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.

Let it grow

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flower in iceI am going to start by owning up to the fact that this post has nothing to do either with the film ‘Frozen’ or with gardening. So for those hoping for some insight on either topic – I am sorry to disappoint. Having said that, if you have any interest in the subject of therapy, or if you are in therapy yourself, I do hope that you read on.

A couple of months ago I had one of those ‘revelatory’ moments through therapy, that it is easy to live for, but hard to come by. It was a significant realisation for me, as it challenged my assumptions about the nature of therapy itself. Those assumptions had affected both my engagement with the process, and also my relationship with my therapist. The ‘revelation’ had an enormous impact on the way in which I approach therapy, on how I relate to my therapist, and on the expectations I have of what ‘should’ happen in session. (“There is no ‘should’, there are no rules”, I can hear my therapist saying….).

In ‘A matter of choice – BPD and self-worth’, I started by saying that therapy has twin tasks – to reveal the ways in which we really think about ourselves; and to ‘make up for’ what has been missing, and that those tasks can be more broadly described as dealing with content (or process) and with relationship. In that post, I said that both of those tasks were important – but that wasn’t the position I started with, several months ago.

So much of what BPD is about is concerned with relationships, and my absolute desire for connection had led me to place the therapeutic relationship at the centre of my therapy. It was my primary interest, and I thought it should be my therapist’s primary interest too. All the reading I had done had pointed to the fact (or so I thought) that the key vehicle for change, particularly with a ‘condition’ such as BPD, was the transformative power of the therapeutic relationship. I thought about it, and I talked about it, endlessly –it was my key preoccupation. Those with BPD are often said to have an ‘all or nothing’ approach to life – and this was certainly the case with how I thought about therapy. The therapeutic relationship mattered – and in the context of sessions, it mattered to the exclusion of all else.

Whenever my therapist suggested that content  and process were important too – or that her task was also to uncover my unconscious thoughts about myself – I argued that that was not possible until the ‘re-provision’ of what had been missing in my life, was well under-way. If the ‘patient’ has not already forged a rock-solid relationship of trust with the therapist, and has not yet been ‘re-parented’, how will they be in a position to cope with the potentially devastating realisations surrounding how they think about themselves? Nothing could have shifted me from that position (or so I thought) – and any attempts by my therapist to try and ‘re-focus’ me, I simply construed as rejection.

My husband often grumbles that I listen to my friends but not to him. He can make a point over and over again, but it’s not until I hear it from an ‘independent source’ (whatever that may mean!) that I actually take it on board, and trust it. In this case, it was only when I read the point my therapist was trying to make, in two separate books by Irvin Yalom (a well-known American psychotherapist and author), that it truly hit home. It grabbed me, in only the way that something can when it truly makes its home in the innermost parts of your being. It made both intellectual and emotional sense and I felt it as a conviction at the deepest level.

In his book ‘Love’s Executioner and other tales of psychotherapy’, Yalom describes his work with a client who, amongst other traumas, had suffered sexual abuse by her father. In that context of that tale, Yalom writes the following (the highlighting for emphasis, is my own):

When I first began to work as a therapist, I naively believed that the past was fixed and knowable; that if I were perspicacious enough, I could discover that first false turn, that fateful train that has led to a life gone wrong; and that I could act on this discovery to set things right again…..But over the years I’ve learned that the therapist’s venture is not to engage the patient in a joint archaeological dig. If any patients have ever been helped in that fashion, it wasn’t because of the search and the finding of that false trail (a life never goes wrong because of a false trail; it goes wrong because the main trail is false). No, a therapist helps a patient not by sifting through the past but by being lovingly present with that person; by being trustworthy, interested; and by believing that their joint activity will ultimately be redemptive and healing. The drama of age regression and incest recapitulation (or, for that matter, any therapeutic cathartic or intellectual project) is healing only because it provides therapist and patient with some interesting shared activity while the real therapeutic force – the relationship – is ripening on the tree.

In his book ‘The Gift of Therapy’, Yalom puts the same point in this way:

But it is not the content of the intellectual treasure trove that matters but the hunt, which is the perfect therapy mating task, offering something to each participant: Patients bask in the attention paid to the most minute details of their life, and the therapist is entranced by the process of solving the riddle of a life. The beauty of it is that it keeps patient and therapist tightly connected while the real agent of change – the therapeutic relationship – is germinating.

As Yalom also states, “In practice, there is a great complexity in the link between the intellectual project and the therapist-patient relationship”. And he does not deny that the key therapeutic force is the relationship itself. So my focus on this aspect was not misplaced – but my focus was certainly too narrow and too exclusive. The therapeutic force  – the relationship – needs feeding in order to maintain its momentum, and its food is both process and content. Its food is ‘the hunt’, ‘the intellectual project’.

I have a tendency to want to ‘do everything right’ – and therapy is no exception. It would be easy for me, therefore, to substitute an exclusive focus on ‘getting the therapeutic relationship right’, with an exclusive focus on ‘getting the content and process right’ – or to try and do both. But I think that would be to both misunderstand the nature of therapy, and also to misunderstand what Yalom is trying to say. In the same chapter in ‘The Gift of Therapy’, Yalom writes that he discovered that what he and what his clients remembered and valued about sessions, were very different. He tended to value intellectual interpretations, whereas they tended to value small personal acts that were relevant to the therapeutic relationship. The precise intellectual interpretation was not what made the crucial difference. He writes that, instead, “…the search for explanation kept us engaged and our engagement ultimately made the difference”.

I take that to mean that it is not necessarily the precise content of sessions that is most important, but the process of talking about the content, and indeed that it what Yalom said when he talked about the ‘treasure hunt’ being more important than the contents of the ‘treasure trove’. And I have seen this borne out in my own therapy. Recently we discussed a difficulty in a friendship, for which I felt a failure and was blaming myself entirely. My therapist kept offering up suggestions for what might have been going on with my friend at the time, and when I thanked my therapist in my next session for the fact that I had since felt much better, she said she had been trying to give me a different perspective. However, what I took away from that session was a sense that she was on my side. Without that sense, I would have been unable to get through my distress and take on that different perspective. The intellectual interpretation and the personal act: two different views on one session, in which our relationship was made stronger through our shared endeavour and exploration.

What I learned from my reading, and from experience itself once I applied that reading to my sessions and ‘widened my focus’, is this: therapeutic alliance is central to change, but it doesn’t have to be central to the conversation.

I was ‘majoring’ on our therapeutic relationship, but in doing so, I wasn’t giving it room to breath or grow. By constantly putting the spotlight on it, I was freezing it in time. By neglecting the importance of content and process, I was completely missing the fact that the relationship grows, in the background, using the process and the content as its sustenance. I was not feeding our relationship – I was stifling it, and starving it of oxygen. I was expecting a flower to grow, in an expanse of ice. I wanted, desperately, for my therapist to care about me. But what was I giving her to care about? What was I telling her about myself, or my life? We all know that our best and deepest friendships are based on shared experiences, and a shared journey (emotionally, even if those friends are not physically present). My therapist and I need to go on a journey together, and to get to know each other through the things we encounter. If we only encounter each other, in isolation from the world around us, there is not enough ‘grist for the mill’, and there is no way to deepen the relationship.

I still have the urge to spend most sessions talking about ‘the relationship’, just as I spend so much time thinking about it. But when I do leave room to talk about other things, it’s amazing how often and how naturally ‘the relationship’ comes into it, whether that’s through the interpretation of  a dream, or the way I reacted following a session, or some other situation. But it comes up in a way that is not forced, and which provides continuity and a deeper understanding between us.

So for those who are also struggling with what to expect of the therapeutic relationship and who find themselves constantly engaged in thought or in talk about it, my suggestion would be – take your eyes off it for a little while. It will grow – if you let it. But it will do so in the background. It will germinate, it will ripen on the tree, while you are engaged in turning over and ploughing other fields. And when you turn your attention back to it again, you will have a rich harvest of shared experience, understanding and mutual caring. You relationship will have matured, and it will be beautiful to behold.

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16 thoughts on “Let it grow

  1. Great post and insight. My wife and I have been trying to get therapy for her for a long time. Hopefully we are at the end of the journey and she will be getting it soon. I think I speak for both of us when I say that according to everything we had read – especially about working with BPD – the relationship with the therapist was crucial and perhaps we were in danger of making that too much of a focus, your post has led me to rethink. Thanks for sharing.

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    • Hello, thank you so much for reading, and I really appreciate your comment. It’s great to hear that you and your wife are working together on this – it’s fantastic for her to have your active support, and I’m really glad it looks as though she will be getting therapy soon 🙂 If you don’t mind me asking, what kind of therapy is she likely to receive?

      Your comment is very interesting, and makes me wonder whether I should do a brief follow-up post with a couple of extra points, particularly as I don’t want to mislead in any way. I agree with you (and your reading) that the relationship with the therapist is crucial, particularly for dealing with BPD. I suppose I was trying to get across the point that although this may be the case (and I think Yalom agrees with that), there is a danger that one can therefore spend all of one’s time obsessing over it, and trying to bring the conversation round to it during every session. (I certainly did). Whereas, crucial though it is, it is more helpful it if the relationship can be allowed to develop gradually and not under pressure, and ‘out of the spotlight’ as it were.

      I tend to think that this sort of ‘problem’ with focus doesn’t happen until you are actually _in_ therapy. When it comes to choosing a therapist (if you have a choice) in the first place, then thinking about your ‘gut instinct’ on how you relate to them, or _could_ relate to them, I think is really important. Once you are _in_ therapy however, the ‘gut instinct’ thing starts to become much more difficult. Whenever I asked other bloggers whether I should stay with my current therapist, they said to go with my ‘gut instinct’, but actually identifying that once you’re immersed in the work of therapy, I found very hard, particularly due to BPD. This is because when things felt like they weren’t working, or that I wasn’t being understood or cared for, it was almost impossible to know whether that was due to ‘not having a good fit’, or something to do with my BPD symptoms themselves. Because so many of the difficulties with BPD are relational, trying to disentangle reactions due to symptoms, and reactions due to transference, from whether or not this is genuinely the right therapist for you, can be tricky. But that’s where going back to the original ‘gut instinct’ that led to your decision to choose them, can be helpful, because that instinct arose before all the other stuff came up to cloud it. Sorry, this is turning into an essay!

      If _do_ end up turning this comment into another post, would you mind if I quoted parts of your comment above, to show what I am replying to?

      The other thing to say is that, as with everything, everyone is different, and my post at least partly reflects the fact that I ‘fall for people’ I make myself vulnerable to – my therapists being no exception! I tend to obsess over relationships, and I think that my overwhelming focus on the therapeutic relationship at least partly reflects that, as well as arising out of the sort of reading that you have been doing, that leads one to dwell on its importance. I think it is important for those entering therapy (and their partners) to be aware that they may develop very strong feelings for their therapist, and that that’s okay. Trying to figure out what those feelings mean or don’t mean can be challenging and difficult, but the therapist can help with that, and ultimately it’s the safest environment in which to work through those sorts of feelings, some of which will stem from transference, and some of which will be in relation to the therapists themselves, as a separate individual.

      I think I’ve gone on for long enough, but I hope that’s helpful rather than rambling, and many many thanks again for reading and commenting. I really do wish you and your wife all the very best in your journey together, as you go through this (and I hope she feels settled in therapy, once she enters it!).

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  2. I think you are absolutely right that the relationship must be allowed to grow naturally through the stories we tell about ourselves and our place in the world and not by forcing discussions about the therapeutic relationship. Those issues will present themselves organically through the process. I also share your admiration for Irvin Yalom (I’ve read nearly all of his books). Beautifully written, thoughtful piece. Thank you for sharing.

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    • Thank you so much, I really appreciate your kinds words 🙂 It’s lovely to find another Yalom fan as well 🙂 I’ve bought many of his books but sadly don’t have much time for reading, so I’ve only read the two mentioned in my post, so far. But I have just started ‘Lying on the couch’…! Which was your favourite? And do you have any other recommendations in terms of good books about therapy? Thank you again for reading 🙂

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      • It is a pleasure and a privilege to read what you have to say. When Nietzche Wept and Love’s Executioner are my favorites. Lying on the Couch was a fun read, but I found The Schopenhauer Cure to be more compelling. I like the way Rollo Mays writes as well if you’re interested in existential psychology and the zeitgeist of the 1960s.

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      • Thank you for the kind words 🙂 I have ‘When Nietzche wept’ and will read that next! I haven’t bought the Schopenhauer Cure but will put it on my Christmas list, and will definitely investigate Rollo Mays, who I haven’t come across yet – thank you! I recently re-discovered Wittgenstein (an old interest of mine) and discovered a relationship between his later writings on the nature of philosophy, and the nature of psychotherapy. Unfortunately most of the relevant books are ridiculously expensive as they are text books in effect, but it’s all quite interesting and I’ve sent my therapist a load of ‘homework’ in terms of articles and papers that I’ve found! I’m not sure it will add hugely to my understanding of therapy (unlike reading Yalom!) but it sort of made me remember what it felt like to be excited and curious about an academic subject again, which was nice!

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      • School was always my safe place, so I get what you mean by the excitement and curiosity toward an academic challenge. I would be an eternal student if it weren’t so darn expensive!

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      • Me too! 🙂 I completely agree with you. I would be an eternal undergraduate. Studies have always been my safe place too, and these days work is the only place where (at least when things aren’t overly stressful), I can ‘switch off’ for a while and adopt a ‘persona’ that carries me through and allows me to function while I’m there. I had a therapy break last week and missed two sessions, and my therapist did suggest that I was getting into philosophy/psychotherapy as a way of keeping therapy alive while distracting myself from the more difficult feelings I was having about her and about our last session. I think she was spot on…..it’s frustrating, because having sent her all these papers, I’d like to talk to her about them, but I just can’t retain information at the moment and I haven’t had sufficient time to make much of anything coherent out of it, in my brain….so I feel bad I’ve wasted her time, but I hope she found it interesting anyway!

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      • All that matters is that YOU found it interesting! 😉

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      • Oh good, well, that at least is true 🙂

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  3. I had to reread this post a couple of times because our idea/approach to the “therapeutic relationship” is completely different. The idea of placing the relationship at the centre of therapy is completely alien to me.

    When I first met my Therapist, beyond trusting his professionalism, I didn’t have any expectations of his role. Whether I can ‘open up’ is largely based on my own courage than on any relationship with him. Yes, it’s important to feel comfortable, but ‘successful therapy’ depends more on a willingness to look within.

    It would be so easy to blame the Therapist for us not being able to open up and face the demons. That courage needs to come from within. If we give too much attention to our therapeutic relationship, are we just avoiding/delaying looking at the stuff that takes us to Therapy in the first place?

    As always, this is a great post and I will certainly be mulling it over in my head for a while…

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    • Thank you for the kind words 🙂 I will be mulling yours over for a while as well, as they definitely tap into something that has been on my mind for a while. I have long suspected that my focus on the relationship is at least partly a smokescreen to prevent other things from being talked about! And it’s ‘convenient’ how when I think I’m going to discuss something other than the relationship, something ‘happens’ (or do I sub-consciously orchestrate it?) to bring the focus back to the relationship.If this _is_ what’s going on – it’s not surprising (or at least, not for me). One of the earliest things to be spotted by more than one of my therapists (which came as a big surprise to me), is that my ‘obsessions’ over people are essentially a coping strategy (and might explain, for example, why I only started self-harming a couple of years ago). Becoming completely absorbed in intense feelings and a new relationship (or even the idea of a relationship) was an escape and a substitution of one type of pain for another, in the way that other coping mechanisms might be used.

      I completely agree that opening up has an awful lot to do with looking in and with courage, and I have managed to push myself to do that, even in situations where I was not as comfortable or trusting in the relationship. But about what the ability or willingness to change, as well as to open up? How do we go from facing the demons, to fighting them? I know ultimately, it all comes down to us, but personally I feel that a lot of what I have confided, or any changes I have made, have stemmed from a greater feelings of acceptance by both my current and previous therapist. Without that ‘safe place’ and those individuals accepting me and being ‘on my side’, I don’t know if the ‘coming to realisations’ would have led to changes. It may well have done – but I simply don’t know. HHmmm….a lot to think about! Thank you so much for your perspective, which I really value 🙂

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  4. Pingback: ‘Shame and anger – when ordinary incidents are filled with extraordinary emotion’ (or ‘Take ordinary incidents into therapy – you never know what you might discover’) | Life in a Bind - BPD and me

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