Borderline Personality

Over the years I have worked a lot with persons who have been diagnosed with Borderline Personality Disorder (BPD). I genuinely enjoy working with folks who are diagnosed BPD. It can be challenging and frustrating at times, but when there is success, the rewards are great. In my experience there is often success. It just takes awhile. It is kinda like gardening.

There is some stigma associated with the diagnosis of BPD which I personally find to be reprehensible.  A lot of practitioners tend to blame or shame the BPD person when there are rough spots in therapy or when the client gets worse instead of better. Some clinicians refuse to work with BPD folks. I think such clinicians need some therapy or at a minimum supervision!

I was fortunate to be trained by some really good clinicians who let me know that blaming my client for treatment failures is a clear sign that I have some personal issues that need to be worked out before I can be an excellent therapist. I had to really accept that I am human, I can fail, I can perform poorly or unwisely, and in the wrong situation my failure might end in someone’s death.

And, of course, the opposite is true as well. (That’s the Dialectic  part of Dialectical Behavior Therapy). Sometimes I can be superb as a therapist and my client self destructs anyway. I have had to accept that I can only do so much- I cannot control anything other than what I say and do when we are in therapy.

Thus, I have had to both accept my limits and accept full responsibility for my actions as a therapist.  And working with people diagnosed with BPD has forced me to progress in acceptance more than anything else I have done.

Another way to say it is that it has helped me deepen my humility, which, in return, deepens my compassion for my clients whatever the diagnosis may be.

I repeatedly tell my BPD folks that I have never seen anyone fail to make progress when they persist in their efforts to heal. I have, however, seen BPD folks unable to persist, and sometimes that has been fatal. When that happens I have to take a serious look at how I might have had some responsibility for my client’s inability to stay on a path toward healing.

What seems to happen between my client and me is that if we can connect, if we can build trust, progress usually happens. It takes a few visits to create the trust and a few more visits to notice some progress.

Unfortunately progress does not always happen. Sometimes there are external situations that interfere. For example, at times my client’s life is so turbulent that there is not enough stability to remain in therapy.  At other times there is just some sort of awkwardness that doesn’t get resolved, and a good working relationship is not created between us.  I am disappointed when that happens, but I don’t really see it as a failure. Not everyone fits with everyone else. At times it just cannot be helped.

Often BPD folks are misdiagnosed for many years. Sometimes they are are told so many different things by so many different healthcare providers that it becomes a confusing, snarled mess that is difficult to untangle. I have had numerous clients who were almost obsessed with the diagnosis- they really wanted to know “if they were Borderline or not”.

Some common things BPD people get diagnosed (sometimes correctly) are things like Bipolar Disorder, Antisocial, Depression, Panic, Anxiety, PTSD, Oppositional, Schizoaffective, etc etc. That list usually means that by the time they get to my office, there have been a lot of meds tried and a lot of labels applied. Untangling this disarray is its own problem!

In addition to working directly with people diagnosed with BPD, I also work with family members or others who are in a relationship with someone diagnosed with BPD- usually a spouse or a child. Often there is a need for marital counseling, family therapy, etc.

I can do work with persons diagnosed with BPD or their family members in my office, on the phone, or using instant messaging or chat. Face-to-face in the office is much better but if you can’t come to my office or go to anyone else’s office, working via the internet or the phone is much better than nothing.

My approach is integrative- I use a lot of strategies from Dialectical Behavior Therapy , Acceptance and Commitment Therapy, Jungian shadow work, and traditional talk therapy. And I often make recommendations for healthy living like a sensible diet or exercise program. An unbalanced body leads to an unbalanced mind.

If you think that  you or a loved one has BPD- please listen to this: There is Hope. A diagnosis of Borderline Personality Disorder is not a prison sentence.  A diagnosis of BPD simply indicates that certain issues are probably going to be prominent in psychotherapy. Issues like relationships, boundaries, abandonment, self destructive behaviors, impulsiveness, depression, addictions, and more.

It sounds like a lot to deal with.  But if we take it slowly, one day at a time, with a healthy dose of compassion, and we are guided by wisdom and patience, progress almost always happens.

Make the effort- you are worth it.

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