Life in a Bind – BPD and me

Borderline Personality Disorder, Generalized Anxiety Disorder, and my therapy journey. Listed in Top Ten Resources for BPD in 2016 by goodtherapy.org. I write for welldoing.org and for Muse Magazine Australia, under the name Clara Bridges.

Therapy – a few thoughts

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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.

 

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11 thoughts on “Therapy – a few thoughts

  1. Another beautiful post! 🙂 Where is the quote from Linehan from, I would love to read it? xxxxx

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  2. Thank you 🙂 I haven’t read the book that the quote is from (Behavioural Treatment of Borderline Personality Disorder), but I saw the quote itself in a really good Time Magazine article which I found some time ago, here: http://content.time.com/time/magazine/article/0,9171,1870491,00.html. I’m not sure whether I technically should have referenced the source of the quote as well as noting who the quote was from??!! It appears, however, that you can no longer access the article as you have to subscribe to view the whole thing, which is odd, as when I looked at it, you could view the whole thing for free…….I think the article goes back to 2009…… xxxxx

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  3. Pingback: Blog for Mental Health 2014 | Life In a Bind

  4. This was a fantastic post, with a lot of really mature thoughts on the good things about therapy and its challenges. Having the “right” fit is critical, as you indicate. It’s something that’s subjective and emotional and hard to put into words. I liken it a little bit to dating, but without the romantic aspect 🙂
    I agree with you that feeling cared for or “loved” as a person is critical in therapy in general and in recovery from BPD. Since it seems like you like reading, I will list a few books on that topic that you and others might be interested in:

    Harold Searles – My Work with Borderline Patients (1986) – one of the best and most honest therapists of borderline and psychotic patients, IMO. Wrote a lot about how the therapist should be afraid to become involved with the patient emotionally in both good and “bad” ways.
    Jeffrey Seinfeld – The Bad Object – talks extensively about therapeutic symbiosis, which is a (good) regression to a primitive child-parent love relationship in therapy
    David Celani – The Treatment of the Borderline Patient – a Fairbairnian approach to treatment of BPD, emphasizes how the therapist should not be afraid to “love” the patient in the way a parent loves a child.
    Bryce Boyer – Psychoanalytic Treatment of Schizophrenic and Characterological Disorders – probably my favorite writer which hardly anyone has heard of. His books discusses many borderline patients that he treated intensively. He was obviously very empathic and not afraid to emotionally get involved with patients.

    I learned so much from their writing and applied it to my own therapy, consciously trying (for the first time with anyone) to develop a positive relationship and to fight through my distrust back when I was severely borderline. Hopefully others can do the same.

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    • Thank you so much – both for the comment on the post itself, and also for taking the time to write about some reading options, which I really appreciate. I have no idea if what I write interests or touches others, and it’s always good to have positive feedback as it motivates me to keep going. I’m a mess at the moment – very very low, and functioning just enough to get through the day with my husband and children. When I can string more than a paragraph together, I would really like to email you, if you’re happy with that, and ask for your thoughts and advice on my therapy situation (you indicated on your blog that you were happy to be contacted?). I have no idea what to do next, as well as being in denial about never seeing my ex-therapist again. I’m hanging on the fantasy of a friendship with her (which I know she’d never agree to) – do you think this is ever possible? I’ve had a brief look through your blog and will come back later and have a more thorough read. What I did see, looked incredibly helpful and interesting. Thank you for stopping by and reading and commenting on my blog – as well as your valuable comments, it led me to your blog as well.

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  5. Sorry things are difficult right now. Sure, I would be happy to talk as indicated on my blog, with the caveat that I’m not a therapist and so cannot provide professional advice. About being friends with one’s therapist, I am “friends” with one of my old therapists – I email her every few months with updates on how I am doing, and she is responsive and friendly. It’s different than a normal friendship, and certainly not as frequent. I want to encourage you that there are many good therapists out there; and to gradually focus on what you can do to find a good new one. It’s great that you were really attached to your therapist and liked them – that’s a hopeful positive sign. A few years ago, I had a therapy relationship end somewhat badly and had to search for another one. It was a long, hard process (although I eventually met with only 5-6 people, and chose one). What I did was temporarily see my old psychiatrist (who’s a nice guy), not for medication, but for once-a-week therapy for several months. I got in contact more with friends and family and kept myself active. And then I did my research on psychodynamic therapists through Psychology Today and other referral sources, and eventually found another good therapist for long-term treatment. I hope that is useful; I know it’s not easy.

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    • Thank you so much for taking the time to reply so fully, I really appreciate it. And of course, I completely understand that you would not be providing professional advice – it would just be great to hear more of your views based on your own experiences of therapy and of your reading. I have a big interest in therapy itself, but little time to read, and so your blog is really helpful in terms of summarising different types and viewpoints. And it was really good to hear from you, that you agree that it’s legitimate to want to feel cared for and loved in therapy, as that’s one question I was really conflicted about. I _felt_ it to be true, but some of the reading I’d done, did not support that viewpoint, and so I was unsure whether my ‘gut feeling’ was simply ‘wishful thinking’. I think I read somewhere on your blog that you had less sympathy for Masterson’s views and that he placed too much emphasis on independence – I agree, and that was what was making me doubt whether I was right to place so much emphasis on the question of feeling cared for. Thank you so much for the encouragement that there are good therapists out there – I tend to ‘settle’ for what I have, and am afraid of confrontation, so it’s hard for me to move on if things aren’t working, and I worry it’s something to do ‘with me’. Things ended with Jane several months ago – since then, I have been seeing someone else, but the ‘fit’ is nowhere near as good. Of course part of me wonders whether I’m just biased because in comparison to Jane, anyone would seem ‘less good’. But even if that’s true, I can’t get round the fact that I don’t feel particularly cared for, or particularly well understood, and that’s a problem. The other major problem is a question of styles, and again, it would be good to have your view on this. Jane did quite a lot of talking – sometimes more than 50%, if I was having a really difficult session, and the interaction and the conversational aspect, feeling like we’re partners, was something incredibly valuable and helped me to think and process. My current therapist talks far far less, and I find that incredibly difficult. I need more interaction, more engagement, I hate the silences, I find them paralysing. Again, I thought that probably told me something about me, and I had to try and ‘get over it’, but although I’ve got better at dealing with them, I still crave the dialogue and the insights that brought….sorry, this is turning into an essay! I will endeavour to put more of this into an email in future 🙂 Thanks again for the support, and the really really useful pointers. I’m so glad you found a series of really good therapists, even when you’d had a really difficult end and it took a long hard road to find another one. The thought of that process fills me with dread, and it’s good to hear of someone who made it through that, with really positive results. Is there much of a different between psychodynamic and psychoanalytic psychotherapists, and do you know much about integrative psychotherapy? Argh – more questions. That’s the problem with being a mine of information 🙂

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  6. This is all interesting to talk and speculate about. No, I don’t know about integrative psychotherapy. What is it?
    About psychoanalysis, I have never actually done it myself. Traditional psychoanalysis involves lying on the couch 4-5 times a week and free associating without looking at the therapist. It’s very rare today because of the cost and other factors. Psychodynamic therapy is different, yes, because it’s face to face, and it involves more practical, direct interventions (i.e. confrontation, advice-giving in some instances) than psychoanalysis. Psychoanalysis would not always be good for borderlines because it requires a lot of emotional strength already, and doesn’t involve face-to-face contact, which could be a problem as it is something borderlines benefit from greatly (face to face contact) in my opinion.
    About the feeling of not feeling right with a particular therapist, I can only say trust your gut instincts and don’t hesitate to follow them if you repeatedly feel that the current situation is not right for you. About how much your therapist talks, when I was a bit less emotionally developed than I am now, I always wanted my therapist to start the session and drive the conversation and talk a lot. Now, I always start the session and can lead the flow of conversation. But back then it was important. If that’s important to you, trust yourself and make sure you’re with someone who is providing you with enough inititation/support in conversations. Learning to trust your intuition and instinct about what relationships are right for you or not is such an important part of getting better. I’m still working on that in the dating arena.
    If you don’t feel quite right with the therapist, there is nothing wrong with interviewing others. It may not have been the best idea, but I once interviewed a couple of other therapists without telling one of my past therapists who I was with at the time. It probably would have been better to be up front about my intentions with her before doing that, but the positive aspect of it was that I wasn’t afraid to look elsewhere, and that I reminded myself that my therapist works for me, not the other way around 🙂
    Masterson is quite outdated now; he was not really a “relational” psychotherapist, and his viewpoints were based on antiquated beliefs about neutrality and other notions from old psychoanalysts who thought that therapy should be a purely professional relationship and that the therapist shouldn’t get overly involved emotionally. More modern – and better- theorists, in my opinion, strongly advocate the development of a regressive (which is a good thing, if controlled) positive loving relationship between patient and therapist. These include Seinfeld, Celani, Searles, Albanese, Adler, Hedges, and others who write about BPD and other personality disorders. It was my goal from a very early stage to develop a prolonged therapeutic symbiosis with my therapist, and I had to absolutely reject what Masterson and Kernberg wrote about regression and love in therapy being “destructive” and “infantile”, because that is so wrong. It’s obvious when you think about it. Love and acceptance is what children need to grow and become healthy individuals, and so love and acceptance are what adult borderlines need to meet the needs they never got met in childhood and become healthy for the first time.

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    • I just wanted to say a quick ‘thank you’, but add that I intend to reply more fully (perhaps over email, rather than here), in a few days, as I have some major work deadlines right now and for the next few days, that are leaving me little time for blogging/reading/commenting! This is all very interesting indeed! And I have already begun to think of the questions I might pose to other therapists if I decide to ‘trial’ some new ones, and key amongst them is your excellent final point – I have to be sure this time, that I will find the acceptance and caring that I need within the therapeutic relationship, and that any prospective therapist sees this as a key part of working with someone with BPD…..

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