It’s a cruel irony that people who have borderline personality disorder (BPD) will often have the most difficulty finding and getting proper treatment from mental health professionals. Because, unlike virtually every other mental disorder in the book, borderline personality disorder is seen as one of the worst of all disorders to try and treat. People with BPD are the most stigmatized amongst a population already burdened with heavy stigma, people with mental health concerns.
Borderline personality disorder is characterized by a long-standing pattern of instability in interpersonal relationships, the person’s own self-image and their emotions. People with borderline personality disorder can also tend to be impulsive. Borderline personality disorder is a fairly rare concern in the general population.
It’s the ever-changing and very intense emotions that set someone with BPD apart from others. Their relationships are fast, furious and fleeting. Whether it be a friendship or a professional therapeutic relationship, people with BPD often find it difficult to hold on to it. Their thoughts are often characterized by what cognitive-behaviorists term “black-or-white” or “all-or-nothing” thinking. You are either 100% on their side, or you are actively against them. There is little in-between.
Given this manner of looking at the world, it’s no wonder people with borderline personality disorder can be challenging to work with. They will often “test” the therapist who works with them, by either engaging in impulsive, dangerous behavior (needing to be “rescued” by the therapist, such as committing an act of self-harm), or by pushing the professional boundaries of the therapeutic relationship into forbidden areas, such as offering a romantic or sexual encounter.
Most therapists throw up their hands when it comes to treating people with BPD. They take up a lot of the therapists’ time and energy (often much more than the typical patient), and very few of the traditional therapeutic techniques in a therapist’s arsenal are effective with someone who suffers from borderline personality disorder.
Dozens of people with borderline personality disorder have shared their stories with us over the years, expressing the pure frustration they experience in trying to find a therapist willing (and able) to work with them (see, for example). They often recount stories of having to go through therapists in their local geographic vicinity like others might go through a box of tissues at a funeral. It’s distressing to hear these stories time and time again.
But that’s not the way it should be.
Borderline personality disorder is a legitimate, recognized mental disorder that involves long-standing and negative patterns of behavior that cause a person great distress. People with BPD need help as much as the person with depression, bipolar disorder or anxiety. But they’re not getting it because they are being discriminated against by therapists who simply don’t want to deal with the time and hassle of someone with BPD.
Therapists can legitimately turn away someone seeking their help if they don’t have the skills, experience or education necessary to treat a specific concern. Borderline personality disorder is best treated with a specific type of cognitive-behavioral therapy called Dialectical Behavior Therapy (DBT). This specific type of psychotherapy requires specialized training and education in order to use it productively and ethically.
Few therapists bother to learn this technique, however, because of the trouble that is commonly associated with people with BPD. Plus, they think, they may not even get reimbursed for treatment of this concern because generally most insurance companies do not cover payment for treatment of personality disorders (no matter how much pain the person is in). This is a bit of a red herring argument, however, as professionals know many reasonable and ethical ways to obtain such payment by adding additional, reimbursable diagnoses on the patient’s chart.
The stigmatization and discrimination of people with borderline personality disorder needs to stop within the mental health profession. This bad behavior reflects poorly upon therapists who repeat the same inaccurate and unfair generalizations about people with BPD as others did about depression three decades ago. Professionals should know the local therapists within their community who are experienced and well-trained to treat borderline personality disorder. And if they find such numbers lacking, they should seriously consider it as a specialization of their own.
But if a therapist does nothing else, they should stop talking about people with borderline personality disorder as second class mental health citizens, and start treating them with the same respect and dignity all people deserve.
89 comments
HELP! My county has taken away my children, 14 years and 1 year, because I have BPD, claiming I am a risk to endangering them.
I raised my 14 year old without incident, and have been a breastfeeding mother of my now 17 month old, who has been in foster care for over two months. There are no issues of neglect, abuse, drugs, alcohol…nothing. But, in Juvenile Dependency court, in order to have your child(ren) removed, you don’t need to have committed any wrong, just the risk of committing a wrong based upon their subjectiveness.
This all began from a false allegation from my baby’s biological father in a custody dispute, and the County has since dropped the original allegation but ran with my BPD, claiming that within the next 16 1/2 years, I could pose a risk of neglect to my child. They have already returned my 14 year old, but are keeping my baby.
No one ever told me that because I was diagnosed with BPD that it was against the law to have children.
I hope this story, on behalf of my baby, reaches the heart of someone who may know recourse. I cannot find any support out there anywhere. No organizations to fight discrimination, as this is the worse kind. To lose your precious child is like a daily death sentence.
I know i have Bpd i am embarrassed ashamed and helpless.. I’ve struggled through life physical verbal emotional abuse. My mind and emotions are reckless i feel bad at times then un emotional.
I’m suffering silently. I have no friends un able to keep friends fall in and out of love. I want to feel normal not bizarre or erratic just normal i feel cursed. I’m very intelligent but flawed by bdp it makes no dame since. I could either laugh scream cry or end it all to no avail.What’s a girl to do!
I was misdiagnosed with bipolar for 25 years. Now I have be fortunate to have an awesome psychiatrist who not only pinpointed my problem, has given me direct and consistent attention to my issues, but has been very generous with his wisdom. I’m blessed. My problem? I cannot find a program or consistent theraputic venue that deals with BPD. I have completed COG,DBT and a 30 day inpatient stay. Where do you go to continue what you are learning?
DBT is a great therapy as is patience and mindfulness with clients experiencing BPD. A therapist must also have good boundaries and sometimes let the client flounder or move on. As a previous post mentioned, …I know first hand of therapists/licensed people who had their careers destroyed by character defamation made by clients and former clients.
Treatment seems like such a catch-22. My college psychology professor was also a clinical psychologist and would tell us about his patient that was borderline. He said one time he innocently had to cancel the session due to having a minor surgical procedure done….he said this patient flew off the handle and told him how hated he was by this patient(he didn’t give out the patients name or sex for obvious reasons when he would tell us stories about is patients/former patients). This patient also tried to get my professors license revoked(the patient failed of course because you don’t get your license revoked for canceling ONE appointment(with ample notice ahead of time). But everyone is different and no one size fits all approach exists to treating BPD patients. Personality disorders are notorious for being refractory to standard treatment…ever try treating someone with anti-social personality disorder? It’s hard to get them in help because a good portion of them are in jail…and the others don’t think they have a problem at all.
i find most therapists and psychiatrists do not tell clients they have a personality disorders.
The anxiety, depression and coping skills are addressed but not the underlying diagnosis.
I also find therapists say “why bother, as the person is not going to change” but feel that they are ethical in continuing to accept money for therapy and ongoing medication.
I personally find this strange; out of respect I inform clients about their disorders- no matter what they are. i think this gives them power.
My best friend of eight years, Shelby, has been in and out of therapy throughout her adolescent life. She has seen multiple therapists and was written off by most as simply bipolar, which was not the case. Because therapists couldn’t correctly diagnose or treat her, they just labeled her as “untreatable”. The stigma against BPD is huge, therapists are not taking enough time or enough care in their patients. They’re making quick diagnosis’ and when the treatment isn’t working they just let their patients go. Shelby is currently nineteen years old and is finally getting the correct treatment. She is going through DBT and group therapy. She says she feels better than she ever has before and it’s all because she finally received the treatment she should’ve gotten a long time ago.
As Patty Fleener writes of so well, when one has BPD he or she is not listened to. The clinician often pre-decides (usually incorrectly) how the pt. will act based on the BPD label itself. In fact, they sort of wait for “evidence” to “prove” themselves correct. The patient is powerless as any evidence to the contrary is quickly ignored to maintain the original position of how “bad” people with BPD are.
There are 256 ways to meet the criteria for BPD. Some share only ONE trait; and most have other diagnoses such as an eating disorder, depression, PTSD, a separate PD, etc. How on earth can they all be the same? They are not!
The name itself is ridiculous as the theory behind the name was debunked decades ago. Yet when I said that to John Gunderson, he said he didn’t think “the research” would stil apply if the name were changed. Huh? They did with multiple personality disorder and manic depression just fine.
Until clinicians are willing to open their eyes and get into the heart and minds of these suffering people there will be no therapeutic alliance and the treatment will do more harm than good. And to think many are seen as trying to get attention when in fact one out of ten ends up commiting suicide. (No doubt some of those suicides are in large part due to the discrimination and abuse by those that were supposed to help.)
It’s well past time to stop blaming the victim here. People with BPD are suffering enormously. The stigma and misperceptions do not help.
I highly recommend Alex Chapman’s The Borderline Personality Disorder Survival Guide. He wonderfully and humorously debunks the most common myths around “BPD.” As far as I can tell, it needs to be read by anyone who considers themself part of a helping profession.
Why don’t therapists like treating borderlines? I can’t speak for anyone but myself, but here goes.
1. Unlike depression, bipolar or other conditions, borderlines can have the nasty habit of lashing out at their therapists. One day we can be the best therapist ever and the only person to ever help and understand them. The next day we can be the most horrible, useless and incompetent clinician ever with no business holding a license. Sorry, but I’m not going to be anyone’s verbal punching bag or whipping boy.
2. I have a solo practice. I also have a family and I like having a life. I do not have the resources to handle habitual crisis calls in the middle of the night, on holidays, etc.
3. From a liability standpoint, their propensity for self-harm makes them too high risk. And given their vindictive rages, if you get on their bad side they are Dept of Professional Regulation complaint or lawsuit waiting to happen.
4. Unless someone is a skilled DBT practitioner, the prognosis for a borderline is poor. I’d rather devote my time and energy to people I have a good chance of helping.
I’m sorry, WHY are you a therapist exactly?
Stick to what you know best – the easy lovely clients who don’t tax you considerable incompetence too much. You are a disgrace to your profession and maybe should consider another profession if you have the ability.
The responses above to a totally honest response by a mental health professional are exactly the reasons no one wants to take on borderlines. So, the therapist should therefor lie at the alter of the borderline and allow themselves to be sacrificed? This type of thinking, I guess enough said Therapists, teachers, etc are human beings too. They are not “being paid” to be your scapegoat. They also like to keep their own licenses and sanity. Borderlines are just, lets face it, the hardest to treat Zero self knowledge except to manipulate and cause chaos and destruction. “victims” in their dramas to the bitter end. It is not the worlds fault you suffer
Dear Self…..WOW!!! So YOU are the cause of stigma against those with BPD. YOU are the one referred to by the author of this excellent article. YOU are the one who writes human beings off with prejudice and discrimination and false accusations. Perhaps you are also one of the BYSTANDERS who choose to do nothing to stop the child abuse that directly causes BPD…..or maybe your bitter because no-one helped you? To say that someone with BPD is a manipulator is ridiculous and naïve and, in light of recent research, completely ill-informed. You may have great self-knowledge but you completely lack any other-knowledge – maybe a wee course in mentalization would be helpful for you. Your lack of any degree of empathy for a group of people who have an authentic mental distress (caused by abuse in most cases) is staggering – perhaps bordering on psychopathic or narcissistic – maybe you don’t know yourself as much as you think you do. Maybe your anger is due to the fact that you cannot face in others what you cannot face in yourself (projection)?
Maybe you need to focus your considerable energies, and apparent desire for a lack of “drama” in life by fighting to stop the horrific abuses in our society – sexual, physical, psychological and neglectful. Maybe you could take SOME responsibility for the part you play in enabling child abuse to continue with impunity in our society. Granted, you maybe don’t want to do that – maybe it’s a bit too much like hard work for you – maybe it’s much easier to write silly little ignorant comments about the victims of your choice to do nothing to prevent their distress in the first place. If that’s the case then maybe you should expect our society to tolerate more people with BPD, since we refuse to prevent their maltreatment as children.
Or maybe you think that people who have BPD should be silenced like all the other people who have been severely abused as babies and children – abusers usually desire this silence, and part of the abuse is to secure the silence by various abuses. You seem to be just another one who seeks to silence the abused. Shame on you. If you really have some courage and integrity and honour, maybe you should stand with them and fight to be heard regarding STOPPING CHILD ABUSE NOW.
If you don’t have the knowledge to understand why a BPD person behaves the way they do, nor the inclination to get sufficient training to try to understand them then might I suggest that you do as you seem to prefer to do, namely focus on the mild to moderate MH conditions (the people you feel able to help) and you own life and family. Selflessness is clearly not your strong point and so your effectiveness as a therapist for those with severe mental distress will be limited. It would be unethical to seek to practice with those with whom you have no ability nor desire to help.
When a small child (or baby) is severely and/or chronically abused then their small undeveloped brains try to find the only way they know how to survive. This leads to major trust issues, attachment disorders, emotional dysregulation and dysfunctional coping strategies. This becomes “hard-wired” and triggers genes that code for specific behaviours that other people find confusing, simply because their genes for these behaviours have not been “triggered” or expressed. This is the main reason that they are hard to cure. In fact they cannot be cured BUT therapy can help them manage their condition. It requires long-term intensive therapy by an informed, trained and motivated therapist. Mostly our professionals are not that motivated to become “good enough” to meet this need in someone.
If someone with serious trust issues takes, what for them is a major leap to trust a therapist, then they invest in that relationship all their hope that this person genuinely cares for them – that’s the “all is good” period. If that therapist then lets them down (as all human therapists will do) then this feels like a very real betrayal and threat to the client. This results in fear and therefore anger in defence – that’s the “all is bad” period. If a therapist is not mature enough to manage their own emotions (poor me), and help the client to manage theirs, nor is “good enough” to help the client see that lack of perfection doesn’t always mean serious threat but is part of a normal relationship, and is able to continue (with boundaries) in therapy – and thereby demonstrate that people can be hurtful as well as trustworthy over a long period of time – then that therapist will simply validate the clients core belief that people cannot be trusted and thte client is worthless and unloveable. They do more damage than good. They reinforce the defensive behaviours they so despise in the client.
Unless you genuinely, authentically care about vulnerable abused human beings, and can see the young maltreated child behind/within the dysfunctional adult in front of you, it’s definitely best if you stick to mild/moderate conditions that don’t challenge your ego too much, but provide you with the strokes you so clearly need yourself.
Your comment is akin to a surgeon deciding he will only pick and choose keyhole surgeries and appendectomies and not bother about complex tumours, cancers and heart transplants, simply because he doesn’t feel like it and it’s ‘too hard.’ Highly unethical.
I was recently diagnosed with BPD. I would have preferred AIDS.
When I was diagnosed the psychiatrist asked me what I thought of or new about BPD.
I explained that the diagnosis meant I might as well have blown my fucking brains out because I’ll NEVER be happy and bring NOTHING but chaos, destruction and misery to everyone unfortunate enough to be around me, ESPECIALLY loved ones. No hope, no treatment, no future, only pain.
Apparently that’s changed and there’s actually treatments for it, but it took the psychiatrist and my social worker about a half hour to try and convince me there’s even a chance of hope.
But yeah.. that’s the perception of BPD.
I have BPD. I dont think that I could say anything that hasn’t been said here except that what I have found is the most frustrating part of this stigma, for me, is being told that my search for a higher standard of care (beyond those with huge prejudices against me) is a symptom of my mental illness. Im having a very hard time with this diagnosis and the ridicule that I am feeling from mental health professionals. I feel as though the way im being treated is making my condition worse.
I have borderline personality disorder and working towards recovery and experienced professionals with a bad attitudes towards people with BPD it makes recovery for the person even more difficult,it is a complexed illness and one patient with BPD to the next have different experiences and should be treated as an individual,alot of people with BPD have had difficult childhoods not all but I’ve met a lot from neglect as a child or in my case I was sexually abuse.
Few therapists would choose to help BPD patients as it requires hard work, knowledge and commitment beyond their abilities. To begin with, they have to authentically care about the welfare of their clients and while most profess to do this, many do not. Many prefer to care about their own career progression and, to that end, are looking either for a quick and easy buck or for an easy session with a client for whom simple brief time-limited CBT will be sufficient. They will provide selective long-term therapy for those that they find interesting but who do not tax them too much. Many therapists become therapists in order to understand themselves better and continue to enjoy Supervision more than sessions with clients. Who likes to be told they are inadequate? Would you? People with PD’s are too challenging for the averagely trained therapist. They also do have a life of their own that they enjoy, and enjoy being paid for the work they do and the benefits that this accrues to them. Patients are often only a means to an end.
People with BPD need to come to terms with the fact that no-one will ever love them the way their mother sould have loved them and that they are not entitled to be loved by anyone in this way. It’s a cruel world and they need to find a way to accept this and realise that they alone can learn to love themselves and care for themselves. If they can do this then they might learn to respect both themselves and others so that they stop threatening to self-harm or commit suicide as this is almost impossible to tolerate. It is very distressing and achieves nothing but the rejection they most fear. Other people prioritise their own welfare, setting boundaries, and people with BPD do the same but without boundaries. They need to learn to empathise with those they say they care about (and ask for help from) and to realise the distress they cause them by their behaviour. This is hard for them to learn when they feel so overwhelmed by emotions and they may need help to learn to tolerate their own emotions, and to realise that feelings are just feelings and do not need to be acted on, but just allowed to pass naturally. No-one is all good or all bad, not even therapists. We are all just limited human beings trying to survive as best we can. We all need to toughen up through suffering, to cultivate more empathy for one another, and to practice our profession more ethically. All people with mental illness are feared by society, who then marginalise (externalise) them, label them and so they are able to hate/stigmatise them – just as some therapy tells us we should do with our negative thoughts/beliefs. Gay people used to be hated in the same way. We, as a society, don’t like difference in any shape so we call others “Personality Disordered”, place them in our collective MH dustbin and seek to ignore them (Out of sight, out of mind). Psychologists are not divine, but fallible limited human beings who know far less than they will admit to. Maybe they need the humility to be more authentic with their clients or to get proper training BEFORE they ruin any more lives due to incompetent (harmful?) behaviour. Maybe we should bring in a euthanasia bill so that we can all benefit from death with dignity instead of the slow torture that some few professionals cause us to endure on top of our mental health “issues”.
Finally, the brain is an organ like any other organ – why do we condemn those whose brain is dysfunctional and not those whose Bowel/heart/lungs etc are dysfunctional? Why was MS a psychological illness up until the health professions developed a test for it and suddenly it became a “legitimate” disease process and was moved out of psychiatry and into neurology? Why has dementia, a known brain disease been moved out of neurology and into psychiatry? Life is never fair.
BPD is often misdiagnosed contributing to therapists treating the wrong disorder (C-PTSD), bipolar disorder, etc. Therapists tend to blame their lack of competence of those they treat.
I was a post-bacc research assistant for a clinical psych lab and heard my mentor speak negatively about people with BPD. I was saddened by that alone.
I eventually left the lab and psychology. I decided instead to move to victimology, where I would hope to put my former criminal justice and police training to use in research. My hope is to research iatrogenic effects of mental help treatment, unsubstantiated claims of trauma, trauma heterogeneity, and therapy abuse as a trauma that deserves healing.
Many minorities, including marginalized persons and those prone to microaggression trauma, including that which concerns those with BPD, have been retraumatized in treatment when microaggressions and flat out discrimination ensue. Where do such unsubstantiated victims turn? Their worsening maladaptive coping which brought them to treatment in the first place? Do they try again and again? And then get blamed for being treatment-resistant when they were not being treated adequately in the first place?
Homeless shelters, psych wards, jail cells, prisons, halfway homes, foster care alumni groups, Section 8 homes, unemployment centers, Social Security offices, rehabilitation centers, victim centers, and domestically violent homes are filled with people who have mental illnesses of all kinds, and those who have not had successful encounters with past mental health providers – regardless of whose fault it was. Nevertheless, people with disorders or symptoms that do not meet a disorder need help. They do not need ad hominem attacks about their character or symptoms or disorder; they need treatment or referrals, and resources in addition to therapy alone. They need more than hotlines, but some stable non-clinical activity like some have suggested above, such as karate, aikido, meetup groups, book clubs, etc. – in addition to therapy.
I just get saddened by the way former victims of maltreatment often get revictimized and then retraumatized by those who are supposed to be trustworthy – therapists.
As a veteran, I am grateful for my “fictive family” support. But those without that support have a harder time in life and with recovery from their mental illnesses. I have been misdiagnosed many times, but I have consistently found decent people in my life and have maintained some friendships for decades.
When I was misdiagnosed in my 30s with BPD, though have always maintained a PTSD diagnosis, and had never had any issues in my teen years or very early 20s, prior to the military but after my graduating from a police reserve academy at age 19, I knew that my traumas had stemmed from the military – not necessarily from childhood, though I concede that resilience during childhood could always reverse when revictimized years later, in adulthood.
That said, my conditioned worsened with the treatments I got from that misdiagnosis. I just kept wondering how those with true BPD must have felt.
I am not Hispanic, but sometimes I appear like it, depending on how I do my makeup and Asian hair. I was called names and also wondered how they must deal with these microaggressions and verbal hate on a near daily basis. Like that, I wondered how hard it would be for those with BPD to experience all this stigma, and dare I say hate.
I really appreciated reading this. Thank you, Dr. Grohol.
I was diagnosed with BPD and PTSD last fall, after a stay in a psychiatric hospital. I am currently seeing a therapist who is trying to help me, but honestly, it’s hard. I seem to take one step forward and two steps back. He wants to believe I am making progress, as do my friends and my loving husband, but sometimes I doubt that I am.
The stay in the hospital was awful! The social worker was a nice sort of guy, but the rest acted like the only thing they were concerned about was making sure I didn’t do something to myself and leave them liable. They took my belongings away from me, didn’t let me shut my door, and watched me every minute. I wasn’t allowed to have shampoo in my room, or my hairbrush. I am incontinent, but wasn’t allowed a bag to put my wet “diapers” in. Talk about humiliating! There was no dignity. Oddly enough, in their search for objects that I could harm myself with, they left behind the only actual sharp object, in plain sight. How funny is that?
I did not know that I was in a locked unit, and could not just go home when I wanted. It felt like prison. I realize why they have to do this when someone threatens to kill themselves, but it was much more like punishment for “bad behavior” than any kind of concern and help. I signed myself out, against their wishes. A few months later, I had another bad bout, where I momentarily lost all reason and attempted to get out of the car and run out onto the highway near my doctor’s office. My husband had to grab hold of me. The nurse called the police! Next thing I know two officers are there to take me to the hospital. I refused to go. We all know what so often happens to mentally ill people in the hands of the police. I didn’t want to die that day after all, so I spoke calmly and said I’m not going. My husband finally convinced them that he would watch over me closely to make sure I was safe.
Since then I have been through many ups and downs. I wouldn’t wish this illness on anyone. My family, except for hubby, does not understand. I’ve been called overly sensitive, ridiculous, selfish, and stupid. I am none of those things. No matter how many times I’ve tried to explain to them what’s happening, and why, they won’t hear me. My brother even told me to f*** off after I asked him to stop being mean to me.
Thankfully I have a loving husband who works in the mental health field, so he understands. He told me that he has frequently heard therapists and doctors making disparaging comments about BPD patients at the hospital where he works. They don’t like to work with this population because we are “difficult”. Yes, there’s a stigma. I’ve been very open with friends about my condition. Some have remained friends with me, others, well, not so much.
People in general do not realize how much pain people with BPD are in. It’s not our fault, either. We can’t just wish it away, any more than a person in a wheelchair can just will themselves to get up and walk. People who think that someone with BPD can get better just by the power of positive thinking have no clue, plain and simple.
I know this is an old article, but I feel compelled to comment because I feel like this whole situation is a Catch-22 for both sides. It’s very true that people with BPD can be helped, and should receive the treatment they need, and that they are stigmatized. They absolutely are.
However, it’s also very true that most clinicians receive no training on how to best treat BPD, and so when we have a BPD client who is screaming at us, swearing at us, calling us at all hours of the day, threatening us, getting mad at us no matter how carefully we word things (walking on eggshells has been a great way to describe it), we don’t know how to respond, and that feeling is terrifying. Not all BPD clients blow up in this way, but the ones that do are very frightening. It’s a hopeless feeling for a therapist too when we don’t know how to treat something. It’s even worse for someone working in private practice, who has no team to back them up if they’re feeling unsafe or out of control of what is happening.
I believe that there are probably some therapists–regardless of orientation–who naturally have a personality or approach that works for BPD. They must know how to set boundaries without walking on eggshells–they’re unfazed when the blow-ups happen, and they can stay calm and validating, but still firm.
The rest of us need to LEARN how to do that. My understanding is that there is now an attempt to develop approaches that are less intensive than DBT that can be used in an outpatient setting. Most therapists don’t have the resources to fully learn and implement a DBT program. So if they continue to develop these alternate approaches and actually TEACH us how to respond when we’re feeling unsafe or scared because of a client’s blow-ups and boundary-pushing, I think more of us would be willing to treat it.
As it stands right now, it’s unethical for those of us without the right demeanor or training to treat it. It’s no different than me sending someone with a severe eating disorder to a clinic that specializes in that, because I am not equipped to treat it. When a therapist doesn’t have the right training, all we’re doing is hurting our own well-being–because we have no idea what we’re doing and we go into every session with the client uncomfortable and frightened, so we’re not at our best–and we hurt the client’s well-being because all we’re doing is giving them a space to play out their unhealthy behaviors, without knowing what to actually do to help them change them.
All of this is to say, the mental health field needs to get a move-on with training more therapists on actual approaches to treat this. Our usual approaches don’t work, and as people have said, BOUNDARIES and learning the right way to respond to anger reactions is so key, because the fear of the anger reactions is a lot of why therapists–I think–avoid working with this, or even sharing a BPD diagnosis because they’re afraid the client will be mad at them for diagnosing that and have an outburst, which they feel they don’t know how to manage.
I WANT the training. I WANT to feel confident when these clients come to me, that I know what to do both for myself, and for them, even when their behaviors or emotions are intense and directed at me. Here’s hoping that actually comes to fruition.
I think the big takaway from your reply should be that therapists need to take BPD as a case by case basis, network within their medical groups for resources and therapists that ARE comfortable treating severe BPD, and be able to forward patients to those therapists if they can’t handle it.
What the article is about, and the main problem here, is that THE MOMENT a therapists hears “BPD” they panic. They don’t wait to see how severe it is, how the symptoms manifest, or if the person has impulsive tendencies.
I myself have BPD, however I’ve never seriously attempted suicide(only like one time in high school and it was for attention with no intention of actually killing myself), and I am VERY introspective in why I think the way I do, and why my emotions get set off. I’ve told people the feeling is like riding a bull, sometimes you get bucked off, but sometimes you can ride it, but either way it’s a wild ride. In fact, my BPD has officially been classified as in remission without actually having had years worth of treatment.
But the problem is, every time I’ve even so barely mentioned BPD to a mental health professional, they suddenly have a complete change of heart without ever even looking into me. THAT is the problem.
I don’t blame ANYONE for refusing to treat a BPD patient that is as bad as you described, and I seriously don’t think that’s the issue here. The problem is how anyone with BPD is all grouped together into a single group of non-treatable people without considering that BPD has a range of severity and symptoms manifest themselves differently in different people.
Here’s what I want you to do: I want you to start thinking about BPD in terms of BPD and “Severe BPD”. Everything you described is considered severe, and that’s the worst of the worst of the symptoms, but it is not the norm.
Part of the stigma that this article talks about is the fact that most mental health professionals only thinking about the severe cases of BPD and don’t even consider less severe cases. They just group it all together as one scary big bad and untreatable diagnosis.
Some of the darkest days of my life came from all the research I did on BPD when I first got the diagnosis. The articles and medical documents and diagnosis of BPD all had no sense of hope. Almost every single one said that I was doomed with tumultuous personal relationships, that I was hard to deal with, that it wouldn’t end, and that anyone who decided to be close to me would have to be strong willed and would end up suffering through my issues.
None of that was true. When I eventually got the diagnosis that I operate just fine, and that most of my symptoms only manifested as internal turmoil and I was able to control them enough to not let my emotions affect people around me or my life in general, I’ve been able to have many healthy relationships, and my emotions have the severity of depression and anxiety.
I’m one of the lucky ones, and I get that, but I hate it when I see mental health professionals group BPD patients altogether in one big bad thing, and discriminate against them all instead of considering it in a case by case basis. In my search for what was going on in my head, I’ve befriended and help be supportive of several people with BPD, and even dated a people with BPD as well. And I know first hand exactly how hard it is to both deal with BPD personally, and deal with others with it as well, and it IS NOT as hopeless as this stigmatization makes it seem.
I also hope others out there read this and gets some hope back from these grim outlooks on BPD. Here’s the advice I give people. Keep in mind I am not a mental health professional, and despite the topic on hand you should seek therapy and professional help and the following isn’t a substitute for professional helpt. This is just info that I’ve learned through my own struggle with BPD, and the things that helped me start living a productive life.
Your emotions are like weather, you can’t always control when they appear, but you can prepare for when they crop up and try to minimize the damage. Sometimes it’s not enough, but after the storm has passed you can always rebuild.
Know that they will crop up and prepare yourself that while your emotions are valid, they aren’t always accurate reactions to reality. Think of every time you’ve over-reacted and didn’t realize it until afterwards, and try to keep that in mind when your emotions get overwhelming.
You are the perfect person to walk yourself through it. What I did that helped me before I started therapy, is that when I was in a good mood, I wrote myself notes walking myself through an outburst. I reminded myself of reality, of how I felt after previous outbursts, and of things I was truly grateful for and afraid to leave. These were things I’d forget or skew during my outbursts. You know best what will calm you down, and if you don’t, try different things. Create a playlist that you listen to during an outburst. Pick a show you like to watch to distract yourself. Something, anything that can make you more comfortable as your ride out this emotional wave.
Eventually I didn’t need to write myself notes, and ended up being able to see the reality distortions caused by extreme emotion for what they were, distortions. That the feeling the world was falling apart was only a distortion caused by the emotions but not the reality. With that thought in mind, I was able to sit back and ride it out. It didn’t always work, and it was like riding a bull without trying to get bucked off, but it was far better than the unrestrained emotional outbursts that I struggled with.
Hope that helps someone in need.
Yes, I apologize for not being clearer in my post about the spectrum of symptoms, because there is absolutely a spectrum. I believe that you and I are arguing similar things. That’s why I said, “Not all BPD clients blow up in this way, but the ones that do are very frightening.†Even ones that don’t go quite that severe can still be frightening—when they repeatedly challenge small things you say, or get mad and start arguing with you because they misinterpreted some small thing you said, etc. It doesn’t always have to escalate to screaming and yelling and swearing to be frightening when you don’t know how to set the boundary. Those are the only BPD clients that scare me, and make me feel like I need training to learn how to address it better when those types of behaviors are occurring. I’m naturally conflict-averse, and while I have no problem with clients exhibiting or expressing strong emotions, I do struggle with it when those emotions are directed at ME in particular.
I actually have some clients who have BPD, or BPD traits, but they lack that explosive anger and reactivity, or the highly severe, risky behaviors. They have never turned their anger on me. We might have had disagreements, but the way they disagreed with me never left me feeling scared or unsafe. Honestly, the clients who have scared me in my time in the field didn’t even have a BPD diagnosis when they came to me; they only scared me because of the behaviors they exhibited once they were in my office.
That being said, what I described in my last post is absolutely, 100% at the severe end of the spectrum. Although I also agree that there are plenty of mental health professionals who hear BPD and DON’T consider that the symptoms are always, always on a continuum and that no two people with the same diagnosis are going to present exactly the same way. It’s unfair to assume that someone’s diagnostic label can tell you everything about them and how their symptoms present.
However, I also have run into people in the field—other professionals included—who have known that I have dealt with the more severe patients who make me walk on eggshells and who have been verbally abusive or intimidating. Some of them told me that while it sucks and is scary, it’s “my job†to hold that abusive behavior because I’m the “only one they have.†THAT is the attitude on the mental health side that I think is completely unfair. Therapists are people too, and we don’t deserve to be abused any more than people with BPD deserve to be stigmatized automatically, just because of the label of their diagnosis.
What it comes down to in the end though, is that I agree with you that more training needs to happen, and there needs to be a much better referral network so that people who aren’t good with this population can actually HELP them by referring them, instead of just outright refusing to see them. I also think that there needs to be more education clarifying that like all disorders, BPD is on a spectrum and that you shouldn’t automatically assume that all people with the disorder are going to have frightening or abusive behaviors. There needs to be more training and more education overall.
Thank you nice to hear this.
Therapist are hard to deal with. Most are too basic to treat complex abuse neglect and emotional invalidation. The problem is most therapists are self serving and think they’re smarter than they are. A degree doesn’t mean they aren’t ignorant or have skill. I wish they made legitimate therapists but most are just nosey unskilled prying woman. It’s a sad profession full of text book knowledge people yet no skills. I never seen such a worthless pathetic profession. They lie and make excuse to not treat their games and ignorance is a night mare. I never seen such a dumb so called profession who think they have a gift. Most therapists couldn’t walk a day in a traumatized person shoes let alone read them or know how to talk with them. Hyperbolics for insurance. Most are incompetent but they come in for an ego. Normal anger is stretched to agitation. Most act as wolf packs for their patronizing colleagues. Most waste your time to talk of themselves. Then they twist their behavior to exploit and overs psychopatholgize clients to defer responsibility. Someone needs to monitor the abuse that goes on with these odd mentality therapists. Sad.