The process of therapy is often on my mind, for many reasons, and it’s something that I hope to write a great deal more about over the coming months. I don’t think I can avoid it, as it forms either the under-current or the overt subject of many of my current therapy sessions, particularly since I lost my ‘perfect’ therapeutic relationship a few months ago. I have done endless internet searching and reading into various aspects of therapy, desperate to find out more about what kind of therapy is ‘best’ for BPD, what I should expect from therapy and what the therapeutic relationship should ‘look like’. The well-known book about BPD, ‘I Hate You, Don’t Leave Me: Understanding the Borderline Personality’, has an excellent section on the various therapies available and the differences between them, and I have round the  ‘In Therapy (a user’s guide to Psychotherapy)’ blog on the Psychology Today website, to be another interesting source of information and views on a range of therapy related issues. Most recently, I have been very pre-occupied by my strong and all-consuming need to feel cared for in therapy, and on that point, I found the following post entitled “Does my therapist care about me?” very helpful.

But for now, I’d just like to make a couple of general points I have learned about therapy. However ‘successful’, or otherwise, my sessions might have been; whether or not I have ended up more depressed and in more anguish when I finished than when I started (!), therapy has undoubtedly made me think about myself, my feelings and my actions, far more than I have ever done before. For the first time, I connected my feelings and behaviour over the last three years or so, with what I went through over a ten year period from starting in the early 1990s. What I now think of as my ‘BPD remission’ period (which ended a few years ago), was preventing me from appreciating the entire picture, whereas I now regularly make connections and see patterns between current events, and past events.

Therapy has made me far more self-aware than I have ever been, although it has to be said that for me, that is a double-edged sword. On the one hand, I believe that self-awareness is fundamental to understanding behaviours, feelings and their origins, and enabling someone to change (if they want to). I have a deep-seated need to understand what I am going through, although ‘deciding to get better’ is something I am actively struggling with. On the other hand, however, self-awareness can feed the BPD individual’s lack of self-worth and perception of themselves as evil. Linehan put it perfectly when she said in Behavioral Treatment of Borderline Personality Disorder (1993): “The patient’s first dilemma, has to do with whom to blame for her predicament. Is she evil, the cause of her own troubles? Or, are other people in the environment or fate to blame? … Is the patient really vulnerable and unable to control her own behavior …? Or is she bad, able to control her reactions but unwilling to do so …?” If I am aware of my behaviour, does that mean that I am causing it? If I am aware of it but do not stop it, is it therefore intentional? And what does all of that say about me as a person?

Therapy has also made me realise that fundamental to the process, particularly for someone with BPD, is the therapist themselves. However appropriate the type of therapy, it simply will not work if the relationship with the therapist is not right. I’m not defining what ‘right’ means – it could mean different things for different people – but it’s paramount that that relationship works for you. I think this is particularly true for people with BPD, given that so often our struggles centre around interpersonal relationships, and our relationship with our therapist is not exempt from that – indeed, we often mirror the turbulence of our other relationships, with our therapists. Therapists who have worked with BPD before will know to expect this and will handle it appropriately, but unfortunately, this is not always the case with those who have less experience in the field, or who are dealing with those who have yet to be diagnosed.

We idealise and devalue our therapists; we test them; we fall in love with them; we fear rejection by them; we trust them one day and are suspicious of them the next; we get angry with them; we push them away; we want to be loved by them; we push boundaries with them; we want them to carry us and our pain, and then we want nothing to do with them. As well as being able to understand and deal with all of that, the best therapists will make us feel safe, understood, and, I would suggest, cared for – something that as people with BPD, we crave. They will also ask the right questions and they will make us think, but they will not judge –  they will empower us rather than try to persuade us into making ‘sensible’ decisions, and they will be honest and empathetic to our needs. A high bar to measure up to? Absolutely – but these therapists do exist and I hope that this will give hope and encouragement to those who may not have had the best experiences of therapy so far.

Therapy is often emotionally draining – without the right ingredients in place, it can also be frustrating, confusing, and potentially damaging. However, it can also be a safe haven – inspiring, supportive, transformational, and a much needed regular opportunity to share the heavy burden that we carry, with someone far more able to contain and bear our pain, than we are often able to. Sessions will vary – some will feel productive, some will feel emotional, some will feel difficult and stilted, some will feel as if you are making great strides forward, and some will feel as if you’re standing still, or even moving backwards. I’ve only recently started to come to grips with the idea that I don’t need to have a startling revelation, be overcome with tears, or feel intense emotions during therapy in order for it to be ‘working’. And some of the best and most ‘connecting’ experiences that I have had in therapy have been those sessions in which my therapist and I have laughed together. In the midst of a sad and somewhat tragic moment, we burst out laughing at something I had said  – not in a way that felt as if my therapist was laughing ‘at me’, but in a way that felt as though we were of one mind in recognising the bitter-sweet incongruity of the moment – from the sublime to the ridiculous and back to the sublime again.

I know that as people with BPD, we can spend our lives looking for ‘the perfect care’, and are repeatedly told we have to accept that this does not exist. Maybe that’s the case – but a good relationship in therapy is some of the best care that we can seek and give ourselves. If you’re reading this and have also been diagnosed with BPD, I really hope it makes a difference to you, as I’m hoping that it will to me.