Who am I? Who are others? One moment I am a good, caring person, the next, angry and ill-willed. Similarly, other people are my friend one day; the next, devalued or distrusted. Mood swings and abrupt perceptual shifts make me a Jeckyl & Hyde character on amphetamines, with transformations occurring on an hourly basis, or even from moment to moment. Personalities, with different ways of feelings and thinking, based on disparate beliefs, step in and out. People, the world, make no sense to me, and I make no sense to them.
Who are these people? Mother? Brother? Father? Lover? Sometimes it’s easy to empathise, relate to what they say, and be a friend, a son, or gentle soul who cares. At other times I walk amidst an alien species who exist in a parallel, yet slightly skewed reality that does not feel real at all. Loved ones become strangers, and I react to them as beings that are dangerous, threatening, or simply unfamiliar. On my return to their reality I find they have been hurt, offended, or have moved on. Friends depart and the intense emotions shared with a lover becomes suddenly absent. This heart then weeps sorrow as my confused mind asks, “What happened? What have I done?”
Over twenty weeks have passed since STEPPS therapy began, and yet I still find myself to be the living incarnation of BPD, having experienced most, if not all the symptoms associated with the disorder. During therapy, I have worked hard to challenge distorted thoughts, erode unhelpful beliefs that arose from past trauma, and regulate my volatile emotions. Yes, armed with positive affirmations and encouraging statements, I have done my best to believe myself to be a good, kind man, and not the Devil in a world populated by demons. Did STEPPS work?
By attending the course, I met some of the nicest people you could want to meet; intelligent and courageous human beings who are struggling to cope with BPD and other disorders. On the therapy side, I also met wonderful people who tried to help. At the end of STEPPS, we all continued to struggle, and will continue to struggle, whether we have BPD or not. For those with BPD, STEPPS did offer some useful tools, which, if incorporated into daily life, could potentially reduce the negative thinking sufferers are prone to, and increase positive thoughts about ourselves, others and the world. With continued effort, these STEPPS tools can help sufferers better regulate their emotions, and in doing so avoid stress that can lead to the rapid onset of psychotic symptoms. As such, quality of life may be improved.
However, the STEPPS therapy program, written twenty years ago, could be made more effective. The group I belonged to felt it lacked in several ways:
My own personal gripe, besides the poor grouping of emotion words, was that STEPPS referred to BPD as an 'illness'. Since STEPPS was written, neuroimaging studies have revealed that BPD brains, as compared to brains belonging to the general population, are structurally different, and process data differently. Impairment of the amygdala, hippocampus, prefrontal cortex and other brain regions, are linked to many of the symptoms associated with BPD, including the sudden, intense and prolonged emotional episodes that those with BPD are infamous for. But if a person had abnormal limb development, and could not walk as well as members of the general population, would you call them ill?
Does having a BPD brain make me ill? Or, is BPD a disability that I must learn to live with, and overcome? Maybe, like an amputee who uses prosthetic blades to run faster than those with legs, I can attach some kind of mental prosthetic to my BPD brain? If I feel emotions more intensely than others around me, maybe I can, with the right emotional training, become more compassionate? And isn't thinking, feeling and acting in compassionate ways emotionally healthy? Well, the STEPPS program suggests so, highlighting altruism and caring for others as a positive path towards better emotional regulation and a happier life.
Over twenty weeks have passed since STEPPS therapy began, and yet I still find myself to be the living incarnation of BPD, having experienced most, if not all the symptoms associated with the disorder. During therapy, I have worked hard to challenge distorted thoughts, erode unhelpful beliefs that arose from past trauma, and regulate my volatile emotions. Yes, armed with positive affirmations and encouraging statements, I have done my best to believe myself to be a good, kind man, and not the Devil in a world populated by demons. Did STEPPS work?
By attending the course, I met some of the nicest people you could want to meet; intelligent and courageous human beings who are struggling to cope with BPD and other disorders. On the therapy side, I also met wonderful people who tried to help. At the end of STEPPS, we all continued to struggle, and will continue to struggle, whether we have BPD or not. For those with BPD, STEPPS did offer some useful tools, which, if incorporated into daily life, could potentially reduce the negative thinking sufferers are prone to, and increase positive thoughts about ourselves, others and the world. With continued effort, these STEPPS tools can help sufferers better regulate their emotions, and in doing so avoid stress that can lead to the rapid onset of psychotic symptoms. As such, quality of life may be improved.
However, the STEPPS therapy program, written twenty years ago, could be made more effective. The group I belonged to felt it lacked in several ways:
- It can give rise to a sense of desperation: is BPD all that I am? After all, the symptoms can seem so powerful and ever-present that it feels as if BPD consumes who we are.
- The STEPPS manual is written with technical words, not plain English, making it difficult to understand and remember without guidance. This is especially true if one has learning difficulties, or had a disrupted education due to BPD. The manual lacked signposting at times, and many felt bewildered. 'Give it seven weeks', the course leaders suggested. That's a long time to wait before believing in your therapy.
- The delivery of the material lacks group-based activities and resources that could make the difficult concepts such as filters (STEPPS 3) and distorted thoughts (STEPPS 4) easier to learn, while fostering a sense of belonging among clients. A Teacher's Pack for the group leader would also help, explaining how best to deliver material, and adapt resources to cultures different to those in the US, where the therapy was developed.
- The paperwork and folder organisation associated with the therapy makes it difficult cope with the constant homework (see below for resources to help manage this). One has to recall that many clients are medicated, either by the doctor or themselves, and experience symptoms that can inhibit concentration and memory recall. Even with the experience of two recent masters degrees, I found it extremely difficult to mine the folder for useful data and understand the approach of the therapy.
- Over 200 'Feeling Words' were thrown at us in a long list, with no definition of what those words mean, or flashcards to help us develop our emotional vocabulary. Further, these Feeling Words were grouped in strange ways, with, for example, confused and bewildered being placed under the ANGRY category. Maybe it is the wannabe wordsmith in me, but I took umbrage at the mismatched synonyms, and looked for a better list of emotion words in the scientific literature to begin developing the Emotion Labelling sheet (see resources).
- The course, or perhaps those that delivered it, assumes that a sufferer’s emotional intensity increases linearly, from low to medium to high intensity. Those conducting my STEPPS therapy group seemed unable to accept that my emotional intensity can leap from a calm, sunny day to a raging hurricane within moments, with no inbetween.
- The impact of comorbidities—the co-existence of two or more related medical conditions, seems not to be accounted for. After seventeen weeks, I was calmly told by my psychiatrist that the therapy would not benefit me greatly because he believed I also had Obsessive Compulsive Disorder, centred around a number of mental compulsions. The STEPPS approach to shape my belief system would therefore not work, and I required a different therapeutic approach. Yes, this is not the fault of the therapy, but with so many comorbidities associated with BPD (see STEPPS 2), alternate strategies may be required to help those whose BPD is made difficult to treat by the impact of other disorders. Whether STEPPS can provide this, or it is down to the experience of the provider, is worth considering.
My own personal gripe, besides the poor grouping of emotion words, was that STEPPS referred to BPD as an 'illness'. Since STEPPS was written, neuroimaging studies have revealed that BPD brains, as compared to brains belonging to the general population, are structurally different, and process data differently. Impairment of the amygdala, hippocampus, prefrontal cortex and other brain regions, are linked to many of the symptoms associated with BPD, including the sudden, intense and prolonged emotional episodes that those with BPD are infamous for. But if a person had abnormal limb development, and could not walk as well as members of the general population, would you call them ill?
Does having a BPD brain make me ill? Or, is BPD a disability that I must learn to live with, and overcome? Maybe, like an amputee who uses prosthetic blades to run faster than those with legs, I can attach some kind of mental prosthetic to my BPD brain? If I feel emotions more intensely than others around me, maybe I can, with the right emotional training, become more compassionate? And isn't thinking, feeling and acting in compassionate ways emotionally healthy? Well, the STEPPS program suggests so, highlighting altruism and caring for others as a positive path towards better emotional regulation and a happier life.
To summarise, I see that therapists face an uphill struggle when caring for a group of people who are hardwired to see things negatively. Therefore a skilled therapist must foster a positive group dynamic from the outset, which means clear signposting, giving clients some idea of where they are and where they are going during the healing process. Essentially, STEPPS can help if provided skilfully and with well-thought out resources to aid providers and clients. From my experience, the current handouts and delivery methods were not optimal. As such, I developed the following Homework Sheets and other resources to help. Naturally, I was asked not to distribute them, even though they were based on the STEPPS methodology, and so remain unsure how effective the flashcards, emotion labelling sheets, and other resources are.
Homework Sheets
As the weeks progress, the homework in STEPPS can become overwhelming. This PDF is designed to allow you to complete the homework in 15-20 minutes each day.
For the first few weeks, you will only need to fill in the first few sections. As the STEPPS therapy progresses, your homework will expand. Fill in the appropriate sections as needed. When therapy has ended, continuing filling in these sheets will help you to reinforce what you have learned.
As the weeks progress, the homework in STEPPS can become overwhelming. This PDF is designed to allow you to complete the homework in 15-20 minutes each day.
For the first few weeks, you will only need to fill in the first few sections. As the STEPPS therapy progresses, your homework will expand. Fill in the appropriate sections as needed. When therapy has ended, continuing filling in these sheets will help you to reinforce what you have learned.
| stepps_homework.pdf |
