I Was Diagnosed With Borderline Personality Disorder ...
Question: I was diagnosed with borderline personality disorder and when I read the book 'I hate you don't leave me' about BPD, I saw that it described me and my relationships, including with therapists. This has been a big problem and now I have found a therapist who seems to understand it. Is there any hard evidence that self-psychology can treat a person like me who agrees with this diagnosis even though I am out of control at times?
Answer (1) It is not the therapy that treats you, but the therapist. So, what is hard evidence with regard to treatment for borderline personality disorder? If you are gradually becoming less at the mercy of your emotions, then this is a possible indication that the therapy is working. Don't expect a quick fix, but rather a rollercoaster ride. If your therapist is trained and experienced in treating BPD, s/he will be used to this. BPD is a confronting diagnosis for many people, but once accepted, with "good therapy", (possibly more than once a week) you may find your life transformed.
Answer provided by Dr Wendy Sinclair
Answer (2) I Hate You, Don't Leave Me is an excellent book and covers the main issues surrounding BPD in great detail. Though of course there can be no guarantees, I can tell you that self psychology is certainly one method of treatment that seems to have some success in the hands of a competent practitioner. If you already feel understood by your prospective therapist, then this is always a good starting point. Being out of control from time to time, is often part and parcel of the condition and I'm sure he / she will understand this. I'm sure you know that you have ahead of you, a very long and hard road to recovery, where patience and perseverance will be of the utmost importance. I wish you well and admire your courage.
Answer provided by David White, Psychotherapist
Answer (3) Your question reminded me of a client I saw some years back who also loved that book and gave it to close friends and lovers to help them deal with her sudden, unpredictable mood swings. She saw me for over eleven years and I assume having not heard from her for a while, that she is doing well. Let me call her Celeste. Celeste came each week for the first year or so and at other times I would not hear from her for months. Then she would come a number of times in short succession during the absolutely worst storms, until they passed. At her most out of control, her most vulnerable, it was almost always about believing her personality, her essential self her very existence was irretrievably dissolving. It could be set off with work, family of origin, ill health or with her partner. Nothing anyone could say or do could convince Celeste otherwise. It was also one of the reasons why she couldn't tolerate anti-depressant medication because her experience of it's emotional effect was of her disappearing down a black hole from which she feared she would never come out.
I felt incredible tenderness toward Celeste during these times as if I was witnessing the death of a self, of a tiny little, flickering light so exquisitely vulnerable and yet in one who lashed out in desperation as if in the throws of death. Thereby creating the very abandonment she most feared. During these times I found myself acting as the memory of Celeste. I would calmly recount when and how she had been here before, what she said, felt and did about it, what worked and what didn't and how it turned out in the end. I would describe her experience in concrete, down to earth terms that enumerated specific, achievable steps that she could take to her recovery. At another level, Celeste relied on me to remember her. She depended on my having a memory of her when she was being engulfed. She feared that I might die and with me, the only believable memory of her would cease.
When I made mistakes, like not returning her phone call within the week she rang for an appointment, Celeste became convinced I was dead and began to give up hope of her survival. These experiences of invalidation, a kind of existential abandonment were profound and ineffable. I think it would test to the limit just about anyone's resources. The experiences of neglect and abandonment told by survivors of the recent tsunami and hurricanes who are left in effect, to rot in hell report not dissimilar experiences of an annihilating helpless fear of psychic dissolution even before they consider the likelihood of physical death. Some throw themselves to their death unable to tolerate abandonment.
Those who identify with the diagnosis of BPD are, to me, the warriors of the frightening underside of our brain's fragile grip on itself. Try an experiment of holding your breath till your heart starts to pound and your face goes red (long, long before you go blue) and you get this desperation to breathe and hold that a bit longer to get a sense of how vulnerable we are and how dependent our sense of self is on breath. That feeling is a one dimensional fraction of what those with BPD have to manage, multi dimensionally, during their worst times. The therapist is more significant than the therapeutic system they adhere to, be it self-psychology or dialectical behavior therapy or the integrative therapy I myself practice.
Celeste worked with a number of therapists, sent by her parents as an 'acting out' adolescent and as an adult, and most contributed to her learning, even though some ended prematurely. Healing takes time and the comprehension, boundaries and skill of the therapists. It probably costs about as much as a new car. But as for 'hard evidence', I would rather recommend the experiences of others than the double blind studies, so often paid for by pharmaceutical companies. Celeste and her partner found significant evidence and support from the international bpd resources site and the Australian site. Some of the non-live chat rooms such as this one proved invaluable to them during critical episodes.
Answer provided by Peter Fox, Clinical Psychologist
