- remember to self-soothe.
d) Abusive Behavior- We add this one in with reservations because most people with BPD are not verbally abusive or violent. However, if this does occur ensure a safe environment is reestablished as soon as possible. Here is how you might handle a verbally abusive person effectively:
Identify their emotions “I see that you are very frustrated and upset” (never say angry as this might make them more angry)
Say you want to help – “….and I do want to help you….”
Ask for what you need – “It is hard for me to do this while you are swearing and raising your voice. I need you to lower your voice and stop swearing before I can help you.”
Offer to Listen after your request is met – “Then I will be happy to discuss the issue with you….”.
Once the group member has calmed down, speak to the person in private. Be sure to have another facilitator stay with the group. This facilitator may need to speak to the group about what just happened. He/she needs to direct conversation to how group members were affected and stay away from discussing the missing group member’s behavior. The comfort agreement is important in this situation: “We do not talk about other group members when they are not present (even out of concern)”.
6) Find a location to hold meetings
Get in touch with your local mental health organizations to see if a room might be available free of charge. Some cities offer rooms in libraries, churches or community halls free of charge. Aim to meet at least every two weeks in a month.
7) Establish your meeting time
For most people evenings are best. This is particularly true of family members of people with BPD who work during the day. Typically a meeting will run from 1.5 – 2 hours. Be clear when setting your meetings, as it will be easy to go over the time scheduled. Structure is very important, so if necessary, inform the group that you can resume an unfinished topic the following week
8) Structure your Meetings
Most people like to have structure to support group meetings. The key here is not to over structure your meetings. Here is a structure we have used successfully:
a) Introduce Facilitator(s) – Provide your name(s) and share whether you have BPD or you are a family member/supporter of someone with BPD.
b) Make Announcements – Share any special announcements with participants and ask if they have any news to share themselves. For example, you might announce community mental health events here, social events you have planned for the group, relevant newspaper stories, etc.
c) Purpose Statement – Read out your purpose statement. Here the one we use in our Borderline Personality Support Group:
1. We are here to support each other with compassion through our common experience of Borderline Personality Disorder (“Borderline” or “BPD”)
2. We recognize that not everyone feels comfortable with the term Borderline. Therefore, we use Borderline interchangeably with the term Emotional Regulation Disorder (ERD).
3. We acknowledge that BPD/ERD is a serious mental illness, caused by biological and environmental factors affecting one’s ability to regulate emotions, control impulses, and enjoy healthy relationships.
4. We welcome individuals with the disorder as well as family members, partners, and friends.
5. We recognize that other conditions such as substance abuse, clinical depression, bipolar disorder and eating disorders often co-occur with this disorder.
6. From time-to-time, individuals with other mental illnesses will visit us. We welcome these individuals, but we keep in mind that our main focus is BPD/ERD.
d) Check in – Everyone gets 2-3 minutes to say their name, whether they are a in recovery from BPD or a supporter, how they are doing and any topics they would like to discuss during “Open Sharing”.
e) Open Sharing – Draw on the individual check-ins to start the conversation. Open up conversation to everyone. Allow plenty of time for “open table”.
f) Collect Donations –Everyone is asked to make a small donation (only if they can) to buy refreshments, pay for photocopying costs, books, etc. Donations can be gathered in a can or any other container.
g) Social Time – Provide Coffee, tea, cookies and, if possible, fruit. If there is no kitchen facility be prepared, to bring a coffee maker with you and all food supplies you will need. If you chose to meet in a restaurant you will not need to do this.
h) Closing – Thank everyone for coming and let them know when the next meeting will be held.
9) Keep Records
Financial Records – You will need to keep a record of all your receipts, especially expenses related to food, photocopying costs and promotion. If you are able, build a spread sheet. If not, keep track of expenses on paper. Ideally it is best to designate a person to take this on who is comfortable with basic bookkeeping. This is particularly important if you hope to become a non-profit association in the future.
10) (Optional) Develop a Library
The Borderline Personality Support Group has purchased a number of BPD books which are available for loan. One of our volunteers administrates the library keeping track of who has borrowed what book and following up when books are overdue
11) Promote your Support Grou
a) Advertise the support group in free community calendars and mental health newsletters
b) Develop a brochure about your group and BPD
c) Post your group on meetup.com
d) Develop a blog for your group (See Borderline Personality Support Group Blog). You can use wordpress.com
e) Get media attention – Contact your local newspapers, community television and ask them to do a story on BPD and the support group. Be prepared to share your own recovery story.
f) Invite professionals from your local mental health authority/agencies to observe your group in action to get referrals
We hope these tips will help you develop your own, unique BPD support group. Our dream is to one day have BPD support groups all over Canada and the United States and then perhaps in other countries too. If you use these tips we would love to hear your feedback. Tell us about yourself, the name of your support group and how these tips have helped you. You can email us at bpdvictoria@gmail.com