#like a lot of behavioral supports and deescalation stuff

[lexosaurus]

Hi sorry to bother you I have a math question and you're the only other math enjoyer I know of on here ; w;

If 1 is no longer considered a prime number because it basically leads to infinite prime factorization, why is it still included in writing out factorials? Barring it from prime factorization because it's infinite, you'd think they'd bar it from any other multiplicative problems, right?

Sorry if this makes no sense, I haven't slept in three days lol

@bibliophilea would actually have a good answer for this question. I just do high school math support! Which is p much all algebra and some pre-calc. I don't like know the theories and stuff! But Bib is a Certified Math Nerd™️

[katenepveu]

This is so amazing that, through the miracle of Google Lens (and, okay, a fair amount of boggling at the limitations of Tumblr's lack of support for basic HTML), I present:

An accessible text-only version of the slides, with image descriptions!

(edit: Tumblr has decided to eat the indents on the bulleted lists! I have added → to indicate that certain bullets are meant to be indented from others! WTF Tumblr!?!?! I'm very sorry to screen reader users who now may have to listen to multiple "right arrow right arrow" in some spots (and if there's something better I can do, please let me know). However since the formatting was fucked anyway I've added a readmore, at least.)

Unfortunately, Tumblr's formatting is so fragile * that I cannot insert a readmore without everything going to heck. I'm very sorry if you don't have "collapse long posts" enabled.

(* If you saw me post this before, no you didn't.)

Start of description:

Slide 1

how to make small talk with patients (and maybe other people too)

or like methods that i've developed and work well for me on average, but ultimately there are no universals in human relations, but i do think these are useful if you don't know where to start

Slide 2

also some of this powerpoint is about conversation in general, some is more specifically about nursing stuff

Slide 3

Most people also want this interaction to go well.

Slide 4

General Principles for Prolonged Small Talk with a Stranger

offer multiple conversational branches

follow patient's lead

ask open-ended questions

proportional conversation contributions

→ 1:3 ratio of talking to listening for customer service

→ personal: equal time speaking or opportunities to speak for all participants

learn to read the room

get personal but not intimate

have anecdotes and phrases ready to go

practice difficult conversations in advance

give it three shots then stop

know your exit strategies

Slide 5

important!! care about the conversation

I'm presenting a bunch of formulas here, but I want to make clear: my interactions are genuine. This is a way of thinking about conversations. All dialogue written here is the gist of what I'm saying. You still (and must!) engage sincerely, in your own voice, and with interest in the other person's thoughts. This is scaffolding you can build a conversation on.

If conversation is a dance, this presentation is explaining the steps of a waltz. You practice those foot diagram movements so you can use them in action. The dance is all in doing the dance.

Slide 6

Small Talk as Nursing Tool

Conversation as Assessment Tool

How are they talking? Slurring, raspy, very very softly, etc.

Do the words form coherent sentences?

Is what they're saying logical? Relevant?

How well can the patient describe their situation: illness, treatment, effects?

What can the patient reliably self-report?

→ capacity: what can patient perceive?

→ expression: what will the patient tell you?

Getting a feel for this patient's way of talking early on helps you detect trends or changes, especially neuro

Conversation to Build Rapport

Forming a good working relationship at the beginning of shift sets good tone.

It is easier deescalate a behavioral situation if you have already established familiarity.

Demonstrating that you're available and responsive to a patient shows they don't have to act out in order to get your attention.

Patients that are comfortable with you are more likely to tell you about subtle changes they might otherwise disregard.

Helps manage patients who talk a LOT

→ This bullet point got really long, so now it has its own slide later

Slide 7

The goal of making conversation as an assessment tool is to gather information about how the patient is experiencing their illness. You can learn about any progress, what the patient views as the most important parts of their hospitalization, and identify needs to address to customize your care plan to this patient's current condition.

Image:

Branching diagram in which

How are you feeling today?

leads to two paths

"I'm feeling [positive emotion]"

(response) "That's great! What happened?"

"I'm feeling [negative emotion]"

(response) "I'm sorry to hear that. What happened?"

text at bottom:

in both cases, you are soliciting further information with an open ended question

Slide 8

What do I talk about when I don't know what questions to ask someone?

the goal is to introduce a topic that both of you have are equally qualified to talk about, typically with the same level of investment, then in the course of talking about the general topic, you find something more specific to follow up on

basic general small talk: weather, traffic, view out of the window, what's on TV (DON'T DO THIS YET WITH THE NEWS), something innocuous happening right now, hospital beds and other amenities, animals and pets, sports

→ pursue whatever provokes enthusiasm

take the general down to the specific

→ weather happens → you talk about this weather → you talk about how it compares to other weather → you talk about how weather has affected your [wedding, sports game, air conditionless bedroom, commute to work, etc--identify your go-to anecdote.]

patient describes symptom → ask how it has been affecting their life

→ they mention a hobby it interferes with → ask about that hobby

patient mentions aspect of their life (job, birthplace, hobby, etc) → say something related to that

→ patient mentions being in the military → you: oh my mom was a military brat, did you have to move a lot?

→ patient mentions the field they work in → you: what's that? [you will learn about the wildest jobs this way]

→ patient mentions interest they have → you: wow that sounds really cool, what do you like best about that?

Slide 9

Aim for Personal, not Intimate

While you both are trying to figure out where the conversation goes, you're aiming for a controlled level of vulnerability: more than a completely "just the facts" professional exchange, less than "I've NEVER told anyone this before."

Reminder: Talking to another person involves vulnerability and risk. (That's why good conversations feel so fun!) Even with generic and uncontroversial topics, someone might accidentally go deeper than they meant, maybe even accidentally hurt someone. Don't linger anywhere you don't want to stay. It's okay to make it obvious you are changing the topic.

Personal

I went to school at [place]. It was not a great time and honestly I do not miss it. Where'd you go?

Intimate

I had a complete mental breakdown in college. At one point, all I did was lie around, smoke weed, and think about dying. It's amazing to me that I made it out at all.

Personal

How are you feeling about retirement?

Intimate

Do you worry that you wasted your life?

Reminder: just because you're comfortable sharing something intimate doesn't mean that the other person is comfortable being on the other side of that. Especially when you are providing care for them and you say something that makes them feel like they need to be responsible for your feelings. Assume intimacy is earned very slowly.

Slide 10

Levels of conversational intimacy

This slide is a flowchart, which begins by stating:

by talking about something personal and superfluous about yourself, you signal that you are open to conversation

Example:

I always wanted cats but I couldn't get until I moved out here a few years back.

Potential responses:

Pets: "oh how many"/ "what breed" / "here's my cat" Pet havers love pets.

Location: they ask "oh, where from?"

If "Pets":

Their pets

→ How are they doing while you're in the hospital? (note: natural way to learn more about their hospitalization)

→ What breed/how old/how big/wow what's it like having a snake

Your pets

If "Location":

Moving here from away

→ Where they/you lived

→ Why they/you moved here

Living here now

→ Ask about place's history

→ Ask for location recommendations

Flowchart notes:

Gradual increase in specificity. More specific = more personal

fun fact! you don't have to have a pet to talk about pets. You can talk about pets you once had, pets you'd like to have, other people's pets in your life, and/or why you don't have a pet (work too much, just don't want one, whatever). Then ask about theirs!

Slide 11

CAVEAT: SOMETIMES YOU'RE GONNA ACCIDENTALLY ASK ABOUT PETS WHO IT TURNS OUT ARE DEAD.

if you don't want to go further on this topic, acknowledge and pivot topics

→ acknowledge example: "I'm so sorry, losing a pet is hard"

→ pivot example: "Did you always have dogs?"

→ good bridge from acknowledging to pivot can pointing out you are changing the topic

→ → "I can't even talk about losing a pet, it bums me out so much."

→ → "I'm so sorry, we can talk about something else."

to see if they want to talk about it, gently probe (this signals you're open to this topic.)

→ "oh no, I'm sorry. how old were they/how long ago was that?"

→ "That's so hard. I remember when I lost [pet], I was so sad I said I'd never get [another pet] again."

if they continue the topic, they usually want to talk about their dead pet

→ Ask neutral to positive general questions

→ → "What were they like?"

→ → "How did you get them?"

→ → "That's a cute name. How'd you pick that?"

→ Talk about the pet's death ONLY IF they mention multiple times that their pet died.

→ → This looks like them discussing the grieving process, the actual event, going into details about what the death and dying process was like.

→ → → Rule of thumb:

→ → → → Multi-sentence answer = probably okay to continue this line of conversation

→ → → → One word answer = bail. new topic.

again, none of this is universal, this is my experience, everyone expresses grief differently, but I've found this to be a good approach for talking about the topic with someone you don't know well.

this also works for talking about dead human people. maybe don't ask about their breed.

Slide 12

You can draw attention to different parts of the same info to steer conversation. Pick your focus.

Example: You broke up with your partner last month, you're doing better but don't want to talk about it, and to distract yourself while heartbroken, you picked up a hobby. Someone you haven't seen in a while asks what's going on in your life:

"I just broke up with my boyfriend."

→ there's no alternate option offered except the boyfriend and the break up

"I'm thinking about starting to date again, but god, it's such a hassle."/ "Been redecorating the apartment. I've never lived alone before, it's a little nerve wracking."

→ your personal life is up for discussion but with a focus on the future, not the past

"I've gotten hardcore into knitting this month. Look at this terrible scarf." / "Nothing interesting. What about you?

→ what if we talked about anything else

Example: Patient with a Gl bleed wants the bed alarm * off.

(* I've actually got a lot of feelings about the lack of actual evidence that bed alarms prevent falls & the way they contribute to our patients' immobility but that's a different ppt & i'm trying to stay on topic A LITTLE.)

"Even if you feel steady now, there's a decent chance you could keep losing blood. You get up, get woozy, and fall without bracing yourself at all, and you've got a Gl bleed and a broken jaw."

→ provides medical reason & its effect on patient

"You'll get cleared to be independent when your condition stabilizes. Right now, if you get up on your own and fall, I guarantee you that bed alarm is NEVER going to be discontinued."

→ addresses a consequence pt might value most

"I know it's super annoying, but it's hospital policy for the first day. My nurse manager will kill me if I turn that off now."

→ I actually hate "hospital policy" as a primary reason, but there are patients out there who 1) really respect rules and/or 2) understand how managers work.

Slide 13

People are not Actually Very Good at Articulating Stuff

Some patients are more direct about their needs than others. For example, these ones don't say, "I'm in pain and would like my medication." Instead: "What is this bed made of, my ass is killing me," or "oh I can't complain I guess," or "fuck you fuck you fuck you, get the hell out of my room."

Things to consider:

IMPORTANT: people can express genuine needs in frightening, annoying, confusing, exhausting ways. Don't deny something someone needs because of the way they showed that they needed it.

Shame

→ people can feel embarrassed/ashamed of being sick or needing help

→ → the loss of autonomy and privacy

→ → especially stigmatized diseases or diseases that patients "did to themselves" (diabetes II, drug use, liver problems related to excessive drinking, complications of suicide attempts, etc)

→ → might lash out at people who provoke that shame

→ → some patients won't endorse pain but will endorse "discomfort."

Recent events

→ a patient who had a security incident today because their mom brought them meth

→ a patient who got a diagnosis today that's one of those life-defining ones

→ a patient with 10/10 pain who has waited ten minutes for someone to answer the call light

Slide 14

More Unspoken Factors

Physical condition

→ how much has the patient slept? when was the last time they ate? what is their pain level? etc

→ how difficult is it for them to eat, go to the bathroom, and turn in bed?

→ → some patients won't ask for help with something because doing it is so uncomfortable

→ → → ex. patient at risk for bed sores refuses repositioning. Why? Pain? Wakes them up? Don't understand why we do this? People do it too fast? Ask!

Time in Hospital

→ what is the relationship between the patient and the floor/careteam they have?

→ → is the patient generally liked?

→ → → if the answer is no, why does staff not like this patient?

→ → → what are possible explanations for those actions?

→ → → how does it affect their patient care?

→ → → has security ever been called? for what?

→ → is the patient part of a marginalized group?

→ → acting like you expect someone to behave badly automatically creates a hostile tone

→ → do they have visitors? are they bored? what entertainment options do they have?

→ → is their room nice to be in? (clean, not smelly, no annoying alarms, stuff in reach)

→ → the bed sucks. how much does it suck?

Slide 15

Expecting a fight can get you a fight.

you don't match their energy, you engage with the energy you want this conversation to have

you can be prepared to deal with unacceptable behavior without expecting that behavior

people get sooooooooo thrown off when you don't get mad back

allow people the opportunity to surprise you

consider your goal in this conversation: is the most important thing for you to be right?

Image: the following three sentences arranged in a circle of arrows that each lead to the next:

You think someone's an asshole so now every intervention with them is a conversation with an asshole.

Other person gets mad at being talked to like they're irrational or stupid or inherently violent so now they act like an asshole

Both of you now believe the other person is an asshole

Slide 16

useful starting points and what I do with them

people can often tell they are being treated different, even if they don't know how. acknowledging behavior is better than ignoring (and resenting) it

→ "So it sounds like from report that today didn't go great. What happened?"

→ "When you yell like that or throw something, I have to leave until you've calmed down."

→ "You shouldn't have been treated like that, and I'm sorry you were."

→ → don't automatically take the side of the hospital--trust me, staff provokes or exacerbates situations ALL THE TIME

sometimes people don't know the rules and expectations, even ones you find obvious

→ do they know they're being too loud? do they know what to hit their call light for? do they know how their meds work and when they get them? do they know when to expect vital signs? do they know why there's a bed alarm?

people generally like it when you acknowledge that things suck and when you try to do something about that

→ "That's rough, buddy." (sincere)

→ I had a patient once who was in 10/10 pain all night long, and through hard work and a lot of tries, I managed to do absolutely nothing to bring that pain down. When I went to say goodbye to her at end of shift, I said, "I'm sorry that tonight was so hard. I've documented everything we did and how it didn't work. Day shift's been told everything and will work with your doctors."

→ → and she said, "I felt better seeing how much you did and knowing that you cared."

→ → and it made me cry! and then incorporate what she said into my nursing philosophy.

Slide 17

MOST CONVERSATIONS ARE THE SAME

I've had public facing jobs my entire working career. For any given position, like 90% of what people ask and talk about are going to be the basically the same, just in different fonts.

learn the most common interactions at your job

→ what always needs to be explained?

→ what always needs to be responded to?

→ what always needs to be said?

identify the best ways you've responded to these questions

→ see what other people do, steal what works

→ identify what works best

→ → what education explanation is the clearest?

→ → what topics prompt the best conversations?

→ → what questions get you good answers?

→ → what work-appropriate anecdotes get the best response?

→ → what makes you and your conversation partner feel productive and comfortable?

→ make templates for yourself for standard conversations

→ practice new responses to see what works best for you

Slide 18

Difficult Conversations (variations on saying, "no, that's not gonna happen")

Do you even need to have this conversation?

→ patients have the right to refuse care, and the right to be involved and aware of their care.

→ Do you have any rationale beyond policy, convenience, or your personal discomfort? kill the cop in your head

→ → examine what you find uncomfortable versus unsafe

When you do have to have these conversations:

→ don't attack, don't defend. state facts, not interpretations.

→ make sure patient knows why this matters TO THEM and what happens TO THEM if nothing changes

→ make sure it is a conversation--ask the patient why this is happening and what would help.

→ listen to the patient. don't argue.

→ → make sure you understand what they're saying

→ → there's a real power in letting people rant

→ respect their decisions, protect their autonomy, believe that they think and act as complexly as you do

example: unhoused patients often deal with food insecurity. They may hoard food in their room or request a lot of snacks and meals they may not eat.

let them! who cares?

if there's dietary restrictions ordered for health reasons, explain to them why and, if possible, seek alternatives.

→ "the reason you can't eat or drink before surgery because sometimes people throw up under anesthesia and choke on whatever was in their stomach. so if you eat, they will cancel the surgery, and you'll have to keep waiting."

if they are requesting enough food that it impacts other patients, try to let them know before they hit that point.

→ "Head's up, we're running low on pudding so you can only get one more cup tonight. You wanna hold off or have it now?"

if the food has gone bad, offer replacements

→ "I'll swap that milk out for a fresh one."

→ "i'm worried that by this point, this food has been sitting out so long, it will make you sick. what else can i get you for you to have at your bedside?"

Slide 19

SOME PHRASES I HAVE ON LOCK

Sometimes someone will say something to you that, for whatever reason, you are utterly unprepared to answer. Practice some generally applicable statements to say in these moments avoid saying something you don't mean out of on the spot panic. (Don't worry about creativity. Sometimes, you simply must embrace cliche.) This can be especially useful if you don't typically have patients in psychosis or with delusions.

Wow, that sounds really [adjective] to deal with.

→ this is the best and easiest catch all. you're acknowledging what they just said without endorsing it, denying it, really expressing any opinion except that something has impacted the patient telling you this. And it's true. That situation IS really [adjective] to deal with.

I don't think we agree on this topic.

→ good for politics

I find what you said hard to believe based on the evidence I have.

→ if patient with delusion really presses you for your opinion on whatever the delusion is

→ always allow for the possibility that they're right

I want to make sure I'm giving you the right answer, so let me go doublecheck before I answer.

→ good when the patient asks a question about care and you're like "HUH. UHHHΗΗΗΗΗ."

I'm sorry. I know this isn't what you wanted to happen.

Slide 20

Help, This Old Man Will Not Stop Telling Me About His Entire Fifty Year Career: Dealing with Talkers

Definition of "talkers":

→ you're told first thing in report that they talk a lot

→ they resist all signals that you'd like to leave now

→ your participation in the conversation is optional: they will just monologue at you

→ often frequently hitting the call light for small requests that they will not cluster together

→ → i.e. getting them their sleep meds, a cup of tea, and a warm blanket will be three separate calls five minutes apart, despite the patient assuring you every time that they can't think of anything else they could need.

Seek conversation with these patients purposefully

→ You are not going to avoid conversation with this patient. It simply won't happen.

→ Staff starts dodging interactions with this patient, leading to the patient calling more and wanting to talk even longer when someone does come

→ → you MUST break this cycle

Invest a specific amount of time to be genuinely engaged in talking with them

→ I will schedule conversation w very high need patients like it is wound care or another procedure.

→ Patients like talking to someone who is not running out the door. Getting undivided attention often calms the desperation to talk.

→ Can make easier to get out of the room faster in the future. They know you'd stay and talk if you could. (And you feel less guilty about dipping.)

Slide 21

HOW TO EXIT A CONVERSATION THAT WON'T END

There's always going to be someone that's like "oh just leave." If I was confident enough to just leave, I wouldn't be making a powerpoint presentation about how to talk. Here are some tricks to derail the monologue and remind everyone of the world outside this room:

Make clear when you arrive how long you can stay. That makes it easier to look at the clock and go, "oh shoot, I gotta run."

→ variation: set a timer on your phone to go off loudly. When it does, say, "I've gotta go check on something."

Have a buddy. Tell them if you don't come out of room 314 in ten minutes to come knock on the door and tell you a doctor is on the phone.

If you have a vocera or other communication device, you might be able to schedule a voice reminder. Patients understand you have to go when your pager equivalent dings.

Say you have to give pain or nausea meds to someone else. Now you sound like a bad nurse if you don't leave.

When all else fails, you just have to go, "Well, I'm gonna leave now, see you in an hour," as you are actively walking out the door.

Slide 22

FIGURING OUT WHEN IT'D ACTUALLY BE REALLY ANNOYING FOR YOU TO TALK

Sometimes patients hold you hostage in endless conversation. Sometimes you're trapping them, and they have much less of an ability to just leave. A lot of patients want peace and quiet; a lot of patients really jump at the chance to talk to someone if given an opportunity. Try three times and see the response.

(1) Overture -- couple sentences in first part of the shift that contains details that are that not essential for practicality and allow for follow up questions.

Overture: "Do you want me to adjust the lights? I love that there's a dimmer switch in this room. This is the only floor I float to that has so many lighting options. Well, this one and maternity."

Every other time I'd ask this question: "Lights on, off, whadya want?"

(2) Question -- ask a question about them that is related to care but not purely medical.

"How have you been sleeping?"/"How have you been eating?"

"Was that your family in here earlier?"

"Oh hey, you transferred here from [x]? That's a long way, how'd they bring you here?"

"Is there anything else I can get you? Do you do word searches or sudoku, anything I can print out for you?"

(3) Follow up once do one more of the two things listed above.

This is for the people that need a little warm up.

If they don't respond meaningfully to any of these three attempts, stick to the strictly professional.

Slide 23

ONE LAST DISCLAIMER BEFORE WE GO

this is stuff that generally works for me, someone who made a powerpoint on minmaxing chit chat. so, yknow. interpret that as you will.

these "rules" are more conservative and rigid than they have to be

→ there's a lot of flexibility and grace in actual conversation. But if you feel like you don't have an ear for the rhythm and content of small talk, it's nice to have structure while you practice.

again: NONE of this means I don't care about a conversation or everything is a formula. everything here is something that's helped me be less anxious about conversations, to improve the conversations I have, and to reduce my mental load so I can enjoy conversations. It's fun to talk to people!

→ I cannot tell you the amount of staggeringly intimate conversations patients have had with me in the middle of the night because I make it clear that I'll listen nonjudgmentally. It is my favorite part of the job and some of the most important care I can provide.

Slide 24

BONUS SECTION: EMPATHY

I have no idea what's obvious to people or not. Here's how I approximate what someone else might be feeling in in situations I've never experienced.

Slide 25

EMPATHY EQUATION because sometimes people don't tell you what they feel or they don't know themselves or they don't know what to ask for in this situation so you have to make a guess.

Break down the situation to its core.

Identify a similar experience I've had.

Identify what I wanted in my similar experience.

Break down I would have wanted down its core.

Adjust for magnitude of the situation.

Apply context specific variables.

See if I can find a way in current circumstances to express the core of what I would have wanted.

Slide 26

Example: Patient who habitually uses fentanyl and meth is admitted for an infected leg wound and grows angry they aren't getting more opioids.

(1) Break down the situation to its core.

patient is in distress

patient perceives that the thing that would relieve that distress is being denied to him by people who could provide it

(2) Identify similar experiences I've had.

miserably enduring earaches as a child

being unable to get my adderall filled and feeling angry that I had to chase down my meds

(3) Identify specifically what I wanted in my similar experience.

my earache to stop

to just get sleep so I didn't have to deal with this

to get my adderall so I didn't feel so concerned with rationing the remaining pills

for people to not treat my problem as meaningless or even an annoyance to them

(4) Break down those wants to their core

pain relief

rest and recovery of my body

reliable access to my medication

respect and compassion

Slide 27

Empathy Example, continued

(5) Adjust for magnitude of the situation.

infected leg wound is much more painful than an earache

(6) Apply context specific variables.

people who use drugs are often shamed for it

patient at baseline tolerates and is used to a very high level of opioids

people don't tend to abuse fentanyl when their life is going well

patient has a new pain on top of chronic condition managed by habitual drug use

(7) See if I can find a way in current circumstances to express the core of what I would have wanted.

pursue multimodal methods of pain relief (tylenol, ice, muscle relaxers, elevation, ice packs, distraction, meds for other symptoms)

prioritize protecting sleep (limit awakenings, cluster care, prioritize your interventions and assessments, etc) and promoting comfort (more pillows, warm blanket, hot chocolate, hospital mocktail, making the room smell better, turning off lights shining directly in patient's eyes)

reach out to doctor about pain management plan, advocate for more opioids if that is indicated (in this example, almost certainly is). sometimes more opioids up front to decrease pain means less opioids overall bc now you're in maintenance mode, not crisis mode. get patient as consistent a pain med schedule as I can so they know when they can expect medication and what it will be. develop plan with patient about when they want to be woken up for meds.

tell the patient what you're doing and what you'll do next if that doesn't work. tell them that you're sorry they are in so much pain and you are trying to improve the situation. proactively round on them to assess progress of your interventions. it is distressing and hurtful to be in pain and feel that no one even cares enough to give you better treatment than you'd get leaving AMA and self-medicating.

No Deep Conversations When Someone Is Still Yelling

Later when things are calmer and you have a better relationship, you can debrief with the patient about what happened. Ask the patient what they were feeling and what would help in the future, while being realistic about what you can and can't promise. While in crisis, keep sentences short, calm, and practical. Focus on taking actions that address the core needs.

End of description.

One of the stranger things about training brand new nurses is explaining how to min max small talk. It feels very weird to coach people on how to chat.

[joyfuldeepend]

Invited In

Recently I had a friend spend some extended time with me and the girls I support. It was a big deal to me. We have a few people who choose to engage or spend time with us. Also I am protective of who they experience. Honestly I never know what I’m going to get each day and while it’s my normal now, I perceive that could be a lot for those not in it regularly. When I recount things that happen sometimes I get unsolicited advice on how people would handle their behavior if it was them. Often people get a little terrified for me and other people are scared for me, which makes sense if it’s not the norm for them.

One thing that I’ve made a personal commitment about, is not to apologize for them. They’re working their stuff out and sometimes I’m confident when we’re in public people might think they have “special needs” or are shocked or think they should be more docile. That being said, choosing to be a safe place for them, for me, means in all settings. That doesn’t mean accepting all behaviors, however it does mean that every situation and behavior doesn’t get addressed right away. If that was the case I’d live in just corrective mode…and that’s not helpful for any one, especially me. There have been many times in stores that one or both are giving into their intrusive thoughts and I pick which battle I will fight based on factors impacted at the moment.

The girls have been in survival mode and lived with conditional love, undependable adults, manipulative families, toxic parenting and the list goes on. It takes awhile to work through those things to get back to zero and start there.

My goal is to get them to be able to graduate high school and hold down a job. Along the way if they learn some character and consideration of others that’s my bonus points. It has taken me a year…A YEAR to get R to be respectful to me (70% of the time), minimal lying, not flipping me off constantly, saying thank you, consider others (well at least me for now), want to spend time with me and say I love you and not be manipulative. She texted me recently and asked if I’d go with her to the doctors to get a shot bc she’s scared. This is HUGE!! Her caseworker said she was proud of her and saw her maturity this week, I could have cried right there. Besides me no one, that I know of, has told her that in years.

K has started recovering from her spirals in less than 2 hours versus the days to week it would take before. She calls me mid spiral and freaking and let’s me deescalate, she wouldn’t do that 3 months ago. I’m praising God for that movement. (UPDATE: things went downhill after I wrote this. After two weeks of up and down she was removed from my home after another police encounter and physical damage occurrence. It was a rough choice, however I’m confident the best one give the circumstances).

I recognize, just like with any kids, people see the current phase, and I…I see the journey and the growth. When interacting with the girls it could be chaotic and they could also be sweet, considerate and naive/youthful. They will always want to listen to music, eat junk food and watch movies and take long drives. As much as it “costs” I still remember that I prayed for this and I’m grateful for the ways people engage or find ways to support me/us as their boundaries allow. So grateful for all of those ways and the continual prayers as I know I do not journey alone, even when it feels like it!!

I say all of these things to say thank you. Thank you to the people who continue to find ways to support or engage with my journey. As a quality time person all of that means the world to me. It looks different for each person and I’m learning to grown in my appreciation of the varying expressions. Thanks friends for diving into the joyful deepend. This is our reminder to keep inviting people in!

[vickyvicarious]

I agree with you so much on the clouded kokoro case. The abuse shouldn't be portrayed as lighthearted and I wanted Ms. Garrideb to go to jail for abuse.

Yeah, I mean Juror 5 has some pretty awful stories but we don't see it onscreen so it's possible he's exaggerating I guess. And the Beates aren't really as bad. They actually seem more doting, it was mostly just that one sprite of her yanking on the scarf around his neck that bothered me. But the Garridebs... whoo boy.

So, in the investigation portion I actually initially thought Joan was going to be a straight-up villain. Every time he talked too much she poured scalding tea on his hand to shut him up! It seemed obvious that she was hiding a dark secret and that he was afraid to speak, at least in front of her. And then after the reveal that they were married, I was kinda surprised that it was just left at "but you still love her/it was just a lover's quarrel" when there seemed so much fear happening, and the reactions were so extreme.

His face was red with a slap most of the time, he got burned tons right in front of us, she insisted that her throwing tons of stuff at him wasn't wrong since she needed to just let the emotion out rather than let it fester, also she tried to basically gaslight him in front of the court by saying she only threw soft things because she loves him? When in fact the stuff she threw could potentially have seriously injured or even killed him. And she set his stuff on fire and ignored him trying to put it out or deescalate the situation. She broke his favorite pipe and ruined his favorite book.

All the super aggressive stuff appears to be meant as "retaliation" for the note in the book from another woman. It sounds like he just bought a used book that already had a love note in it, but even if that's not the case, they both seem too used to her behavior for me to think this is the first time. She talks about being "fiery" or whatever, and when she burns him he sometimes says stuff that's like "stop, we're in front of people". Which! If she's this comfortable hurting him in front of strangers or in a court of law, then what about when they're alone together?! And I know he's trying to keep up appearances a lot with the whole maid thing, but that seems to be equally a role she wants to play so it's not like he's being super oppressive or anything. Not that it would make her abusing him any better even if he were hiding her away or having an affair.

I mean, when you list it off it's not funny at all (not that I found it amusing in the first place...). I imagine she's getting charged for some kind of assault at the end of the case? But it sure seems like she's gonna get off really easily for this, since the injury was an accident, the injured party is no longer in a coma, and Mr. Garrideb came up to support her. He's clearly not going to be pressing any kind of charges, even assuming in-universe there isn't an attitude that "women can't be abusers", which is definitely the vibe I got from this case.

It would be really nice to imagine otherwise, though. That with all this out there someone reaches out to Mr. Garrideb about not having to live with this treatment. Maybe Inspector Gregson or van Zieks (thinking of his moment of kindness with the Beates where he basically promised not to fire the guy for what he did). And then eventually they prosecute or something.

[sirensinmymind]

My bf thinks he has bpd and he fits a ton of the symptoms. what do you think i can do to make him feel better? we've definitely had issues of him getting upset about things i've done where i had no intention of being hurtful, like telling him I was out with friends and I would text him later, and when i call him a couple hours later he's mad at me. do you have any advice as a person with bpd?

First off I’m so bless that you asked me, but just got to put it out there that my experience with BPD might be different from your boyfriend’s experience, but I’ll share what I’ve learned. When I was first diagnosed, I was coming out of the hospital for a suicide attempt, and they made it seem like the end of the world that I had BPD… They pretty much demonized the disorder and that scared me. I did some research about BPD straight off and all the results for BPD were like “my bitch of a gf has BPD pity me” and “how long until my BPD partner cheats on me”…. And just a lot of stuff about BPD people having a really hard time in relationships. This is not the case for most of the time. Once I started talking to other people with BPD I realized 1) we are normal functioning humans 2) they are so many people out there with BPD and 3) we deserve to be in relationships and find love. Living with BPD is a struggle but there’s so much that you can do to make it better.

What I would say to your boyfriend:1) remind him that you’ll still love him with BPD2) remind him that you love him at random points, it means a lot3) encourage him to seek treatment, offer to go with him if he’s scared4) he might need reassurance sometimes, try to support him when you can5) have a talk with him about healthy boundaries. I did this with my past significant others and it helped to know where we stood at times

About your boyfriend getting angry with you, it will happen sometimes. As a person with BPD, I get anxious when I don’t know where or when my FP will get back, and I get jealous when they’re out with friends. I think what would help with that is just send him little updates when you’re out so he knows your OK and that youre thinking about him, it means a lot. But I’d suggest talking to him about what would make him less anxious/jealous.

Here’s what I would suggest for you boyfriend, or for anyone with BPD:

1) Work on healthy communication. This is #1 for a reason. In all my relationships, platonic or romantic, I encourage complete honestly and bluntness because I usually can’t tell when I’m acting irrationally. It’s important for the people around you to feel comfortable telling you when they feel hurt, so just try to let them know that they have a safe space to communicate with you at any time. And the other way around too! Ask the people in your life to share the same respect and listen to your concerns genuinely. Healthy communication is crucial with BPD. For example, when my Favorite Person leaves me on read when we’re texting, the BPD part of me freaks out and jumps to the conclusion that they hate me. In this situation, I want to freak but the most reasonable thing to do is just talk it out with my FP. It’s taken me some time, but I’ve learned that it’s better to talk things out than let them just slowly simmer in your brain.

2) You will get roasted for things that you do, so try to take them constructively. I’ve done some bad shit in my day, but thankfully I’ve come to the point where I can reflect on what people tell me I’ve done wrong and use it to make myself stronger. We will all make mistakes sometimes, so just use the experience in a positive light. For example, my fear of abandonment makes me hella jealous of my friends hanging out with other people. I’ve been called out for being jealous before, so now I tell my friends to call me out whenever I’m acting jealous. Once they call me out, I can fix my behavior accordingly.

3) DBT is hella useful. I suggest anyone with the means and access to DBT to take advantage of it. It is such a useful type of therapy that is actually more class based than therapy based. What I mean is that DBT teaches you skills to cope with intrusive thoughts, how to handle relationships, what to do when you’re having a breakdown and how to deescalate…. So many things!! DBT is structured for people with BPD, so along with learning life saving skills, you have a community of people who are going through the same thing as you mentally. I’ve met so many people through DBT and their perspective has helped me grow as a person, so I would just highly recommend! What’s also important though is having an individual therapist that is versed with BPD. You would be surprised at the amount of therapists that have old stereotypes about BPD, that won’t take BPD clients because they’re “"harder”“…. do some research on the best therapist for yourself.

4) Surround yourself with positive influences. Idk if this is just a me thing, but because of my BPD I have allowed abusive relationships to occur because it was better than being alone. Don’t !!! Do !!! What !!! I !!! Did!! You are worth so much more than you know and should be with people who bring you up, not down. If your FP is being abusive or just hurtful, cut that motherf@$ker off real quick. Trust me, it’s better to be alone than have to feel shitty about yourself through their behaviour.

5) speak out for your needs and talk to them with the people you care about

I hoped this helps a little bit, if you or your boyfriend have any other questions or just want to talk more just send me a message ❤️