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.


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Good therapy

For Jane

A fellow blogger said that I should write more about Jane, my ex-therapist, because she sounded like a good therapist. I said that I wanted to – that I wanted to write about all the things she did that made her such a good therapist, and more importantly, such a good therapist for me, as ultimately, I think that it’s the therapeutic relationship that is the key to how well a therapy works. But I also said that part of me was afraid. Afraid that if I wrote about it, there would be nothing else left to say. That all we went through and the work we did together, will make up just a few words on a page. That that will be the end of that.

But the reality is, that is the end of that, and in a way, that’s another reason for writing. Not just to show why she was indeed such a good therapist, but as a way of saying goodbye. And that is something I find it so hard to do. So hard, that my reply to Jane’s last email was a ‘holding reply’, while I tried to gather my thoughts and feelings enough to figure out what it was I truly wanted to say. That was two weeks ago, and the longer I wait, the more apparent it becomes that I’m simply postponing two things that feel impossible – finding the perfect words, and bringing our relationship to a conclusion. I can’t promise that this will be my final word on the subject of Jane, but it will be my final word to her.

And if this ‘final word’ sounds a bit like a love letter, I guess that’s what it is.  But if there’s one thing that therapy has helped me to realise about love over the last few months, is that it is complicated, and so are its origins. That although the Ancient Greeks may have tried to carve it up and separate it out  into four different types of feelings, it defies simple definition, compartmentalisation or categorisation. I don’t try to analyse my feelings about Jane. Not just because they scare me (though that is true), but because I don’t need to. My feelings just are – and they don’t have to be of one type, or another.

So how do I answer my fellow blogger? What did Jane do, that was such ‘good therapy’?

She held me. Figuratively. By which I mean, that she held and contained everything I was and felt, without judgment and without becoming overwhelmed by it. She was a vessel into which I could pour out everything that was hurting me, but without diminishing either her, or me, in the process. Her capacity to contain me was intimately linked to her capacity to stay bounded. I was acutely aware (in a way that was both painful and reassuring) of a gentle but unyielding boundary – of the fact that I was ‘fully known’ but that she was ‘hidden’ from me. She reassured me that what I did see of her, was real, and not a mask. That ‘Jane the therapist’ was part of who Jane was, and not a pretense, or a role. And I was grateful for that reassurance. But I was even more grateful for both the infinite containment and acceptance, and the immoveable boundaries that made it possible. Because of those things, she was the ultimate safe place.

She gave me permission. She gave me permission to feel the things I felt, and to talk about them. And she gave it explicitly – she said, “I give you permission”. At first this sounded strange, but now I know she did it because she knew what I needed to hear, even when I didn’t know. She knew I didn’t, in reality, need her permission (or anyone else’s) – but she also knew that I couldn’t give it to myself, because there were certain things I had never been ‘allowed’ to feel or be. And hearing her say it, made it feel okay. It made the feelings themselves, okay to be felt.

She finished my sentences. She really saw me, into the depths of me, and the words that she used, demonstrated that. My hunger for intensity; my need to ‘merge’ with her – she saw, and spoke, about them both, without me needing to say very much by way of explanation. For that hour every week, we shared the same mental space, as well as the same physical space. If ever there was someone who I felt was ‘on my wavelength’, it was her.

She walked alongside me. She knew that it was my journey, to be taken at my pace. She told me that it was okay that I couldn’t yet commit to wanting to get better, because it felt as though for that to happen, part of me would have to die. She took subtle (and sometimes not so subtle) cues from me about what I was prepared or ready to talk about, and she opened up painful areas slowly, carefully, and so very gently. She was happy for me just to ‘be there’, wherever ‘there’ was – I didn’t have to do, or say, or feel, anything that I wasn’t ready for.

She related to the different parts of me. I often felt I had two ‘modes’ in therapy: the adult who relished what felt like a truly ‘equal’ relationship for the first time in her life; and the twelve year old who felt completely vulnerable and just wanted to be guided, protected and sheltered. She made them both feel valued, and gave them what they needed. She praised and encouraged the child, for example, by letting her know that she ‘led’ the conversation, far more frequently than she thought she did. And she reminded the adult that therapy was a partnership, that they worked well together, and that she was making progress. At the same time, when the adult (or was it the child?) was desperate to lay certain ‘victories’ at her door, she saw that need and desperation, and graciously accepted those victories.

She wasn’t afraid of how I felt about her. Even though I was terrified that my attachment and my intense feelings for her would repel her, and would drive her away, she repeatedly reassured me that nothing I said or felt, changed her view of me. And she understood that even though I truly believed her when she gave me those assurances, I still doubted and panicked that I would lose her and that she would end therapy with me, when I was out of her presence.

She reached out to me. In the silences, when I could not talk because I was so ashamed or afraid of how she would react to what I was thinking and feeling, she let me know that I could do it. That I could talk to her. She always gave me time, but she didn’t just leave me drowning in wordless space – was it because she knew that the space would have felt horrifically empty, and full of abandonment?

She cared about me. Professionally, of course. But she cared about me. The same blogger who said that I should write about Jane, also said that you can train yourself to look for cues or signs that your therapist cares about you. I don’t think I trained myself to look for them – although I think it’s fair to say that my idealisation of her probably led me to look for those signs, wherever I could find them. I cannot list all of the ways in which she made me feel cared for – there are too many. Even the fact that she was always up-front and direct with me, which I had originally seen ‘just’ as evidence of the fact that she realised how important these qualities were for me in order to establish trust – I now look at as another form and demonstration of caring.

But there are two instances that I cling onto, dearly, when it comes to reminding myself of that care. Two phrases that I will never forget, that she didn’t need to say, but that meant, and mean, the world. Our penultimate session was charged with emotion, and somewhere along the way, wires got crossed – I thought she’d misunderstood something I’d said, and she thought I’d misunderstood something she’d said. When that became clear, she replied: “we were afraid that we had hurt each other”. “We were afraid that we had hurt each other”. She was worried about hurting me. It took my breath away.

But perhaps not as much as when I said that I wanted a hug but knew I couldn’t have one, and she said that I could have a “metaphorical hug”. A metaphorical hug, a ‘safe embrace’ – the most that she could legitimately give me. But in giving me that, she gave me so much more – she gave me the sense that when it came to holding me, she would have, if she could have. I hope she will forgive me if I’m misinterpreting her words. I hope she can allow herself to be misinterpreted if she knows what it means to me  – if she knows that it will allow me to hold myself in her caring and in her regard, indefinitely.

To me, this was all ‘good therapy’. It was all good therapy for me. And all of it, ultimately, amounts to this. She validated me.

Validating: ‘causing a person to feel valued or worthwhile’.

She ‘held me’. She gave me permission. She finished my sentences. She walked alongside me. She related to the different parts of me. She wasn’t afraid of how I felt about her. She reached out to me. She cared about me. She validated me. Validation – so much more than the sum of its parts. So intrinsic to the source of borderline pain; so intrinsic to its solution.

All we went through and the work we did together is so much more than the words on this page.

This is my final follow-up to the ‘holding reply’ I sent to Jane’s last email.

“I want to say ‘thank you’ for being held. So gently, so honestly, so safely. So acceptingly, so caringly, so validatingly. You will always mean so very much, and I am so very grateful for you.

Just this last time, I won’t end by saying ‘with love’. Just this last time, I’ll say what I never had the courage to say to you before.

I love you.”

 

 

 


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Mental health blogging: the old-fashioned way

The 1870s way, to be precise.

James Thomson (1834-1882) suffered from insomnia, alcoholism and chronic depression, and his most famous poem, ‘The City of Dreadful Night’, was a product of those struggles. I hope he would have forgiven me for likening his poem to an exceedingly long blog post. I do it only because for me, the first few verses, which describe his motivations for writing, perfectly encapsulate a number of my own (and perhaps others’) reasons for blogging about mental health. Reasons that include: a desire to expose the truth, unpleasant though it may sometimes be; to break free of the need to always remain ‘hidden’; to feel empowered by being able to express pain; and to reach out, to gain a sense of fellowship, and to realise that we are not alone in our experiences.

I discovered this poem in the forgotten recesses of my school library, many years ago. I have loved it ever since, particularly the first and last sections. I wanted to share it with you, particularly as verses 1, 2 and 5 (copied in the image below) spoke to me so strongly of the desire to give form and expression to reality ‘as it really is’ and to connect with other ‘fellow travellers’. And it’s inspiring that we can do that across the centuries, as well as across the technological ether.

 

blogging final


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Trigger-unhappy: BPD and abandonment

Trigger – unhappy: that is me. The DSM-IV Criterion 1 for Borderline Personality Disorder has really been getting me down recently, and has been firing up the synapses in my brain left, right and centre (or maybe that should be just left and right).

Criterion 1, ‘Frantic efforts to avoid real or imagine abandonment’ is manifesting itself as hypersensitivity to anything that might be construed (or misconstrued) as rejection, being ignored, misunderstood, sidelined, or not being cared for. And as usual, it’s some of those who I feel closest to, those who I have ‘let in’ and confided in, who are setting off these chain reactions in me. I observe those reactions and responses within myself, and I find them on the one hand self-centred, irrational and abhorrent, and on the other hand completely irrefutable. ‘Intellectual knowledge’ of the reality of the situation doesn’t seem to affect how I feel about it, or the way in which I interpret it. I know one thing – but I feel another.

Triggered: A school friend who I told about my blog several weeks ago, has not yet mentioned it, and seems to be oblivious to the fact that I’m reliving the pain and grief of losing my ex-therapist all over again. I know that she hasn’t had a great deal of time to read it recently, as she has been away, and at my own request is reading posts in chronological order and may not have encountered the relevant entries. But I cannot feel what I know. Instead, I feel hurt and resentful. Instead, I regret ever telling her about my blog, or about my mental health difficulties in general, and I see this as just another reason why my pain should be kept private after all.

Triggered: Another school friend, who also has BPD, was meant to call last week for a chat but didn’t, because she was numbing her own pain with alcohol. A few days later she failed to call again, because she was taking a friend in trouble to the Minor Injuries Unit. I know that she had received some bad news on that first occasion, and that she could not have foreseen the situation with her friend, who obviously needed her. But I cannot feel what I know. Instead, I feel as though it’s just another example of how she responds to others and is emotionally available to them when they need her, but not to me. Instead, I feel angry at myself and at her for needing her, and for feeling helpless in the face of that need.

Triggered: My husband came back from a weekend away, and didn’t give me a hug or any indication that he cared or wanted to know how I had got on while he was gone. I know that he was just reacting to the fact that I was withdrawn and silent. I know that each one of us was waiting for the other person to act and speak first, and that the months and years of inadvertently misunderstanding and hurting each other, has led us each to try and protect ourselves first and foremost, from further hurt. Instead, I felt suicidal – utterly desolate and alone. I felt unreal and unloved and unworthy. I felt rejected and I retreated further into myself. He thought I was ignoring him and that I didn’t care. I was trying to cope with wanting to die, because I felt he didn’t care.

Triggered: My therapist took what felt like an age of silence to think and phrase an answer to the fact that I had just told her that I had been experiencing difficulties with our therapy for some time, and that I had a decision to make about whether we should continue. I know that she was just thinking, and trying to assimilate what I had revealed, and reply in the way she thought best. But I cannot feel what I know. Instead, I felt as though I was on the knife-edge of abandonment – that as I had just revealed that I was thinking of leaving her, she would decide that she could no longer see me. It took every ounce of effort not to break the silence and tell her how unbearable the knife-edge was. How I was both shattering inwardly and at the same trying to burst out of my skin to escape the feelings of rejection, disapproval, and uncertainty of what was coming next.

Triggered: My ex-therapist, Jane, responded to my frantic efforts to avoid the very real ‘abandonment’ of never seeing her again, by saying that she did not think it was advisable to have just a couple of sessions without the prospect of ongoing work, and did not maintain contact or have friendships with those she had seen in a professional capacity. I had followed ‘numbness and denial’ with a desperate plea for something more, though with the very real fear and expectation that it would come to nothing.

I know that Jane had to reply the way she did. I know that her reply, though devastating in its finality, was necessary, and everything I have come to expect from her. It was professional, maintained boundaries, and was written in the spirit of keeping us both safe. I asked her to be honest – and she was. But I also asked her to be gentle – and she was. Her reply was reassuring, validating, clear, and above all, caring. Not in any obvious way – I can only wish that she would come out and say it! But it was there, in every other way – in the things that she didn’t say, as well as in the things that she did. And here’s the curious thing. I do feel what I know.

I knew Jane for weeks, not years. I have had virtually no contact with her for months. But, despite all the odds, and despite the difficulty that I (and many others with BPD) have with object constancy, and holding on to the reality of another individual, in their absence – I still believe that she understood and cared about me. That she cares about me. Perhaps almost as much as being abandoned by her in the present, I was terrified her reply would shatter my perfect and idealised view of her. That I would be abandoned by that sense of caring and the reality of the work we did together. The sense of self-acceptance that she gave me has vanished. But the sense that I was cared for by her, is, miraculously, still there.

I’m not oblivious to the fact that I may be particularly trigger-unhappy at the moment because I could be splitting off any negative emotions I may have had about Jane’s ‘abandonment’ and am transferring them onto others. I have always been passionate about ‘protecting Jane from myself’ and from any possibility of devaluing her, or reducing the height of her pedestal even by a millimetre. I don’t feel angry at her. I don’t feel rejected by her.

But do I know what I feel?

 


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Waiting

I told my therapist I was thinking about leaving because I didn’t feel cared for or understood. My therapist told me that establishing a therapy takes time. I told my therapist that I couldn’t just wait for someone to come along and understand and care about me. She said that it was about waiting to come to the realisation that I was cared for. 

She asked me if I knew T.S. Eliot’s ‘Four Quartets’. She said that part of it was about waiting. This is that part.

waiting 3

 


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Constant craving – BPD and the need to feel understood

Wanting to be understood is part of the human condition. For someone with BPD, that can be a craving so strong that it eclipses almost everything else, save what I’m coming to see two sides of the same coin – wanting to be loved.

Wanting to be understood can be the force that drives us so strongly to connect with another individual that it tries to push all boundaries, physical and emotional, out of the way. I remember vividly, when in the grips of an obsessive attachment, the sense of wanting to be ‘in another person’s head’ and ‘under their skin’, or, conversely, the sense of wanting to be ‘taken over’ and ‘subsumed within another’s identity’. I’ve heard it described as ‘the urge to merge’, and I think it has its source in the desire for a perfect connection, a perfect understanding. A union so metaphysically powerful there is no need for words in order to convey meaning.

However, wanting to be understood can also be the force that drives us to put up barriers and build barricades behind which we hide ourselves. The desire is so strong, that when it is not met, or met ‘imperfectly’, the inevitable result is devastating pain and disappointment. We dare not take the risk of making ourselves vulnerable, or trying to explain how we feel, because we could not bear the pain of being misunderstood, particularly by those we most yearn to be close to. It’s the reason my husband still knows virtually nothing of what has been going on in my head for the last few years, and why my marriage is essentially in crisis. I cannot bear the thought of opening up, and not being understood. It’s the reason why I’m contemplating leaving my current therapist – because I have opened up, and because I don’t feel understood, and that has been a source of great distress, on a number of occasions.

Wanting to be understood is part of the human condition, but that doesn’t mean that we all experience it in the same way. Many individuals with BPD are acutely sensitive to any sense of being invalidated, and being told that everyone has these feelings and reactions, but perhaps not quite to the same extent, can feel like a minimisation of their difficulties. On the other hand, it is also hugely painful and isolating to feel as though your thoughts and feelings are so out of kilter with society’s ‘norms’, that you may as well be inhabiting a different planet to everyone else. I remember a mild dissociative episode in which I felt as if life was going on on another train, while I was stuck alone on my express train to ‘who-knows-where’, my reality frame-shifted onto a parallel, un-intersecting track.

I think I’m coming to realise that both of the above positions can be true. That the borderline’s experience can be a more intense and perhaps a more ‘extreme’ version of a standard, human reaction, without this being invalidating; but that those experiences can take place within the context of a BPD worldview that does not just frame-shift the way that ‘most people’ see things (if I may make a gross generalisation), but completely turns it on its head.

Feeling as though my therapist and I are worlds apart, is not normally a positive experience. However during my last session, I came up against the stark realisation that parts of my world-view that I do not question and assumptions which I assume that everyone makes, are far from universal – and it was a breath-takingly powerful experience. According to my therapist, ‘most people’ go around feeling understood ‘most of the time’, and don’t find it difficult to trust in that understanding, even when it is not being made explicit. That may sound like an obvious point, but it was genuinely news to me. As was the realisation that my default position is precisely the opposite – why would I assume, let alone trust, that I was understood by anybody? It seems like an utterly bizarre way to approach life, and other people.

And yet, why so bizarre? It makes perfect sense that those who have grown up feeling understood and accepted, not only come to expect or assume understanding and acceptance from others, but also feel they have little need to hide who they are, and are therefore open to giving others the opportunity to understand them. But the experience of so many with BPD is one of growing up in an invalidating environment in which understanding and acceptance were in short supply. And those who experience pain over not being understood or accepted for who they are, very quickly learn to close themselves off and present only a version of themselves to others, which they feel will be acceptable. My assumption of a lack of understanding is therefore based on a worldview created through my earliest lived experiences. However, it is also reinforced by the fact that I am not giving others the opportunity to understand me, because I am not allowing myself to be truly ‘seen’.

Sitting diagonally across from each other, in our small therapy room, the obvious disconnect in worldviews was palpable, almost comical. My therapist said I found it hard to trust and believe that I was understood. To her, the significant and profound realisation was the fact that I do not assume that I am understood. To me, the significant and profound realisation was the fact that other people do.  Thus demonstrating that in fact,  she had not really understood me at all. Alanis Morissette, take note – there’s something that’s actually ironic.

 

 


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Draining The Lake

Beautiful words; beautiful imagery.
I find it hard to write about the things that I’m ‘in the thick of’, when I’m ‘in the thick of things’. I rely on others’ words that really resonate with where I am right now – songs, poems, posts.
I still can’t accept the finality of loss. I know I need to ‘drain the lake’ but it feels as though I’m drowning in an ocean that’s immeasurably deep; that is impossible to drain. I can’t cry the fear away. But I also fear that one day I will stop crying. And what will it mean if I do?

Thoughts. Musings. Electrical Synapses.

I had therapy today, I don’t think I’ve ever cried so much before. A knife was being twisted inside me and the pain was unbearable.

I didn’t want to accept things I knew were true. What didn’t let me do it was fear, a paralyzing fear that I now feel has been shattered.

Tears can remove self imposed veils and I’ve cried enough already, it’s time to drain the lake.

image

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Self-harm – in under two minutes

*TRIGGER WARNING*

In a way, I was rather relieved when my one of my ex-therapists (let’s call her Nina), did and said something so objectionable, that all of the other objectionable things that she said and did paled into insignificance. I had been feeling as if my previous annoyance might have been unjustifiable, and I was worried that I had not been ‘giving her a fair go’ due to the fact that she looked as though she was still in high school.

Never mind the fact that she twirled her hair during sessions, while I was pouring out my emotions and pain. Perhaps I was being over-sensitive when I found that mildly irritating and somewhat offensive. And maybe her bizarre habit of pretending to draw diagrams and write sentences with her hand on the wall next to her chair, was actually helpful to some of her other clients. As if somehow it would help me to better understand what she was driving at – it didn’t.

But it was her attitude and approach to self-harm that, quite literally, made me see red. It made me want to quit therapy, and it almost led me to write a letter of complaint to her employers, and if you knew how very much I hate complaining about anything, you would understand just how angry I must have been. Just the other day I paid twice the advertised price for a piece of cake in the canteen because I didn’t want to make a fuss – you get the picture.

It wasn’t even the fact that she called self-harm ‘unhelpful’, though that in itself betrayed, at worst, a worrying lack of insight, and at best, a worrying lack of care in her use of words. As someone who has been self-harming for the last couple of years, I would agree that it is not a particularly healthy coping mechanism, and ultimately it is not ‘helpful’ to recovery. However, it  is a coping mechanism, and as such, it is helpful to the individual who uses it. Please don’t misunderstand me – I’m not in any way advocating self-harm, or trying to undermine the immense and courageous efforts of those who struggle daily to stay free of it. That’s why there is a *trigger warning* at the start of this post – I would hate for anything I say to act as a catalyst for anyone’s self harm.

I’m just making the point that if it was not helpful in one way or another to the individual concerned, they probably wouldn’t do it. I’m not defining or restricting the ways in which it can be helpful. In fact, the longer my self-harming goes on, the more I realise that it can mean very different things to different people, and different things to the same person, over time. Self-harm evolves, it changes, it’s never quite the same tomorrow as it was today. And the reasons, motivations, and meanings behind it are myriad.

The incident that took my breath away (though not in a positive sense), involved both a visual image and a statement that she used in response to the fact that I had said that sometimes, although I was desperate to self-harm, I just didn’t have the time to do it. I think it was the image, more than the words, that I found so utterly abhorrent. It was as if she had suddenly entered a very private part of my psyche, and had just defiled it by trampling all over it.

“Surely it only takes a couple of minutes – you just go into the bathroom and make a quick cut?”. Her right hand made the action of drawing a razor blade across her left wrist. The room was suddenly silent – the air laden with assumptions.

I wouldn’t expect most people who did not have personal experience of self-harm, to have a great deal of knowledge or understanding about it, although it saddens me that there is still the widely-held misconception that all those who self-harm are wanting to end their lives, whereas in fact they might be fighting in the only way that they know how, to stay alive. However, I think it’s only right to hold professionals to a different set of standards: to expect a more in-depth level of knowledge and understanding, and a sensitive and appropriate response to a client’s discussion of self-harm. For some, even raising the topic openly in therapy may feel risky and may be a tremendously painful and uncomfortable experience.

I had never told Nina what form my self-harm took – cutting may be one of the most common, but there are many other methods. I had also never told her where I self-harmed. In my case, although I do cut, it’s most frequently on my hips (and at that time, was almost exclusively on my hips). It felt as though her words and actions were a gross generalisation of an incredibly complex phenomenon. But more than that, I found them insulting in the way that they seemed to display a lack of care, interest and sensitivity in my own particular circumstances – not only in the form that my self-harm took, but in the reasons and the motivations behind it, and in what it was trying to express. It felt like a complete disregard of me as a person – although I didn’t have the language to describe it as such at the time, it felt incredibly invalidating.

Quite uncharacteristically (I hate confrontation even more than I hate complaining), I plucked up the courage to tell her, at the end of the session, that for me, self-harming takes a hell of a lot longer than two minutes. Either fortunately or unfortunately, depending on how you look at it, with small children and a husband almost constantly around, I can rarely self-harm completely on impulse. Plus, as any parent will know, a mother’s trips to the bathroom are rarely unaccompanied! In addition, I have to hide my ‘tools’ very well, not only for the sake of keeping my self-harm secret, but so that they are not accessible to my children. That’s aside from the fact that I find I need to make several cuts in one sitting, and that clearing up ‘the evidence’ after the event, takes time.

All of which adds up to substantially more than two minutes.

 

[There are a large number of helpful and informative websites by charities and national or governmental bodies of various kinds, for those dealing with self-harm, and for those supporting them. There are some in particular, that I hope to reference and write about in future posts. There are also a very large number of excellent blog posts out there on self-harming, including these, on ten common self-harming methods, and on two less frequently talked about methods, trichotillomania, and dermatillomania. Finally, I was very much struck by this post, entitled ‘Self-harm is normal’ – a real plea for openness and acceptance of something that is ‘normal’ not in the sense that it should be ‘normalized’ within society as a whole, but by virtue of the fact that it is part of the language and landscape of so many different types of mental health difficulties.]