Post by Mel on Jan 15, 2006 23:10:34 GMT -5
Borderline Therapy and Other Thoughts
Updated: 4/02
While researching information about the borderline personality disorder (BPD), we find that there are many different "orientations" to BPD including psychoanalytic, biological, eclectic, biosocial and cognitive. See page on "Major Orientations to BPD."
We read one book and say to ourselves that we finally have some answers, only to find that the next book about BPD may say something entirely different. Some professionals even tell us we cannot get better. As a result, many of us are confused. All we know is that we are hurting and we want the pain to go away.
I would like to address these issues with you that coincide with current research. So much still remains unknown about this disorder, yet we do know more now.
First of all, it is extremely important to know that no form of therapy will assist a person with the borderline personality disorder unless the person is properly medicated, reducing many of the symptoms. Paul Markovitz, M.D., Ph. D, states "Antidepressants do not change the hardwiring. They simply damp down the circuits to a point where many individuals can control their lives. Mood swings, somatic complaints, rage, irritability, binge eating, anxiety, and even black-white thinking are reduced significantly. The treatment now is crude compared to what we will do 10 to 15 years from now, but it works. I have seen virtually no data that therapy reverses the illness. While CBT helps a bit, it impacts on life is limited. I have seen no data that it reduces any of the things medications reduce. I think therapy is a good thing, but in all fields of medicine we use it after we fix what is broken, e.g., rehab (therapy) following heart surgery and weight training after ligaments in a knee have been repaired. Current forms of therapy need to be continually upgraded and reevaluated, just like I do with medications.
I am always galled by the concept of therapy prior to medications. It supposes if an individual really tried, they could be better. BPD is a debilitating biological illness. Talking to it is like talking to diabetes. First insulin, then therapy."
First of all, I believe that many forms of therapy that borderlines are currently receiving are not only not helping them, but in fact, are hurting them, i.e. making their symptoms, behavior and emotional pain worse.
This is happening due to the lack of education by therapists, psychologists, psychiatrists and social workers about the borderline personality disorder. I have experienced this as a client, seen it in co-workers and hear constantly from borderlines that write me that their therapy is making them worse.
Why is This Happening?
First of all, I am not addressing Dialectical Behavior Therapy (DBT) or other forms of cognitive behavior therapy which keeps the borderline in the present, focusing on changing thinking patterns and behaviors.
However I have heard rumors that some DBT therapists ask clients to go off of their medications prior to therapy. If you are asked this, I hope you run. If you don't, I hope you stay alive long enough to complete the DBT therapy in case you experience suicidal depression.
Some people feel that DBT alone is all someone with BPD will need for treatment. Personally I cannot disagree more as we are dealing with a medical disorder - a broken brain, if you will. Cognitive behavior therapy does affect the brain but not the extent of borderline recovery.
We all have an area in our brain that regulates our emotions. When an upsetting event occurs, we respond emotionally to that event. The level of emotion we feel in response is usually in proportion to the level of the event that occurred.
However, in borderlines, this area in our brains "malfunctions." We have problems with emotion regulation. An upsetting event can occur and we might experience a level of emotional reaction that is far beyond what is "appropriate." We can go from feeling ok to suicidal very quickly. Sometimes there is no in between.
This is another reason we don't handle stress well. I know for myself, a certain level of stress can render me bed-bound.
I recommend we be aware of these aspects about ourselves, accept them and avoid stress wherever possible. We need to take extra care of ourselves, making decisions about our lives that reduce stress levels.
Psychodynamic therapy, according to the 3/02 Harvard Mental Health Letter is highly recommended along with DBT. The choice of therapy depends upon the person and the level of functioning. This form of therapy brings the unconscious to the conscious level and deals with transference issues.
For example the therapist may point out that the client has misplaced anger. The client may be expressing angry feelings at the therapist and the therapist may suggest that the client is really angry with someone in their past. The client in this form of therapy tells their life story
It is recommended that more than one therapist be involved in a person with BPD's treatment. Consulting co-workers and supervisors is highly recommended due to transference and countertransference.
It is extremely important to treat depression in borderline patients and to take all suicidal threats seriously. No suicide contracts are not enough. These patients may need to be hospitalized.
While waiting for medications like SSRI's or mood stabilizers to work, a benzodiazepine like Ativan can assist with anxiety.
Remember, how can you help someone with a biological problem with therapy? Remember Dr. Markovitz's statement? "Talking to it is like talking to diabetes. First insulin, then therapy."
I remember two different therapists telling me, after advising them of my BPD diagnosis, "It doesn't matter what your diagnosis is. I don't group people into categories. I treat everyone the same." If you hear this from a counselor, don't just walk to the exit, run! They simply don't have a clue of how to treat borderlines.
Anytime your therapy takes you to "the edge, feeling suicidal" it is time to STOP! The suicide rate for borderlines is 10% and this moves up to 25% if the person also has a diagnosis of panic disorder.
Yes, we need therapy, but we need to live through it. We just need the right kind of therapy and therapists desperately need to be educated regarding this.
I hear constantly how borderlines go in and out of the hospital during therapy. On top of that, many counselors will "dump" their client while in the hospital as they don't want to take a "risky client." Many borderlines are dumped by counselors because they display BPD symptoms, when the therapist knew initially that the client had the BPD. Imagine how this would feel to someone who already has tremendous issues with abandonment.
Many years ago when I lived in California, I was a successful social worker with Children's Services, which by the way is one of the most stressful jobs there is. In fact, I was only able to work there for a short period of time.
During this time, I was very serious about getting well and participated in therapy for a year. It was during this time I had to take two six month temporary disabilities off of work and wound up in the psychiatric hospital where I received my first diagnosis of borderline personality disorder at the age of 33.
The counselor, in fact encouraged me to "get in touch" with my emotional pain. He was attempting "uncovery work" (trying to bring up memories from the past) and felt my increased emotional pain from the therapy was a "good thing" as "sometimes the feelings come before the memory."
This sounded all fine and well at the time, however my life spiraled downward rapidly and I became a miserable human being experiencing suicidal ideation.
I became so depressed during this time that my 11 year old daughter, in an attempt to take care of herself wanted to live with her father.
Here I was without my job, without my daughter who was my life and I became bed-bound. Incidentally never did any "memories" surface and I am not a better person in any way shape nor form for experiencing that year long therapy. This is not to mention how this time in my life affected my young daughter.
As people who have the BPD diagnosis, we need to think about our children and sometimes make painful, unselfish decisions. Borderline parents more than anything need support from family - anything from baby-sitting to emotional support.
Sadly it is normally the case where we receive the opposite of emotional support and are judged as a bad person. Families further isolate us because of our behavior. Many times I was not pleasant to be around. Sometimes I would rage and I made poor decisions about my life which made it difficult emotionally for my family to stick around me.
I think what families need foremost is emotional support for themselves as they are in pain also and they need education about our disorder.
Therapy That Will Help
Drug therapy first! Otherwise you are simply and completely wasting your time. You need to give insulin to a diabetic before they can receive any assistance from therapy. Remember that the BPD is biological.
I believe the kind of therapy that will help borderlines is the kind that focuses on the "here and now," on self-defeating behavior, on emotion regulation, and to learn to like and love ourselves.
I have not spoken to someone with BPD yet that has answered "yes" when asked if they like themselves. Borderlines have a very low self-esteem.
Becoming educated about this disorder, I believe, is a large part of getting better.
When we begin to understand the medical component to this disorder, we can begin to forgive ourselves for our behavior, our mistakes and our past decision making.
Many people could not understand for example, why I stayed in unhealthy relationships. What they didn't understand was that without the unhealthy relationship, I felt that I ceased to exist - that I was invisible and to me, that was pretty scary stuff.
I didn't make poor, self-defeating decisions about my life because I was a weak or stupid person. I was trying to survive emotionally. Speaking of "being stupid", borderlines for some reason seem to be more intelligent than "the average bear."
Perhaps therapy that could have taught me that I would indeed survive without that unhealthy relationship would have improved my decision making skills.
I remember many times in unhealthy relationships, having the tremendous need to have contact with the person, even though it cost me my pride, self esteem, etc. I would have gone to just about any lengths to get that "fix."
At one point finally I realized that it really wasn’t the other person I needed to see. A very high level of anxiety would build up within me after a period of time of not seeing this person and usually the reason I contacted the person was to reduce this enormous level of anxiety.
I remember the anxiety level being extremely high, affecting my breathing, and my own ability to function - to work, etc. The felt scary to me as I did not know how high this anxiety level would go.
I remember seeing a psychologist for only a brief period of time (due to lack of finances) and she would encourage me not to contact the other person. She stated she wanted me to see that I could handle the anxiety, to reduce my fears, to see how high this anxiety would go. I never did get to that level as soon I was without a therapist of any kind as I was so disabled I could not work long enough to keep any money. I was disabled for years before I finally decided I would try to get on Social Security Disability (SSD).
What Therapists Need to Know about Borderlines
Therapists need to know that while working with us, we don’t "do therapy" the way most of their clients do. As I mentioned about emotional regulation, borderlines feel their feelings deeper than most people and our emotions are unregulated. We become suicidal rather quickly and spontaneously.
If you are not comfortable treating people who have the BPD, have any feelings of negativity about them, please do not put someone through this. They deserve better.
I remember leaving one therapist’s office feeling suicidal merely because she confronted me. Confrontation is a great skill to use in therapy for many patients that are stuck or too secure in their unhealthy behavior. The Harvard Mental Health Letter discusses using confrontation if it is appropriate. This would require an excellent assessment of the client first.
We cannot handle stress as well as many people. We are not weak, we have brains that have malfunctioned and betrayed us. Many times our brains "fire out of control" and we feel dysphoric (anxiety, depression, despair, rage) and life is painful, so painful it is hard to express in words.
Don’t try to cheer us up during these times, or tell us to "keep our chin up." It must be understood that we are hurting at the physical, biological level. Just as an epileptic has seizures, we don’t tell them to "cheer up" during their seizures. Encourage us to keep our appointments with our Drs. in regards to our medications.
BPD is not a disorder of the personality. It will not help to try to "figure out what event in life" caused this disorder. It will not help to blame the parents or the environment. I do not believe this is where the BPD originates from anyway. This is wasted energy in my opinion in the treatment of borderlines.
First step, medication to help the brain, to stop the seizures, the rages, the mood swings, the depression, etc. If these symptoms can even out, THEN perhaps the borderline can undergo some level of therapy.
There is no cure, however there is treatment. Many borderlines report having no symptoms later in life, yet others note no improvement. As the book "Imbroglio" states, there are no borderlines alike.
Many people in the helping profession do not feel good about using labels on individuals from the "mental health bible" - the DSM IV which discusses diagnosis and criteria. So, many discard these labels, some to the extent that they will not read a client’s chart before counseling them.
As I mentioned earlier, this attitude about labels sounds noble and caring, yet it is an extremely dangerous practice for people with borderline personality disorder.
Many therapists refuse to treat people with BPD for many reasons. One being my very point, that they can easily be triggered and become suicidal, wind up in the hospital etc. and many therapists don’t want to deal with that.
Some therapists think these clients are very hard to work with. They are many times not easy to be around sometimes. Let’s face it, we rage, experience mood swings, split, etc. In fact, I remember slamming my counselor’s door a few times.
Therapist Shopping
Becoming educated about our borderline disorder, knowing and accepting our limitations will help protect us "out there" in a world where borderlines are widely misunderstood and are, in my opinion, wide open to being hurt and damaged further by lack of education by professionals. We must protect ourselves.
We know we need therapy and that we need help and thus the process of shopping for a therapist must be done wisely.
Many of us however, don’t have the luxury of "shopping" due to our insurance, lack of finances, etc. We have to "take what we can get."
However, for those who *can* shop, look for someone who is experienced in working with borderlines. Ask them to fill out a questionnaire that I have created.
DBT (Dialectical Behavior Therapy)
I encourage you if possible to obtain this form of therapy created by Marsha Linehan, from the University of Seattle in Washington. It is therapy especially designed for borderlines.
DBT has assisted many people who have the borderline personality disorder. However, DBT has not helped everyone with the BPD. It is not a "cure-all" in my opinion.
There is a workbook out that I recommend in my book section called "Skills Training Manual for Treating Borderline Personality Disorder. (Uk) (Can)" I encourage you to get that and begin working in it.
There is a DBT email support group on-line that I have posted in the "Resources" section.
I know in New York for example that Medicare will cover DBT and now in certain places in Oregon, the Oregon Health Plan will pay for it. Check it out where you live. See if you can afford it and if you can find someone who does DBT. I believe there is a severe shortage of people who are trained in DBT. Hopefully in the future this will not be a problem.
Some Final Comments
Remember that you are vitally important and an extremely precious human being. You deserve the best of care and the best out of life. You deserve good medical care and therapy as well.
I don’t know at what level you are functioning when you read this, but whatever level that is, you MUST find the strength to get the help you need. You are worth it. Your self-esteem may be in the bucket right now but you must know that these feelings are simply a part of your illness. They are not reality. You did not ask for your illness. You did not cause it and it is not your fault.
You are not alone, you are among many even though you do not see them, they suffer with you and like you. I know. I was there and I am not there now. This should tell you that there is hope. There is a light, though it may appear dim, out there at the end of this long tunnel you are in now. In my opinion, medication will shorten this tunnel tremendously.
There is always light out there for you. There is love out there and peace. There is healing.
I know the pain you feel. Here is an unfinished poem I wrote after many years of therapy. It is important to note that I was not on medication when I wrote it:
DEPRESSION
It is there for me, waiting, waiting like a black widow...so patiently to inject it's black poisonous vile into me, to put it's arms around me and envelope my inner core and once it has me, it's weightless shape turns so heavy, weighing me down as if I am anchored and cannot move.
I write, my fingers tap away on the keyboard, my mind moving quickly, always busy. I know it is waiting but...it cannot find me now...I am turned away. My shield is up.
But I know it's patience. It will out wait me, out last me. When I have grown heavy and tired of fighting, it will come and it will come hard, like a bolt of lightening...as if I had been struck, being thrown several feet away. I am down and in it's web and I cannot pull free. I twist and turn and cry out in pain and still, it has me.
Then it gently lies to me as if it were a demon from Hell. It tells me I am worthless and hated. It tells me to end this pain and take the very life God gave me...and I feel God has been struck down from the heavens because I don't feel His presence.
This deep black hole has no stairs in which to climb...alone in the darkness, alone in pain, crying out to the universe that has no ears.
This black thing is my constant companion. It has walked with me for many years. When I am free from it, I know it is still there, waiting patiently, so very still.
REFERENCES
Harvard Mental Health Letter
March 2002
Updated: 4/02
Updated: 4/02
While researching information about the borderline personality disorder (BPD), we find that there are many different "orientations" to BPD including psychoanalytic, biological, eclectic, biosocial and cognitive. See page on "Major Orientations to BPD."
We read one book and say to ourselves that we finally have some answers, only to find that the next book about BPD may say something entirely different. Some professionals even tell us we cannot get better. As a result, many of us are confused. All we know is that we are hurting and we want the pain to go away.
I would like to address these issues with you that coincide with current research. So much still remains unknown about this disorder, yet we do know more now.
First of all, it is extremely important to know that no form of therapy will assist a person with the borderline personality disorder unless the person is properly medicated, reducing many of the symptoms. Paul Markovitz, M.D., Ph. D, states "Antidepressants do not change the hardwiring. They simply damp down the circuits to a point where many individuals can control their lives. Mood swings, somatic complaints, rage, irritability, binge eating, anxiety, and even black-white thinking are reduced significantly. The treatment now is crude compared to what we will do 10 to 15 years from now, but it works. I have seen virtually no data that therapy reverses the illness. While CBT helps a bit, it impacts on life is limited. I have seen no data that it reduces any of the things medications reduce. I think therapy is a good thing, but in all fields of medicine we use it after we fix what is broken, e.g., rehab (therapy) following heart surgery and weight training after ligaments in a knee have been repaired. Current forms of therapy need to be continually upgraded and reevaluated, just like I do with medications.
I am always galled by the concept of therapy prior to medications. It supposes if an individual really tried, they could be better. BPD is a debilitating biological illness. Talking to it is like talking to diabetes. First insulin, then therapy."
First of all, I believe that many forms of therapy that borderlines are currently receiving are not only not helping them, but in fact, are hurting them, i.e. making their symptoms, behavior and emotional pain worse.
This is happening due to the lack of education by therapists, psychologists, psychiatrists and social workers about the borderline personality disorder. I have experienced this as a client, seen it in co-workers and hear constantly from borderlines that write me that their therapy is making them worse.
Why is This Happening?
First of all, I am not addressing Dialectical Behavior Therapy (DBT) or other forms of cognitive behavior therapy which keeps the borderline in the present, focusing on changing thinking patterns and behaviors.
However I have heard rumors that some DBT therapists ask clients to go off of their medications prior to therapy. If you are asked this, I hope you run. If you don't, I hope you stay alive long enough to complete the DBT therapy in case you experience suicidal depression.
Some people feel that DBT alone is all someone with BPD will need for treatment. Personally I cannot disagree more as we are dealing with a medical disorder - a broken brain, if you will. Cognitive behavior therapy does affect the brain but not the extent of borderline recovery.
We all have an area in our brain that regulates our emotions. When an upsetting event occurs, we respond emotionally to that event. The level of emotion we feel in response is usually in proportion to the level of the event that occurred.
However, in borderlines, this area in our brains "malfunctions." We have problems with emotion regulation. An upsetting event can occur and we might experience a level of emotional reaction that is far beyond what is "appropriate." We can go from feeling ok to suicidal very quickly. Sometimes there is no in between.
This is another reason we don't handle stress well. I know for myself, a certain level of stress can render me bed-bound.
I recommend we be aware of these aspects about ourselves, accept them and avoid stress wherever possible. We need to take extra care of ourselves, making decisions about our lives that reduce stress levels.
Psychodynamic therapy, according to the 3/02 Harvard Mental Health Letter is highly recommended along with DBT. The choice of therapy depends upon the person and the level of functioning. This form of therapy brings the unconscious to the conscious level and deals with transference issues.
For example the therapist may point out that the client has misplaced anger. The client may be expressing angry feelings at the therapist and the therapist may suggest that the client is really angry with someone in their past. The client in this form of therapy tells their life story
It is recommended that more than one therapist be involved in a person with BPD's treatment. Consulting co-workers and supervisors is highly recommended due to transference and countertransference.
It is extremely important to treat depression in borderline patients and to take all suicidal threats seriously. No suicide contracts are not enough. These patients may need to be hospitalized.
While waiting for medications like SSRI's or mood stabilizers to work, a benzodiazepine like Ativan can assist with anxiety.
Remember, how can you help someone with a biological problem with therapy? Remember Dr. Markovitz's statement? "Talking to it is like talking to diabetes. First insulin, then therapy."
I remember two different therapists telling me, after advising them of my BPD diagnosis, "It doesn't matter what your diagnosis is. I don't group people into categories. I treat everyone the same." If you hear this from a counselor, don't just walk to the exit, run! They simply don't have a clue of how to treat borderlines.
Anytime your therapy takes you to "the edge, feeling suicidal" it is time to STOP! The suicide rate for borderlines is 10% and this moves up to 25% if the person also has a diagnosis of panic disorder.
Yes, we need therapy, but we need to live through it. We just need the right kind of therapy and therapists desperately need to be educated regarding this.
I hear constantly how borderlines go in and out of the hospital during therapy. On top of that, many counselors will "dump" their client while in the hospital as they don't want to take a "risky client." Many borderlines are dumped by counselors because they display BPD symptoms, when the therapist knew initially that the client had the BPD. Imagine how this would feel to someone who already has tremendous issues with abandonment.
Many years ago when I lived in California, I was a successful social worker with Children's Services, which by the way is one of the most stressful jobs there is. In fact, I was only able to work there for a short period of time.
During this time, I was very serious about getting well and participated in therapy for a year. It was during this time I had to take two six month temporary disabilities off of work and wound up in the psychiatric hospital where I received my first diagnosis of borderline personality disorder at the age of 33.
The counselor, in fact encouraged me to "get in touch" with my emotional pain. He was attempting "uncovery work" (trying to bring up memories from the past) and felt my increased emotional pain from the therapy was a "good thing" as "sometimes the feelings come before the memory."
This sounded all fine and well at the time, however my life spiraled downward rapidly and I became a miserable human being experiencing suicidal ideation.
I became so depressed during this time that my 11 year old daughter, in an attempt to take care of herself wanted to live with her father.
Here I was without my job, without my daughter who was my life and I became bed-bound. Incidentally never did any "memories" surface and I am not a better person in any way shape nor form for experiencing that year long therapy. This is not to mention how this time in my life affected my young daughter.
As people who have the BPD diagnosis, we need to think about our children and sometimes make painful, unselfish decisions. Borderline parents more than anything need support from family - anything from baby-sitting to emotional support.
Sadly it is normally the case where we receive the opposite of emotional support and are judged as a bad person. Families further isolate us because of our behavior. Many times I was not pleasant to be around. Sometimes I would rage and I made poor decisions about my life which made it difficult emotionally for my family to stick around me.
I think what families need foremost is emotional support for themselves as they are in pain also and they need education about our disorder.
Therapy That Will Help
Drug therapy first! Otherwise you are simply and completely wasting your time. You need to give insulin to a diabetic before they can receive any assistance from therapy. Remember that the BPD is biological.
I believe the kind of therapy that will help borderlines is the kind that focuses on the "here and now," on self-defeating behavior, on emotion regulation, and to learn to like and love ourselves.
I have not spoken to someone with BPD yet that has answered "yes" when asked if they like themselves. Borderlines have a very low self-esteem.
Becoming educated about this disorder, I believe, is a large part of getting better.
When we begin to understand the medical component to this disorder, we can begin to forgive ourselves for our behavior, our mistakes and our past decision making.
Many people could not understand for example, why I stayed in unhealthy relationships. What they didn't understand was that without the unhealthy relationship, I felt that I ceased to exist - that I was invisible and to me, that was pretty scary stuff.
I didn't make poor, self-defeating decisions about my life because I was a weak or stupid person. I was trying to survive emotionally. Speaking of "being stupid", borderlines for some reason seem to be more intelligent than "the average bear."
Perhaps therapy that could have taught me that I would indeed survive without that unhealthy relationship would have improved my decision making skills.
I remember many times in unhealthy relationships, having the tremendous need to have contact with the person, even though it cost me my pride, self esteem, etc. I would have gone to just about any lengths to get that "fix."
At one point finally I realized that it really wasn’t the other person I needed to see. A very high level of anxiety would build up within me after a period of time of not seeing this person and usually the reason I contacted the person was to reduce this enormous level of anxiety.
I remember the anxiety level being extremely high, affecting my breathing, and my own ability to function - to work, etc. The felt scary to me as I did not know how high this anxiety level would go.
I remember seeing a psychologist for only a brief period of time (due to lack of finances) and she would encourage me not to contact the other person. She stated she wanted me to see that I could handle the anxiety, to reduce my fears, to see how high this anxiety would go. I never did get to that level as soon I was without a therapist of any kind as I was so disabled I could not work long enough to keep any money. I was disabled for years before I finally decided I would try to get on Social Security Disability (SSD).
What Therapists Need to Know about Borderlines
Therapists need to know that while working with us, we don’t "do therapy" the way most of their clients do. As I mentioned about emotional regulation, borderlines feel their feelings deeper than most people and our emotions are unregulated. We become suicidal rather quickly and spontaneously.
If you are not comfortable treating people who have the BPD, have any feelings of negativity about them, please do not put someone through this. They deserve better.
I remember leaving one therapist’s office feeling suicidal merely because she confronted me. Confrontation is a great skill to use in therapy for many patients that are stuck or too secure in their unhealthy behavior. The Harvard Mental Health Letter discusses using confrontation if it is appropriate. This would require an excellent assessment of the client first.
We cannot handle stress as well as many people. We are not weak, we have brains that have malfunctioned and betrayed us. Many times our brains "fire out of control" and we feel dysphoric (anxiety, depression, despair, rage) and life is painful, so painful it is hard to express in words.
Don’t try to cheer us up during these times, or tell us to "keep our chin up." It must be understood that we are hurting at the physical, biological level. Just as an epileptic has seizures, we don’t tell them to "cheer up" during their seizures. Encourage us to keep our appointments with our Drs. in regards to our medications.
BPD is not a disorder of the personality. It will not help to try to "figure out what event in life" caused this disorder. It will not help to blame the parents or the environment. I do not believe this is where the BPD originates from anyway. This is wasted energy in my opinion in the treatment of borderlines.
First step, medication to help the brain, to stop the seizures, the rages, the mood swings, the depression, etc. If these symptoms can even out, THEN perhaps the borderline can undergo some level of therapy.
There is no cure, however there is treatment. Many borderlines report having no symptoms later in life, yet others note no improvement. As the book "Imbroglio" states, there are no borderlines alike.
Many people in the helping profession do not feel good about using labels on individuals from the "mental health bible" - the DSM IV which discusses diagnosis and criteria. So, many discard these labels, some to the extent that they will not read a client’s chart before counseling them.
As I mentioned earlier, this attitude about labels sounds noble and caring, yet it is an extremely dangerous practice for people with borderline personality disorder.
Many therapists refuse to treat people with BPD for many reasons. One being my very point, that they can easily be triggered and become suicidal, wind up in the hospital etc. and many therapists don’t want to deal with that.
Some therapists think these clients are very hard to work with. They are many times not easy to be around sometimes. Let’s face it, we rage, experience mood swings, split, etc. In fact, I remember slamming my counselor’s door a few times.
Therapist Shopping
Becoming educated about our borderline disorder, knowing and accepting our limitations will help protect us "out there" in a world where borderlines are widely misunderstood and are, in my opinion, wide open to being hurt and damaged further by lack of education by professionals. We must protect ourselves.
We know we need therapy and that we need help and thus the process of shopping for a therapist must be done wisely.
Many of us however, don’t have the luxury of "shopping" due to our insurance, lack of finances, etc. We have to "take what we can get."
However, for those who *can* shop, look for someone who is experienced in working with borderlines. Ask them to fill out a questionnaire that I have created.
DBT (Dialectical Behavior Therapy)
I encourage you if possible to obtain this form of therapy created by Marsha Linehan, from the University of Seattle in Washington. It is therapy especially designed for borderlines.
DBT has assisted many people who have the borderline personality disorder. However, DBT has not helped everyone with the BPD. It is not a "cure-all" in my opinion.
There is a workbook out that I recommend in my book section called "Skills Training Manual for Treating Borderline Personality Disorder. (Uk) (Can)" I encourage you to get that and begin working in it.
There is a DBT email support group on-line that I have posted in the "Resources" section.
I know in New York for example that Medicare will cover DBT and now in certain places in Oregon, the Oregon Health Plan will pay for it. Check it out where you live. See if you can afford it and if you can find someone who does DBT. I believe there is a severe shortage of people who are trained in DBT. Hopefully in the future this will not be a problem.
Some Final Comments
Remember that you are vitally important and an extremely precious human being. You deserve the best of care and the best out of life. You deserve good medical care and therapy as well.
I don’t know at what level you are functioning when you read this, but whatever level that is, you MUST find the strength to get the help you need. You are worth it. Your self-esteem may be in the bucket right now but you must know that these feelings are simply a part of your illness. They are not reality. You did not ask for your illness. You did not cause it and it is not your fault.
You are not alone, you are among many even though you do not see them, they suffer with you and like you. I know. I was there and I am not there now. This should tell you that there is hope. There is a light, though it may appear dim, out there at the end of this long tunnel you are in now. In my opinion, medication will shorten this tunnel tremendously.
There is always light out there for you. There is love out there and peace. There is healing.
I know the pain you feel. Here is an unfinished poem I wrote after many years of therapy. It is important to note that I was not on medication when I wrote it:
DEPRESSION
It is there for me, waiting, waiting like a black widow...so patiently to inject it's black poisonous vile into me, to put it's arms around me and envelope my inner core and once it has me, it's weightless shape turns so heavy, weighing me down as if I am anchored and cannot move.
I write, my fingers tap away on the keyboard, my mind moving quickly, always busy. I know it is waiting but...it cannot find me now...I am turned away. My shield is up.
But I know it's patience. It will out wait me, out last me. When I have grown heavy and tired of fighting, it will come and it will come hard, like a bolt of lightening...as if I had been struck, being thrown several feet away. I am down and in it's web and I cannot pull free. I twist and turn and cry out in pain and still, it has me.
Then it gently lies to me as if it were a demon from Hell. It tells me I am worthless and hated. It tells me to end this pain and take the very life God gave me...and I feel God has been struck down from the heavens because I don't feel His presence.
This deep black hole has no stairs in which to climb...alone in the darkness, alone in pain, crying out to the universe that has no ears.
This black thing is my constant companion. It has walked with me for many years. When I am free from it, I know it is still there, waiting patiently, so very still.
REFERENCES
Harvard Mental Health Letter
March 2002
Updated: 4/02