And welcome back to family health matters.

I’m Shelley Irwin with me today, Dr. Elizabeth Cyr from Pine rest Christian mental health services, and Matthew will call you Matt Sharpe of Sharpe Therapy that’s with an e, so I get the best as I always say, Matt Sharpe talk to me about how you spend your day in this world of psychology.

I have the distinct privilege of working with men and women every day just talking with them about the mental health challenges that they have.

I have some of the greatest and most amazing clients that ever have existed.

So it’s it’s really fun to to see people put their hand in the air and say that they need some help and I get to come alongside them and help them understand their problems and and help them find new solutions.

Right, and it’s Sharpe therapy?

Matthew sharpe therapy, yes.

So you’ve got your name the buck stops here.

That way I know where my office is.

I can always find it because my name’s right on the door, so.

Well, we know there might be a few jokes involved today in a good way with another hat that you wear.

I will bring that up as well.

Dr. Elizabeth Cyr appreciate the good work you do with pine rest.

Thank you.

Yes, what do you do?

What what’s a nine to five like or should I say a 24 hour day?

Well, first and foremost, I’m a dialectrical behavior therapist, DBT for short.

um and I have the privilege of working with eight other clinicians on the DBT team, working to serve individuals, many of whom are diagnosed with borderline personality disorder are in the throes of emotion dysregulation and are lur working to build the life that they want.

when I’m not doing that, I’m also helping support other clinicians who may be serving such clients, who may be on our waiting list or who may not quite be ready for services of that magnitude.

and then I’m also helping coordinate and coordinate DBT services and increase access to care.

Well, much to take apart.

I trust you’re busy.

I’m busy..

I diagnosis of borderline personality disorder.

BPD.

uh, is it out there?

It is out there.

Yes.

What is it?

Well, first and foremost, it’s the it’s a disorder of emotion dysregulation.

What does that mean exactly?

Oftentimes people struggling feel like their emotions are in control of them.

Marshall Lenehan would describe these individuals as being third degree burn victims.

Only a lot of the pain is on the inside, so people on the outside aren’t seeing it.

And if you can imagine what that’s like walking through the world like.

oftentimes they’re doing the best they can to keep a handle on the emotion dysregulation and pain that they feel.

So this, of course, leads to difficulty in relationships.

It’s sometimes leads to identity disturbance, impulsivity.

Oftentimes at the expense of the self, it can sometimes these individuals struggle with suicidal thoughts, self harm as a means of trying to cope, um trying to do what they can just to keep themselves um kind of at baseline and managing these really intense emotions.

Sometimes there’s also a sense of not belonging or feeling like those around them don’t like them, making it really hard for them to interact with their world.

Treatment for a control or for a cure, for a control with a reduction in symptoms, Oftentimes, especially at least what the research tells us for individuals who I can only speak to DBT.

that’s not the only evidenceased treatment for borderline personality disorder.

just happens to be my passion an area of expertise.

Um but we know that individuals who complete DBT do report decreased symptom symptoms of BPD and oftentimes no longer meet criteria when they’re done.

That doesn’t mean the work is done then.

Oftentimes we do encourage clients to keep working towards utilizing their coping skills, working towards their life worth living goals and taking steps to engage in more emotional exposure, manage any trauma symptoms or PTSD symptoms in order to make sure that we can keep those higher risk symptoms at bay.

Thank you.

Matt Sharpe, could we see these symptoms as early as the teen years?

Most of the literature would say that the earliest the diagnosis of borderline personality could be given as around 16.

I know many of us as clinicians don’t like to put you know, that heavy of a diagnosis on someone, you know, that young, just because their brains are still forming and developing.

But some of the patterns of behavior definitely can be there.

It’s when someone’s in relationship with a person who struggles with borderline personality disorder, we can experience from that person a lot of go away, I hate you, but don’t leave me sort of behaviors where we kind of get pushed away and pulled back in and it makes it very difficult to exist in relationships.

And that behavior pattern can start in teens, but usually the diagnosis is given later on in adulthood.

Once you perhaps make the diagnosis or know that you’re dealing with the BPD, what’s next for you?

What do your services?

as we were talking about, you know, knowing that suicidal ideation and self harm is is often a feature of this diagnosis, you know, obviously the first step is is for most of us is to make sure that we have, you know safety plans in place and we can start to address some of those more high risk behaviors.

using dialectical behavioral therapy, cognitive behavioral therapy, which is a specialty of mine, and other evidence-based therapies like transference focus, therapy, mentalization-based therapy and others.

we can actually start to develop a sequence of treatments that can help people resolve symptoms, manage risk, live that life worth living.

So it’s it’s a complicated and often hopefully very beneficial journey.

Yes, I’ll have you add to that, Dr. Cyr.

You you’re making the diagnosis.

What what’s the next step for your clients?

Yeah, so oftentimes people are coming to me when they are already engaging in DBT, so oftententimes it’s not uncommon for individuals with BPD to go through a series of clinicians.

um and so oftentimes by the time they come into my office and are seeing me, um they are really looking for any semblance of hope.

And so what I’m doing first is, of course, like Matt mentioned, we’re assessing for high risk behaviorors, we’re wanting to make sure that supports are in place, safety plans are in place, like worth living um goals are developed so that we can ensure that somebody is working towards those and has a sense of hope, then we’re really working to get them involved in our comprehensive treatment program.

So DBT is a comprehensive approach.

So it involves individual weekly therapy.

It involves skills training.

um group that meets once a week for two hours.

It also involves phone coaching, and it involves a special special consultation group for DBT clinicians.

um in order to make sure that we are supported, we are doing the best that we can to work with clients.

um to help them achieve the life that they want.

Have a step back.

DB DPT.T.BT.

The D stands for dialectical.

Take the that apart for me uh medical terminology wise.

Yeah, what dialectical means, it’s it’s the idea that two seemingly opposing things can exist at the same time.

So what does that mean exactly?

How does that show up?

Why is that important to BPD treatment?

As Matt was mentioning, there can often be this push and pull that comes, right?

I I hate you, no, don’t leave me.

And oftentimes what we see with individuals with BPD is they can engage in black and white thinking.

and it’s very hard for them to hold the idea that two things can exist at once.

Things like somebody can be both frustr frustrating to us, but also we can compassionately love them at the same time.

Oftentimes, in a given moment, those things are hard for them to hold at the same time.

So we as DBT therapists are working consistently, to help manage that balance and help offer treatment to them utilizing our own dialectics.

So one of the major dialectics within dialectical behavior therapy is balancing that of change and acceptance.

What we mean by that is accepting the client as they are in a given moment, recognizing they’re doing the best they can.

They want to improve, even if at the same time they need to do better, try harder and be more motivated to change.

and then, as we’re accepting them in that way, we’re working to push for change.

We’re asking them to change how they’re interacting with their world.

We’re getting them to utilize skills.

We’re getting them to engage in things that are especially very hard to pull out, and we make sure that they don’t feel like they have to do that alone, which is why we have phone coaching.

Anybody who’s learned a new skill or a behavior knows how hard it is to break behavior patterns.

That’s especially for true for people struggling with BPD who have already developed their way of coping often through more self- estructive measures, like suicidal behavior, self harm, substance abuse, eating issues.

because they’re looking just to feel better and those those provide short- term relief, exactly.

You wanna go with the layman’s term, Matt, thank you.

Matt, talk to me a little bit about bringing the family in with this treatment.

It can be a difficult task to be in relationship with someone who is struggling with BPD just because the emotional dysregulation takes a toll on us.

There’s a reason why, you know, the DBT team and other clinicians, when we work with BPD clients a lot, we have to invest a lot of time in our self-care, just to make sure that we’re able to stay kind of centered and grounded and be emotionally resilient and with our clients.

And that’s important for families as well, because as they’re living with a loved one or in a relationship with a loved one who has these these these shifts between black and white thinking and can have some of these strong emotional moments.

It’s really important for them to do their own self-care.

I encourage family members to have a supportive person, a therapist of their own.

I have a number of clients who they don’t have BPD, but a loved one does.

And so trying to activate some educational resources for them so they can understand the disorder and where the behaviors are coming from.

that helps give them a different frame of reference, so when their loved one is having a disregulated moment, they’re able to put a frame of meaning around that and say, oh, they’re they’re experiencing this.

And and even just to help them maintain their emotions and boundaries in a healthy way while being loving to their family member.

At what point do you know that perhaps uh the regular days of therapy are that you perhaps met a goal and maybe it’s time for homework?

Well, in in all the therapy that I do, uh homework and meeting goals is that that’s every single day.

we we always send at least I would send clients home with something to work on or practice or rehearse, here’s a skill we learned or here’s a a behavior pattern we want you to track and and take note of between sessions and at least every six months, I sit down with my clients and just say, hey, how how are we coming on these goals?

Where where are we getting to?

And it really can be a tremendous source of excitement and therapy to see someone recognize in a very concrete way that I am functioning differently.

and I do have a client who we worked with some BPD issues, and I noticed the client kept saying, I’m trying to get better.

I’m trying to get better.

I’m trying to be better.

And when we did a treatment review, at least in a couple areas of their symptomology, they were able to say, I am better in this area.

I I’ve got to this goal.

It was a tremendous cause of celebration and hope for them in their treatment.

Does this stuffier fall under a We all know the answer mental health, mental illness as well.

Yes, it does.

I think how are we doing, I guess, against the stereotype of this?

I I think we’ve made a lot of strides.

I think, like anything else, we can always continue to do more, much like we’re doing here.

Even us coming together today is us working to decrease stigma, to let people know you don’t have to suffer in silence.

There are you can educate yourself and find treatment.

There is hope.

Do you also educate the family and your clients on general life skills such as eating 80% healthy exercise, other, you know, get your sleep.

Does that factor in?

Oh, absolutely.

Actually, in DBT, it’s called the Please skill, so it’s an acronym that we give to clients to help them remember that taking care of their body takes care of their mind and reduces risk of vulnerability to intense emotions.

Yes.

Grade today’s state of mental health, uh, what else are you seeing, Matt?

Well, the the state of mental health as far as services, you know, obviously we’ve seen tremendous increases in the number of people seeking services since COVID, at least we have in our practice and and I’m happy for that.

I’m happy that after the COVID crisis, more people are willing to say, yep, I need some help, I need some assistance.

There is still that stigma there especially among us as men that says, you know, I can’t do this because it will seem weak, or I don’t know how to talk about my feelings and I do love it when people say stigmatizing things like it’s all in your head.

Yes, that’s actually where it comes from.

Thank you very much.

All of our mental health issues are located up in our head.

It’s sort of like saying my heart problem is all in my chest, yes, that identifies the source.

But but being able to come alongside people and say, it’s a struggle.

And when we come alongside another human being and offer help, it doesn’t matter if I’m a therapist or just a good friend, you know it’s not a sign of weakness.

It’s a sign of you know recognition that I need more help.

And so we are seeing more people come in in our practice, I’m sure pine rust is as well.

and that I think is a wonderful thing.

Yes.

Keeping with you, Matt Sharpe is it okay to laugh when you therapy talk to me about that hat you wear?

Oh, absolutely, yeah, I have the distinct privilege of also being a stand up comedian and I work under the heading of stand up therapy live, and you know, besides just helping people laugh, which is a wonderful source of of stress reduction and increases oxygenation in the blood and all these wonderful things.

and and if we’re honest, we just like hanging out with happier people.

so it helps in that way.

It also humor is a great way of reframing our view of the world around us.

And a lot of our problems, like anxiety on a daily basis, often take place because I’ve gotten stuck in a doom loop of thinking that’s producing anxiety, and if I can just change my view of that reality, it can give relief to some of my anxiety symptoms.

So we call that cognitive reframing and therapy, we call it a set up in a punchline in a comedy bit, so it absolutely laughter is a essential for for good health.

Dr. Cyr back to your specialty with the borderline personality disorders, medication often often prescribed.

So therapy is the first line of defense.

It is also important that they the client is working with a comprehensive treatment team, and so they can seek psychiatry services to help them manage maybe dual diagnoses that can sometimes accompany the disorder, things like major depression and anxiety.

Is this familial?

Is there genetic guts?

So research is finding that there is a connection hereditarily.

We know it we we’re still kind of teasing apart what that looks like and know that it’s a bit more complicated, but it it does tend to increase the likelihood of you developing BPD if you do have a family member who also struggles with the disorder.

We talked on the teen.

Could a senior begin to develop a personality disorder?

Typically not, we would want to see, you know, personality disorders.

We tend to see a frequent chronic pattern of difficulty.

For at least six months, usually people have struggled for a long time, with a personality disorder.

So it it’s not to say that it could never happen, but we would want to be ruling out if there’s a sudden change in emotional state or emotion regulation.

We would want to make sure that there isn’t something other under underlying going on or something medical and make sure that we would treat that first.

A little tangent keep staying on the topic of the senior.

We’ve been hearing that some seniors are lonely in these times.

I’ll I’ll start with you, Matt.

do they come and ask for help?

Uh, yes, um we are seeing at least in my practice, more seniors looking for help.

I think one of the saddest demographics I’ve heard is that the one of the bigger increases in suicide attempts is among people who are 75 and older.

We’ve actually seen a decrease in the last few years in the 15 to 24-year-old category for people who are attempting suicide, which is wonderful.

We’re we’re grateful that the prevention work that’s being done and that demographic is working.

But as people age and they start to lose hope, we do see an increase in suicidal behaviors and there is the isolation that takes place.

And because we live in a fragmented society, oftentimes our seniors are experiencing their sunset years without family close around them.

And so that’s something that does impact mental health and a negative way.

Although there’s one demographic that has a statistically zero percent suicide rate.

And I was shocked when I heard this.

African-American women over six5.

And in looking at a lot of the culture, they have a tremendous connection to their family, to their churches.

There’s a an honor and a reverence, and I think that plays a tremendous part of it as well.

And so looking at some of our our cultural friends, we can say there’s great benefit to having our seniors being connected to families and friends and their communities and they have so much to give us that us young uns need to learn from and can help them in their mental health as well.

What else are you seeing in your world at Pine Rest?

So I think people are struggling with our our typical presentations, anxiety, depression, bipolar disorder.

We are seeing more disconnection, an increase in anxiety.

Things feel a little unsteady right now.

um and and so we’re seeing people really struggling with that and wanting to form some sort of connection, wanting to try to develop resources in order to be able to manage the the day to day experiences that they have.

They’re wanting to build relationships and are struggling in some ways.

Do you worry about our screen screen time use?

It is something that that concerns me only because it pulls us out of our day to day experiences.

It’s not to say that it’s bad, we should never be doing it.

It’s it’s to make sure that we’re balancing it out with real life human connection and that we’re engaging in our world, knowing that that helps us feel satisfied, connected in in part of something bigger.

Did you mention group therapy is involved with the borderline?

I did, yes.

How does that work?

So, it’s a skills training group, so we essentially say oftenentimes borderline personality disorder, emotion dysregulation as a result of a skills deficit.

And so, as a result, we feel it is important to make sure people have the skills needed in order to be able to navigate the difficulty they experience.

So clients attend a two hour group weekly where they have homework.

they present homework to talk about how they utilize the skills throughout the week, and then they have a psychoedation lesson, where they learn about distressed tolerance, learn about emotion dysregulation, learn about um interpersonal effectiveness and learn mindfulness, all of which help them work towards the goals that they have.

In your practice, whether it’s BPD or other group therapy work?

In my setting, it’s a little bit harder just because of the space that we’re in, but I’ There on the couch, right?

Only so many, yeah, it’s hard to get more than three.

But no, group group therapy in general is a wonderful experience because not only do we learn the skills and the educational components, but there is that sense where I really can see around the circle that I’m not the only one struggling with this, just the the validation of, oh, you too.

Okay, me too, great.

And and just to know that I’m not alone in my struggle and it’s in the groups that I’ve led, I’ve watched the group members teach each other and learn from each other just as much as they’re learning from me.

And so that that really becomes a a fun experience of growth together.

We talk screen time.

What about social media and our kids?

Again, we all know the answer, butup, it’s it is out there.

um and like all tools, it can be used and abused, and I think uh social media can be a wonderful platform.

I think most of us are on it, you know, professionally to enhance our work.

the problem that I see is when when that’s all we have.

If a young person or even an adult has their world wrapped up in their phone and on their screen only, they need some friends IRL, you, in real life as well.

And so those connections are so important.

Just psychologically, knowing that we have a connection to another human being is such a powerful force in our life.

So hopefully a prescription to take a walk in the woods every other day is is somewhat healing in itself.

I’m kind of all over the map, we’ll get back to a borderline before we finish.

But what about the topic of bullying?

And I’m going to go with either of you to answer, do you care for the one who is the bully?

Or are you often caring for the one who’s complaining of being bullied?

Interestingly, they’re often the same person.

A lot of people, not all, but a lot of people, a lot of young people who engage in bullying behavors, have also, of course, been bullied in some way in their own life, whether it’s at home or in other settings.

And so oftentimes they will experience both.

When I care for the and I don’t work a lot with young people.

I work mostly with teenagers, um and adults, but oftentimes the kids who are bullied, you know, it does affect them.

That’ that’s part of my story.

Part of the reason I got into comedy was I learned as the as the kid who was overweight that if I can make other people laugh at the bully, then he’s not picking on me so much.

Well, I guess that worked out for me in the long run, but helping the bullied kids develop those whatever their coping mechanisms are to find meaning and purpose and in an internal resilience is really important and then helping the bullies, which, to be honest, I see more of the bullied kids than the bullies themselves come into therapy, but trying to help them, you know, understand that place of woundedness in them.

that can be a powerful journey for them.

I see who got you involved in this niche.

I I’ve always had a passion for working with individuals struggling with more chronic mental health issues.

And it seemed like a natural fit.

I would see people come into my practice, desperately looking for a different way to experience their world, struggling with so much pain.

and I found that DBT was so helpful in being able to help guide them on the journey to healing.

And so it really just felt like a natural progression as I was going along and trying to understand how I as a clinician could help them better and in doing the digging, that’s what led me to DBT.

You had mentioned one of your specialtiesies was it cognitive behavior behavioral therapy?

How would you explain that in Leman’s terms?

In layman’s terms, we think our feelings.

That’s the cognitive perspective, that if I’m if I’m experiencing a negative emotion or a state- like anxiety, we want to work backwards to find the moment or the event where that began and then what are my thoughts about that event, my interpretation of the event?

if we can identify a thinking error or a distortion in that, whether I’m over generalizing or catastrophizing catastrophizing, something like that, making it a catastrophic thought.

Yeah, somewhere in there, absolutely.

But if we can resolve that distortion and help people see their situation from a more truthful perspective, then often the negative emotions will resolve.

And so that’s the basis of cognitive therapy.

Five minutes left, let me do bring up the topic of suicide.

If one is experiencing some some of these thoughts, what’s the action item.

So there’s lots of different ways in in which you can access care.

First and foremost, anybody struggling with suicide, I need you to know even if it feels impossible today to that things are going to get better, it can.

We know therapy can be helpful, we know having a really solid care team can help you get on the journey of healing.

There are also numbers like 98.

I Pine rest also has a number that you can call for services.

If you’re in need of some guidance on what to do, of course, if it is a significant emergency, you can always show up at the ER or dial 911 for help your comments, please.

Oh, absolutely.

when when they established 988, that to me was such an important thing because the suicide mental health hotline, it used to be an 800 number that I don’t even remember what it was.

And so now they’ve made it a nationwide access just like 911 brings the ambulance to the police 988 connects you to help for suicidal crisis.

Most of our community mental health services will have some form of the same kind of stabilization team that can come out.

And so obviously if someone is feeling suicidal, they should call right away and get into services.

And then for us as clinicians, one of the scariest journeys we have is if somebody is is not able to share with us what’s going on.

So we try to create that space where people can say, you know, I’m starting to feel hopeless.

I’m starting to have some dark thoughts, and then we can come around them and offer some support.

I have a couple of protocols that we use to help identify some of those underlying sources of the suicidal crisis.

And typically when people work that process, they are able to resolve the crisis, find hope, develop new skills of resilience, and really see a tremendous resolution of the suicidal crisis.

Thank you.

We will see you on stage next week.

Yes, ma’am Yes, wealthyater Wednesday night.

Wednesday night, 7 o’clock here in Grand Rapids.. No patient names.

Oh, absolutely not.

Thank you for you.

What’s your take on message when it comes to B B d and more.

The greatest thing we have in general is the connection to other humans.

If we have people around us who love us and we have a therapist who cares for us, we can indeed rise above so many of our problems.

Bordline personalities sort of.

How do we find out more about you and your work?

for therapy, you can find me at Matthewsharpetherapy.com and for all the other fun stuff, standuptherapylive.com.

Great, thanks for that’s all right.

I give you a little over a minute to gotta take us home with uh with the good news with this topic.

We know that borderline personality disorder can be treated and that we can help people live the life that they want.

We are very lucky to live in Michigan where there are a number of different programs that serve individuals with BPD.

and so help is out there.

If you need help accessing it, there are lots of different resources that you can look up, um and it is available to you.

What would be is there a national association with this niche, not to put you on the spot, but there is there may be, I don’t know for sure.

We do have something called so within the community mental health system, there is a big push to try and offer DBT in more of our communities.

What there is a group of people working behind the scenes.

It’s not quite ready yet, but they’re working to put a map together for residents within Michigan so they can go to their demographic area and see where there may be a DBT program available.

Right?

DBT, BPD, honey do, keep it all straight, but that’s why you hear you need to do.

how do we find out more about you and yours?

Yeah, so you’re welcome to search me on the the Pine rest.org website.

You can also, if you have questions or in need of resources, I’m always happy to try to connect people.

You can email me at Elizabeth.cyr@pinerest.org Great.

And uh I trust you’ll be in the front seat watching uh your colleague.

Oh, how could I not?

I guess I should ask you the same question.

We don’t want to laugh at uh a borderline personality disorder, but is laughter good for usically is so important for us.

It it helps us remind us that we there is hope and that we can get through tough things.

Right.

All right,reciate you both.

Thank you.

Thank you.

Appreciate you for watching.

Thank you for you.