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 Post subject: BPD too hard to treat?
PostPosted: Fri Sep 23, 2011 12:52 pm 
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A friend of mine in Australia is currently taking a course in which the focus is on personality disorder's and the main lecturer is doing a research project on BPD. Anyway, this lecturer has all but said that people with BPD are hopeless, treating them is an exercise in futility and we will never really get better. (Or words to that effect.)

I actually laughed out loud when I read that.

She also said that people with BPD suffer - not necessarily worse but in different ways than people with other personality disorders. (I actually kind of see the point on that one.)

What do you all think?

I know I for one think that's a big bunch of horse-hockey and that the failure in those words is from the clinician, not the patient. That said, as my friend pointed out, ANYONE who is resisting treatment is ultimately going to make therapy a futile project, not just those with BPD.

My premise is that obviously people have to WANT to get better and have to be invested in doing the hard work of rewiring their thought patterns into healthy coping techniques and strategies. I think too that clinicians can be too namby-pamby in their approach to BPD. I think many mental health issues require a delicate (especially depression, anxiety, DID, etc.) but when we're talking about BPD, I actually think that bluntness that's often avoided in conventional therapy settings is actually quite beneficial to BPD recovery work.

Thoughts? Feedback? Insights?

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 Post subject: Re: BPD too hard to treat?
PostPosted: Fri Sep 23, 2011 1:43 pm 
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I have to agree with that, I have often wished my pdoc would be more "honest" with me. I am diagnosed BP not BPD but I think it's only because I myself am not always honest with my psychiatrist. I am afraid of hospitalization. Does that make sense?


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 Post subject: Re: BPD too hard to treat?
PostPosted: Fri Sep 23, 2011 5:26 pm 
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Ash, I agree with you -- that lecturer is misinformed or misguided or mis-something.

There are most certainly people with BPD who are relentlessly manipulative and difficult, but I'm convinced that there are people like that who don't have BPD -- perhaps they have a different PD, or maybe they're just plain obnoxious. And then there are people who enter therapy with no real intent to commit to it and really work, and that, again, could be true of anybody with any kind of mental/emotional problem. (full disclosure: I did this for years, sometimes because I knew I'd be moving so there was no point in really digging in with a therapist I'd be leaving, but most often because I was just plain afraid to confront my demons, so I'd circle the truth and avoid "coming clean" about the depth of my issues. My current therapist was quite quick to pick up on this, and wouldn't let me get away with it. I thought she might terminate me on a few occasions because I know I frustrated her, but we've hung in there together.)

I think therapists are justified in giving up on, or "firing," a patient who clearly is not going to cooperate, but I also think there are a bunch of therapists out there who are way too quick to pull the plug, perhaps being familiar with the "truth" that BPD patients are "impossible" and therefore being totally predisposed to judging them that way, or perhaps because they just aren't very good therapists to begin with -- maybe no self-confidence, or general lack of experience, or they're pursuing a vocation that they just don't belong in. (Side note: I got into a very weird sort of verbal sparring match this summer with a guy who claimed he was a child psychiatrist -- apparently not practicing now, according to the mutual friend whose party we were attending -- and who had extremely strange views about how parents, schools, and clubs "indoctrinate" children and warp their minds. It scares me half to death thinking about the damage he might have done to his patients and their families if that was his attitude going into treating them. He most definitely should NOT have been practicing psychiatry.)

Regardless of the role the skills or judgment of the therapist, though, nobody is going to get better unless they really want to and are truly committed to whatever program of therapy they get into. And I do believe that change can be so difficult, and the whole idea of it so frightening, to people with severe BPD that they just aren't able to do that, at least in the beginning. It's not merely a matter of finding a good medication, or adjusting to altered life circumstances, but having to basically relearn your total world-view, your most basic patterns of thinking, and all your coping mechanisms. That's pretty daunting stuff, so maybe it's no wonder that it's scary and hard enough that a lot of people fail in at least their first few attempts at therapy.

Martha, I hope you'll eventually get to a point where you trust your psychiatrist and/or therapist enough to be fully honest with them. If hiding the truth -- therefore avoiding dealing with fixing it -- keeps you unwell and unstable, you're more likely, in my opinion, to eventually need hospitalization than if you bite the bullet, 'fess up, and really work on getting better. Hospitalization generally only happens if you're considered to be a danger to yourself or others -- are you either of those things? If not, then don't worry so much about it. If you were in the past, but can show that you aren't now and are really working on getting better, you should be OK.

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 Post subject: Re: BPD too hard to treat?
PostPosted: Sat Sep 24, 2011 9:16 am 
When I was feeling funky and really hopeless about myself, I remember sitting in my therapist's office, snorting and sniffling and asked "Am I hopeless? Is there a point to this?"

We talked about the stigma surrounding BPD, and recovery. We talked about the mental health professionals who refuse to treat those with BPD. It was of her personal opinion, that therapists who throw their hands up in the air and say "That's it. There's nothing I can do here, BPD is not treatable.", are neglecting to incorporate different treatments. My T was pretty unconventional, in some aspects. We incorporated ALL different approaches in therapy, finding what worked and what didn't.

We also talked about some people's resistance to treatment. You have to factor in a few things here - You have patients coming in for no other reason than to appease their partner, agreeing to therapy to avoid 'abandonment'. In many cases, there is no true self-motivation there and there's a lot of denial. In that case, and a few different others, therapy is sort of null and void as the person isn't there, being really serious and dedicated about getting better. That really goes for anyone, though, regardless of diagnosis.

I would agree, too, that delicacy has had a relatively minor role in my recovery. I've asked my T on several occasions in the past to just "tell me like it is". She was hesitant in this approach initially, but it was so necessary for me to build a thicker skin, to learn how to receive constructive criticism and take an objective look at myself. Not to say I didn't storm out of the office in the past, I sure did. lol.


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 Post subject: Re: BPD too hard to treat?
PostPosted: Sun Sep 25, 2011 5:28 pm 
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Goof thoughts and feedback, people - thanks. I know that sometimes my blunt/abrasive style can be "a bit much" for some people so it's nice to hear that others feel there can be a bit too sugar-coating or "blank slate" style/approach of clinicians. I don't know that folks with BPD are necessarily 'tougher' than the average patient, per se, but I suppose it's possible. After all, we deal with cataclysmic rejection and abandonment pretty much all the time, right?! What's a few honest words from a therapist in comparison to that. Heh.

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 Post subject: Re: BPD too hard to treat?
PostPosted: Sat Oct 01, 2011 4:00 pm 
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I once had a wonderful therapist gently refuse to treat me. He said that his office was more equipped to deal with "the 'oh, my boyfriend broke up with me right before finals' kind of issues." Maybe some of these professionals are afraid to commit to the kind of therapy that a serious psychiatric illness warrants, maybe some of them have been unsuccessful in helping a borderline patient and got a bruised ego about it, so they take a patient-blaming approach.

I had a therapist who was too easy on me, and nothing ever happened. I could usually turn it around so that we were talking about his personal life instead of mine.

I had a therapist who had trouble seeing past the diagnosis. I think she was trying to push my buttons to get a reaction from me (hard to do if we aren't close), see what my triggers are, etc. She was a little too "blunt" with me--calling me a slut, pushing for me to forfeit custody of my children, trying to make me admit that any interpersonal problems I had were totally my fault. I didn't trust her, and it took me a long time to trust my own judgement about situations with people after all the "responsibility" she talked me into taking.

I had a psychiatrist who just couldn't admit that she was wrong, after she diagnosed me with Bipolar 1. At my last visit, when I told her I was going to do therapy instead of medication, she told me she hoped I came to my senses before I got seriously hurt. I'm fine.

I had a psychiatrist who thought enough Xanax would cure ANYTHING. My brother still sees him, he's up to 180 .5s a month.

I had a psychiatrist who wouldn't really diagnose me. Every test she did was inconclusive, every problem I had was provisional, generalized or not otherwise specified.

I had a great therapist who, while he didn't really have a specialty, tended to have patients who were court ordered to attend. He's the one who finally got through to me. He really made it a point to make me do the work--journaling, mood charts, homework, stuff like that. By concentrating on dealing with learned helplessness and just trying to keep my other problems below crisis levels, I've made a lot of progress.

I guess my point with all this is that there are a lot of different schools of thought, a lot of attitudes and approaches. Some of these people are really dedicated to helping people, and some are making several hundred dollars an hour doing med checks and that's all they really care about.


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 Post subject: Re: BPD too hard to treat?
PostPosted: Sun Oct 02, 2011 4:09 pm 
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I also had similar experiences with therapists, Anna Nicole -- some were too gentle, some too brutal, some too interested solely in meds. I actually gave up on therapy and meds for a time because of so many unproductive encounters.

I think there's also something to be said for a patient being ready for therapy. Looking back, I'd hazard a guess that the therapist I categorized as "too brutal" was probably no more blunt or direct than the therapist who actually made all the difference in the world to me.

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 Post subject: Re: BPD too hard to treat?
PostPosted: Tue Nov 08, 2011 4:17 pm 
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And this subject about sums up my fears. I want to recover, and I do do the steps, it just feels futile. The stigma is terrifying for me. The lack of interest in the mental health field is simply numbing. I dunno. Most of u have been conscious of BPD and well on the road, my experience these months have not been very positive.


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 Post subject: Re: BPD too hard to treat?
PostPosted: Fri Nov 11, 2011 1:33 pm 
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Stranjer,

If it helps any, it seems to me (at least in my limited exposure & here in the USA) that the stigma is centralized to mental health professionals. Not all of them, mind you. There are a fair number of MH professionals committed to DBT, CBT and working with borderline personality disorder patients. We haven't been completely written off, I have to believe that. The stigma doesn't seem to leak out into the regular world that much. It's true that a number of television shows tend to throw "BPD" around when speaking of a heinous crime or awful offender but for the most part, when you mention to a regular person on the street or in the supermarket the phrase "borderline personality disorder" they just tend to look at you blankly. They have no concept of what BPD actually is. Schizophrenia is easily categorized, as is manic-depression (bi-polar) or multiple personality disorder (dissociative identity) but borderline just makes no sense to the general public.

In that context, it seems that the only hurdle to recovery is either believing in one's own committment to recovery work solo or persisting in the search for a competent, willing mental health professional for the journey.

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 Post subject: Re: BPD too hard to treat?
PostPosted: Tue Nov 15, 2011 7:11 am 
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Pss that lecturer sounds like an A hole. It is possible to overcome BPD for sure! It just takes a lot of work on the person with the BPD's part. I often tell myself because I procrastinate and am lazy and don't do the exercises I need to to get to my best self. I have to work! And stop being lazy!! If you really want something you will get it! Especially if you put the work into it. I don't know about other people with BPD but I tend to give up on things that don't come easy. Like if I have to work for it and it becomes difficult I have a tendency to just give up and forget the whole thing. Which brings me right back to my starting point. Meds can only do so much! I have less outbursts and anger when I'm on my meds but that dosent mean I don't have anger and outbursts. I do! They are less frequent but in order to stop them I need to step up, and help myself even if it's hard!!


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 Post subject: Re: BPD too hard to treat?
PostPosted: Mon Nov 28, 2011 7:33 am 
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Hi! I really relate to a lot of different points here. I was diagnosed with Bipolar at age 17 after a manic/psychotic episode and the diagnosis stuck for almost 20 years! -- even though I had some of the classic signs of BPD almost right from the beginning. For instance, I started self harming at 17 and had severe over attachment/abandonment issues. For instance at 19 I self harmed after getting impulsively way overattached to a young counselor at the dorm I was in, and then her leaving after only about a week of knowing her....I think, because of my tendency to have transient psychotic episodes (I've had 3) - which is actually a BPD trait - I've been wrongly diagnosed. Anyways, I am finally full accepting my Borderline Personality Disorder diagnosis 20 years after my symptoms began - and what a pity. I wish I had access this diagnosis earlier. I am being seen by a highly skilled, highly experienced psychoanayst, and with regard to this topic - he says that BPD is a very promising diagnosis - because it is entirely curable!! Bipolar, DID, Schizophrenia can be more problematic, but BPD, while very painful - with work and the right therapy - we can all get well with Gód's help.
Wishing everyone here a speedy and complete recovery, MorningStar


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