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May 31, 2019

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ReVisioning Borderline Personality Disorder: Seeing The Person Within

Written by Theresa Hasting, LMHC

I remember my first job out of graduate school, working in a psychiatric inpatient facility, and listening intently as nurses and doctors spoke about the patients with whom we were working.  A patient in particular sticks in my mind, a young adult female who had been in and out of our facility ten times in the past two months, who loudly exclaimed her self-harm for all to see and hear.  The stigma of Borderline Personality Disorder (BPD) that I witnessed some twenty years ago is still with me. Since that time, I have revised how I think of people who present with these symptoms and with this diagnosis, realizing how these behaviors do not define them, but rather how they are an expression of fear, of pain, of vulnerability, and of anxiety.

An article, that many of you may have seen, recently floated across Facebook: “We need to treat borderline personality disorder for what it really it is – a response to trauma.”  I was intrigued and as I read through the comments posted prior to the reading the actual article, I realized just how much the stigma of BPD hasn’t actually changed in the past twenty years.  I still hear parents gasp with shock and fear at the mention of BPD traits.

Let’s forget the Facebook article, that while true and accurate, isn’t actually a credible source and instead examine scholarly research.  A study by Bandelow, et al, (2005) indicated that those diagnosed with BPD had a statistically higher rate of early childhood trauma than the control sample.  These traumas ranged from abuse and neglect, parental separation, childhood illnesses, medical trauma, unhealthy family systems, etc. Premature birth was also noted as statistically higher for those diagnosed with this disorder.  This is one of many research articles making this link.

In practice with adolescents and their parents, those presenting with borderline traits consistently have a history of trauma and as they describe the symptoms we are so familiar with (poor ego strength, instability in functioning and achieving goals, impairment in relationships, frequent mood changes, separation insecurity, anxiety, impulsivity and/or risk-taking, and hostility), they talk about really wanting connection, to feel safe in relation to others, fearing rejection and abandonment, and having big emotional responses to small situations that they don’t understand any more than the next person.  Sometimes, I hear stories of a big Trauma and other times I hear stories of little traumas that accumulated over time. It may be that there were dozens, maybe hundreds of little emotional betrayals and hurts that added up and derailed a child’s ability to trust someone with their care. They described the need to be impenetrable and safe while simultaneously tormented by the human desire to feel closeness, created the push/pull dynamic that friends, families, and therapists are so acutely aware of.

The Facebook article is right…it is time we recognized BPD as a response to trauma.  Rather than focus on the very difficult symptoms to manage, recognize the strength being presented to you in their ability to survive.  Recognize that inside the layers of muck, there is a precious human being desperate for safe connection. With this new formulation of BPD at hand, we also have to look at how we treat BPD.  Ultimately, we have to approach treatment from a trauma-informed lens, one that aims at healing, providing reparative experiences, and teaching healthy attachment. To do this, we must focus on emotional regulation, emotion tolerance, debating negative self talk, building ego strength and finding ways to celebrate success; all in the context of healthy relationships being role-modeled and the clinician providing a safe, non-judgemental space to hold what is present and return it back to the person in a form they can digest in order to heal the relational trauma of the past.  Only then, will a person be able to move to a place of accountability, examining unhealthy relational patterns, and work on their ensuing identity crisis as the “get better.”

Ultimately, what a client who presents with these symptoms needs from their treatment team is compassion and the unwavering ability to see through the unpleasant layers of protection they have covered themselves in.  Or, in the words of the late Dr. Karyn Purvis, who specialized in relational and developmental trauma: “It is powerful for [people] to know that they are loved and adored even in the midst of their worst behaviors.”

May 28, 2019

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CLINICAL SPOTLIGHT: THERESA HASTING, LMHC, SP

Theresa Hasting received her Bachelors of Arts in Psychology from McMurry University in 2003 and earned her Masters of Arts degree in Family Psychology from Hardin Simmons University in 2005. She is currently enrolled in a Ph.D. program in Depth Psychology at Pacifica Graduate Institute.

Theresa has extensive training in trauma informed care; examining the impact that trauma and chronic stress has on a person’s neurochemistry, brain development, attachment style, cognitions and behaviors. She is a Trust Based Relational Intervention Educator and certified SandPlay Practitioner. Additionally, she has specialized training in Motivational Interviewing and Trauma Focused Cognitive Behavioral Therapy. Additionally, Theresa has been a trainer/consultant for the Nurturing Parenting Programs® since 2011 and has facilitated Nurturing Parenting groups since 2008, utilizing individual, in home, and group parenting classes.

Prior to joining the Pacific Quest team, Theresa worked as a Clinical Director for a large adoption and children’s behavioral health agency. She developed training for staff and families on Trauma Informed Care topics, Nurturing Parenting®, and Trust Based Relational Intervention® (TBRI) principles. She also has experience as a clinician for adolescents and adults in psychiatric settings. Theresa has worked with youth and adults who have experienced physical and sexual abuse, attachment trauma, adjustment issues, depression, anxiety, emotional and behavioral dysregulation, substance abuse issues, psychosis, and interpersonal conflict. Theresa has presented at many state and national conferences. She is a member of the American Counseling Association (ACA).

Theresa’s passion is working with youth and families to facilitate healthy relationships. She has a strong belief in the need for holistic, whole-person oriented work that focuses on “re-setting” the mind and the body. Pacific Quest attracted Theresa because of its focus on these key aspects of treatment, which are often overlooked in other treatment settings.

Theresa has a diverse background and a keen sense of appreciation for other cultures. Having grown up in Prague, she has a love for international travel and hopes to share these experiences with her husband and daughter. Theresa enjoys cooking, photography, scuba diving, travel, and going on adventures in the Hawaiian islands.

Parent Testimonials:

Theresa is wonderful!. We cannot thank her enough for the work she did with all of us. She does amazing work.

Theresa was incredibly helpful. She was the perfect fit for our family and we enjoyed being challenged and pushed.

Theresa is the best!

May 7, 2019

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Planting seeds of Horticulture Therapy in the Community

Kumu Carrie’s 6th grade class gathered at 8am for their usual attendance, announcements, and oli to start off their Ho’okele class. However, today there was a change in scenery. The desks were pushed aside and in the middle of the room lay a tray of soil, bunches of mint and oregano cuttings, and an assortment of plants, seeds, and books on therapeutic horticulture. Kumu Carrie invited me to be a guest speaker for her class on the benefits of nature and the topic of therapeutic horticulture, and it was a pleasure to rearrange the classroom.

The students wasted no time noticing, commenting, and examining the plants. The observed some to smell good or bad, some were fuzzy or dry, and some they thought were pretty or ugly. We all started by sharing a little bit about our history with gardening, and shifted into a deeper exploration into our senses by exploring the mint and mexican oregano. I then taught the students the basics of the Neurosequential Model of Therapeutics (NMT Model) and discussed how they could use their senses to help ground themselves and regulate their nervous systems. They were excited to share stories of what the herbs reminded them of, take nibbles of the leaves, and some students even shared their experiences with essential oils in helping to calm their emotions.

Next the students were given a basil seed to hold in their hands. They were told to watch and see what happens as a few drops of water were added to the seed. The student gave voice to their uncertainty by saying, “What’s going to happen?… Is it going to explode?…Is it going to be ok?… It looks like it’s getting fluffy!” Students were able to relate to how sometimes in life it can be hard to sit in uncertainty while other students said they love suspense and mystery.

The students proceeded to plant the basil seeds, digging their hands in the soil. The students all showed each other their dirty fingernails and learned about the microbes that have coevolved with humans and live in the soil. Students learned that when these microbes interact with our hands, they can release endorphins in our brains. One student inquisitively asked, “What are endorphins?” The class was astonished to learn that these chemicals in their brains help them feel good.

Last but not least, the students were given the chance to label their seeds. Giggles were heard across the room as newly planted seeds were being named, and worms were being unearthed in the soil bin. Soon ‘Wormy’ was the talk of the classroom, and everyone was huddled around the soil bin searching for worms to add to their pots of soil and seeds.

After the most extensive worm hunt by 6th graders of 2019, the class circled up and recited a Mahalo oli and the class was dismissed. The energy of the students was palpable as they were buzzing about their new plants, talking about gardening, and discussing how they were going to take care of their new seeds.

Thank you very much to Kumu Carrie for inviting us into your classroom and gifting us with an opportunity to share the joy and healing powers of gardening. Mahalo nui loa.

May 6, 2019

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I Found My Own Superpower

When I was sent to Pacific Quest, I had to really accept that there is no fairy tale ending. A handsome prince won’t come take me a away and solve all my problems. Being bullied into isolation left me with only books, video games, and TV. All were perfect examples of an ideal world where if you keep going for long enough, the time to stand up on the lunch table and roast the bullies will happen. All I needed to do was wait. 

But there is no half-giant to tell me I’m a witch or talking cat to tell me I’m the moon princess reborn. I realized I needed to go through some intense treatment to actually find a reason to keep going through life. So, for the next two and half months, I worked hard to get a grip and continue a normal life. I was then sent to Solstice East to work even harder and dig even deeper. 

I now know how to (realistically) stand up for myself, stay in the moment, and overall stay stronger than I’ve ever been. By learning regulation skills, social awareness, and all sorts of other things that would exceed the word limit, I learned to not wait for the magic white horse or closet that leads to an adventure. I found my own superpower which is my resilience, strength, humor, love, and empathy. Instead of looking for an unrealistic outside source for myself to fix my problems, I turn inward and stand strong for my opinions and my life.

May 6, 2019

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Praise From a Parent

Our son attended PQ from late 2017 through Spring of 2018. When we were first choosing a place for him we consulted with a specialist who was able to recommend several programs. As we did online research of the programs we noticed multiple conflicting reviews on the sites which hosted these reviews.  It was a challenge to get  a “proper” sense of the programs and which were good and which were just average. In the end we chose to ignore the mixed messages online and go with the strength of the recommendation for PQ which our advisor provided after having placed many young adults there. It is because of that experience that I write this review. 

It is a hard decision to put your child in any program; certainly so with a wilderness program so far away from our home and with a unique agenda like PQ’s. Our son started the program in a poor state of mind – depressed, unmotivated and not looking to spend his time doing much other than sleeping. But through the unique benefits of wilderness therapy and the support systems in place at PQ he began to break his old habits and start to show progress towards retraining his outlook, ambitions and his day to day activities.  It was a slow and steady progress with steps backwards along the way but we always felt reassured by the help he received from his PQ team. We were so impressed by his therapist Andrea and thus were keen to follow her lead and her advice and try to get our son back to a “regulated” state. She was a constant force in a dark time and we are forever grateful to her and the rest of the staff around her.

In the end our son embraced the PQ experience and used his new focus to begin a transition program which was geared to getting back into his college career. Our therapist at PQ was involved in the selection process and helped us to find a program which built upon the foundation established by his PQ experience. I know it is a very difficult and very individual situation when choosing a program for one’s child but we do feel our son gained much from his stay at PQ. I know all will not have the same experience but in the end we feel blessed with the way things turned out and are happy we entrusted our loved one to PQ.

April 29, 2019

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You Can Be Anything You Want to Be

Researchers have been focusing on the tragedy of teenage suicide clusters specifically in Northern California.  One of the confusing variables in these clusters is that the students are originating from families of affluence and high academic backgrounds.  Many kids in these communities comment on the pressure they feel to be “successful”.  Not long ago affluent children were considered to be a low risk group compared to children in lower socioeconomic communities.   Suniya Luthar, Ph.D. conducted research that suggests that children of affluence experience more substance abuse, anxiety and depression than comparison groups of children with lower incomes.  Researchers are reporting evidence in affluent adolescents of guilt, depression or anxiety that comes with “having everything.”  Two sets of potential causes have come forward in the discussion: pressure to achieve and isolation from parents.

Parenting labels have been circulating around the media and it is now common to hear phrases like “helicopter parents”, “tiger moms”, and “bulldozer parents”.  Most recently there have been examples of parents bribing colleges and committing other crimes to help secure their child’s placement into top colleges and universities. Adolescents in this group describe their experience as an “unrelenting” pressure from feeling not only high expectations from a range of adults in their lives (parents, teachers, coaches, etc.) but also as a self-induced burden. There is constant comparing of grades, GPA’s and course level selection with peers.

As parents work long hours to provide the financial resources to fund opportunities for their families and to model work ethic, they often spend time away from their children.  Some research has reported junior high students being left home alone for several hours per day. There is a commonly held belief that isolation can promote self-sufficiency. However, this level of isolation can mean the family is not spending time together perhaps due to parent’s career demands or excessive after school activities. Isolation is considered both literal and emotional. There is the absence of a caregiver, but also a diminishing degree of emotional closeness to a caregiver.

In addition to the clinically significant rates of anxiety and depression found in children and adolescents with affluence, there are also significantly higher levels of substance abuse reported such as drinking to intoxication, e-cigarettes, JUUL, marijuana and other illicit drugs. Some studies suggest using drugs is an effort to self-medicate. Studies also show that these adolescents are using substances in order to manage or reduce their stress. Other studies show there is a pressure to use drugs to try to fit in or be popular.

There is a need to address the pressured academic climate and the emotional struggles that affluent children face today. There is an increase in stress related physical complaints such as headaches, stomachaches, insomnia and exaggerated health problems. Another interesting factor is that many of these adolescents do not feel like they have the right to be sad or scared.  They are feeling extreme gulit when they learn through the media about people with limited or no resources. We believe there is a tremendous burden that is felt by affluent children to do “something special”.  They are constantly told, “You can be anything you want to be,” which adds even more pressure not to waste their opportunity or squander the resources and sacrifices their families have made for them.

At Pacific Quest, we collaboratively come together to support families who are feeling the stress and pressure of their children’s challenges. We delve deeply to understand the complex factors, address them and work on sustainable change. We work to get out of the cycle of over-scheduling and focus on family time, connection and communication. There needs to be a collective shift into balance, personal health and wellbeing.

Psychology Today

National Institute of Health

Brian Konik, Ph.D., Licensed Clinical Psychologist

Kristen McFee, MA, LPCC, LMHC, LPC

April 25, 2019

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Clinical Spotlight: Dr. Brian Konik, Ph.D.

Prior to joining the clinical team at Pacific Quest, Dr. Konik worked as a Clinical Psychologist in private practice in Annapolis, Maryland. For 10 years at Spectrum Behavioral Health, he treated adolescents and young adults with issues ranging from anxiety, depression, trauma, and substance use/abuse, to learning differences, significant behavioral problems, and developmental disabilities. Dr. Konik also has extensive training in and experience with parent/child interaction therapy, parent training, and family group counseling, as well as specialized training in suicide/crisis intervention. While in Annapolis, he served regularly as a contracted behavioral specialist with the local public school system and as a consultant with private, independent day schools, conferring with teachers and administrators on issues experienced by his clients, their families, and educators.

Brian has had enriching experiences at outdoor/experiential educational positions in the past and is enthusiastic about transitioning back to this type of lifestyle with his young family. His education, training, and experience allow him to provide a variety of new and complementary services to Pacific Quest’s dynamic wilderness therapy program.

Parent Testimonials:

PQ was such a wonderful experience for our daughter. She did not want to leave!! Throughout her stay, we learned so much from Dr. Konik. His insightfulness, expertise, and compassion were so helpful. PQ gave our daughter the foundation to start to build a new future and we couldn’t have asked for anything more.

We are most grateful to the careful attention we think our daughter received and for Dr. Brian Konik’s work with our daughter and with us. Thank you so much!

April 25, 2019

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Clinical Spotlight- Kristen McFee, MA, LPCC

Kristen has served youth who have experienced concerns related to anxiety, depression, trauma/abuse, eating disorders, substance abuse/dependence, grief and loss and parent/child relationship difficulty. She considers vulnerability as a foundation for trust and teaching healthy communication patterns essential for working with families. Kristen implements an insight-oriented and strengths-based approach.

Kristen encourages meaningful change and healing through her compassion, a calm presence and attunement with others. She believes that everyone deserves unconditional positive regard. She utilizes a variety of evidence-based approaches such as Motivational Interviewing and Cognitive Behavioral Therapy. Kristen has been trained in EMDR, the Neurosequential Model of Therapeutics, Sandplay therapy, Dialectical Behavioral Therapy and Trauma Focused CBT.

Parent Testimonials:

We have worked with a TON of therapists and Kristen McFee is an absolute Rock Star!

Kristen’s availability and responsiveness were a HUGE plus for us parents. She was incredibly effective with our son and we are so thankful.

April 11, 2019

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The Art of Empathic Listening- Bill Miller

Dr. Bill Miller, expert in empathy, listening, and motivational interviewing, hosted a full-day workshop in Oahu this winter.  Six members of the Pacific Quest clinical team were able to attend. His presentation, titled “Listening Well: The Art of Empathic Listening,” focused on the interpersonal skill of accurate empathy, and captivated a sold-out audience at the University of Hawaii-Hilo.  Mental health counselors, substance abuse counselors, nurses, hospice workers, and other island residents all came together for this phenomenal event.   Below are the perspectives of three members of the Pacific Quest clinical team who were in attendance.

Mike McGee, CSAC

As the Adolescent Family Program Manager and Substance Abuse and Addictions Recovery Specialist, and having recently received the internationally recognized credential of Certified Substance Abuse Counselor (CSAC) from the state of Hawaii, I first heard about Dr. Miller’s workshop when I was invited to be part of the board organizing the event.  It was an incredible honor to receive such invitation, and to meet Dr. Miller in person.  I was especially struck by his patience, humbleness, and overwhelming sense of serenity and kindness.  I thought that I understood Motivational Interviewing well before this event, but I really appreciated the primary focus on empathic listening.  It seems well understood that listening is one of the most important components of therapy, yet it is easy to see how we can sometimes get in our client’s way with our agendas and definitions of growth.  I think we can easily focus on the technicalities of a therapeutic approach and miss what actually makes it work- compassion and understanding.

Dr. Elnur Gajiev, Psy.D.
Dr. Miller, a pioneer in his own right, highlighted the work of the late Carl Rogers and spoke to the tremendous therapeutic power of empathic listening and responding in kind. Though Rogers’ work is sometimes thought of as structureless in it’s advocacy of unconditional positive regard, Dr. Miller asserted just the opposite, noting how “Accurate Empathy” is as much a scientific and clinical approach as it is an art, and cited several empirical studies to support this point. He also noted how Empathic Listening is far more than simply a technique to utilize in sessions in order to build rapport or shift towards some predesignated therapeutic aim, but more so a way of being – a practice founded upon the principles of partnership, acceptance, compassion, and evocation – which changes us in seemingly all aspects of our lives as we continue to enact and embody it. To prove this notion, he led us through a number of experiential exercises in which his instructions fine-tuned our use of our empathic faculties (verbal and nonverbal alike) and understandings of one another. There were many moments of laughter, in which we noticed how often we may trip ourselves up through “doing too much” rather than tuning into what is already there; as well as moments of deep understanding and shared insights.

Dr. Miller’s lessons rippled far beyond the domains of Motivational Interviewing to connect to a foundational element within the art and the craft of what we practice on a daily basis. He imparted a greater appreciation for the role of Empathic Listening in our work and in our lives, and we are incredibly grateful for his visit to our wonderful home here in the Pacific Ocean.

Dr. John Souza, Jr., LMFT, DMFT

I first became aware of Dr. Miller when I was approached by one of his close friends and colleagues here on the Big Island of Hawaii, who invited me to form a committee with the goal of offering this workshop. I had no idea who Bill Miller was, nor did I necessarily think that a workshop on listening would be well received; I mean, who doesn’t know how to listen?! After 11-months of committee meetings, reading Dr. Miller’s book (Listening Well), and realizing how much research Dr. Miller had done on the subject of listening and empathy (including his work on Motivational Interviewing) I came to appreciate what this conference was offering: An opportunity to counterbalance the over-emphasis on specific models of clinical practice; to implement our outcomes data that overwhelmingly speaks to the importance of relationships in improving client’s mental health; and to learn that the art of listening well and accurate empathy can be learned if one is willing to first practice the discipline.

As part of the workshop committee, it was difficult to actually participate in the same way as my colleagues. However, seeing so many PQ therapists in the context of a much broader community of local practitioners, I appreciated that what we had done was bridged our PQ world with that of the larger population of providers in Hawai’i. We were all there to learn to improve our relationships. My hope is that this workshop will continue to inspire improved relationships across work environments, professions, and cultures, particularly here on the Big Island.

March 18, 2019

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Life Happens FOR You, Not TO You

Getting a student into wilderness therapy requires the effort of many dedicated and committed people. By the time students reach Pacific Quest, they’re in deep, open to at least giving it a try…until they don’t. Uncertainty and fear arise, and then questions emerge like, “Where will this journey lead me,” and the externalization we so often witness in the form of “Why are my parents doing this to me?”

This generation of student consistently shows up with applications to PQ that read, “I am depressed and anxious.” Why is this? Is it the environmental uncertainty, the current instability of our political system, combined with the gun violence in schools and messages they heard as children like, “you can be anything you want to be” until they find that they need to struggle much harder than they thought would be required while trying to flourish in a college setting without the support system grounded in their parents’ involvement?

The notion that “Life is happening for you, not to you” is a powerful reframe that can shift the sense of failure, and the fear of uncertainty to excitement and then hope.

Lately I’ve been running a group built around this topic of uncertainty and the theme of life is happening for you, not to you. I talk about the Yale University study (https://qz.com/1343503/a-new-study-from-yale-scientists-shows-how-uncertainty-helps-us-learn/) that says that the brain benefits from volatility and that uncertainty switches on the learning parts of our brain.

When I teach this to our students they experience a shift in perspective. Maybe this “not knowing” is a good thing, maybe I’m not failing or screwed up forever. Maybe I don’t have to complete college in four years. Maybe I just need to learn more skills to make it work out there. The shame falls away and the possibility that I am right where I need to be emerges. A significant shift occurs as the student moves from victim-hood to sovereignty.

I don’t know about you, but most of the really juicy changes in my life have not been planned, rather they emerged from my courage to embrace uncertainty and follow my heart, trusting that if I stay healthy, and do the right things and show up with kindness and compassion towards myself and others that great things will happen, and they have.

Students at PQ and their families step into uncertainty when they enroll with us, and it takes a collective effort to hold the uncertainty with confidence that what we do works, and it does. They begin to build small positive experiences that reinforce a belief in their personal agency, defined as the ability to set ones own course, and to be effective at reaching ones own goals in life. Stepping into the uncertainty, the mystery of life brings expansion of consciousness and disrupts old neurological pathways.  And as a student recently shared with me, “If you can’t get out, get in,” that’s when the magic begins to happen.