Medication Issue

[Notwendy]

I read your wife's response to my post and it appears she was triggered by my suggestion that she was part of the problem. In general it is not a good idea for pwBPD to see the posts here. It's not that we intend to upset them but in the process of looking at all sides of a situation, the posts can be triggering.

Little of what I can see about your wife's distress is probably based on reality. Yet her feelings are real and feelings can feel like facts. When making a referral appointment - it is acceptable to say what the appointment is for. This happens all the time. Whenever you make an appointment- for doctor/dentist/ repairman - they are likely to ask in general what that's about. Then they will get more details at the appointment. I agree with waverider that they are not likely out to get your wife. They are probably just trying to do their job.

The "victim " perspective is something I personally think is common. If your wife feels like a victim of her doctors- then they are the ones at fault for all this. But this makes her helpless. She has a choice to go along with their treatment plan or not.

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[Akita]

Sometimes when my wife sees that other people share my perspective it helps her, other times she feels ganged up on.  This was a ganged up on response.  She has her appointment.  She is very anxious over it.  I don't know how to support her.  She had a violent response after sexual activity.  Screaming head banging crying uncontrollably.  I don't know how to help.  She has been cutting today and sneaking out windows to leave with no one knowing.  I don't know what to do.

[Notwendy]

I don't know what to do either. These are her feelings. Of course it's stressful- nobody likes the discomfort of being evaluated. People do stressful/ uncomfortable things sometimes if they want the results- getting better, a job, education. Kids learn they have to get shots to avoid catching bad diseases, study for a test to pass a class, go to the dentist. Part of their maturing is to learn to self sooth when they are distressed during things that lead to something good- and to make other decisions if something does not. This skill also includes learning boundaries- when to allow others ( like the doctor) into your privacy and when not to ( strangers, acquaintances ) .

These are skills that are not well developed in someone with BPD. Yet if they have a partner who is soothing their distress for them- they won't learn to manage it. It's hard to let someone feel their own distress. Of course- keep safety in mind- if you think she is a danger to herself or others - she needs immediate medical care (hospital) but otherwise it is her distress and we can't control someone else's feelings. I'm sure you are reassuring her that you care.

[Notwendy]

Sometimes the issue of self soothing is also with the partner. If we have trouble with boundaries- the division between what is our feelings and what is theirs is blurry. When they are distressed it is very uncomfortable. We may act as if we are helping them- but are actually relieving ourselves of our own discomfort when they are distressed.

It makes sense that we don't want to see someone we care about hurting. But this kind of codependency goes beyond that- to trying to control the other persons feelings- to "make" them feel better. But we can't control other people's feelings. We can be supportive - allow space for them to feel what they feel but to do this we need to be able to handle our own feelings too.

[Akita]

Her appointment is today.  Anxiety is high.  I didn't even mention the appointment or attempt to comfort her in any way.  I was upset that she didn't want to kiss me goodbye when I left for work.  Am I not supposed to ignore her unless she brings it up?  Shouldn't i ignore her and let her handle her own distress?

[waverider]

Her appointment is today.  Anxiety is high.  I didn't even mention the appointment or attempt to comfort her in any way.  I was upset that she didn't want to kiss me goodbye when I left for work.  Am I not supposed to ignore her unless she brings it up?  Shouldn't i ignore her and let her handle her own distress?

A hug and a smile should speak volumes.

Most likely nothing life changing is going to come of it, it will just be another of the many appointments that come and go.

[Akita]

She is back and annoyed.  The provider didn't seem to know much about her situation and was confused as to what he could do for her.  She thought he would be more knowledgeable because her current therapist sent a referral and the front office called the new provider.  She felt it was a huge waste of time as he simply asked her what medication she would like to try then he told her to research to see if she thought it would work for her side effects wise and pregnancy wise.  She felt like he was doing nothing to help her.  He seemed confused to his role in her treatment especially after he discovered they provide medication evaluation at her therapist's office.  He doesn't understand why they don't keep the treatment in house.  She tried to explain her experience with the PA but couldn't give him a good reason for why the other PA and psychiatrist won't help her.  She feels that it's due to her being labeled borderline but didn't tell the new guy that she is borderline or that she suspects that's why no one in her psychologist's office is willing to have her as a client.  She feels sad tonight.  She wants to be "normal" and is tired of feeling pulled around by her emotions.  She just wants it all to stop.  She wants to write an angry letter to the psychologist about what a waste of time her appointment was.  Not sure if I should encourage or discourage this.

[Notwendy]

It is hard to know how much of her perception is based on reality, her feelings, or the fact that once the treatment team is painted black, it is seen as inadequate no matter what.

I have heard this kind of thing many times from my BPD mother. The hospital was a "terrible place", the staff were incompetent. The doctor "abandoned" her. Yet the hospital has good ratings. The truth is probably somewhere in between "terrible" and "perfect", but with black and white thinking, those are the only two choices.

I don't have any advice for how to deal with this. People think what they think and it isn't something we can control.

It's her choice to write the letter or not. It isn't your place to encourage it or discourage it. Let her decide. Deciding when to step in or not is a lesson in dealing with co-dependency. People do have freedom to choose to do things we may not agree with. The time to step in is when their actions may lead to harm - don't let a friend hurt themselves physically, spend family money recklessly, things like that. But something like writing a letter- even if it isn't the best decision, is their choice to make. Consequences- both negative and positives, are lessons to be learned- and if we don't let people make choices, they don't learn them. Perhaps the doctors will be angry or put off by the letter, but that isn't seriously physically threatening.

[waverider]

The worse thing that can happen by her writing a letter is that the doctors get to see how her mind ticks. They wont take anything personally. If they do then they are not the right ones for her.

As Wendy says it is not your decision even if she is looking to you to validate her choices. You only need to validate that she does have choices and can express her feelings.

Many appointments will have a go nowhere feel about them. Even if it is just eliminating options and ticking off procedural steps, no matter how frustrating its just one of the steps to go through. Even if it just to put the medication issue back on the original practice, they have explored the avenue of a second opinion regardless of whether it produces any alternative answers.

With my wife's counselling I normally go with her, even though this its not usual, and its not couples counselling. The main reason is that when she goes alone she misinterprets things, always claims she is not heard. It also stops her hijacking the sessions onto some distraction issue.

I usually have to reinforce what was said afterwards rather than allowing her to believe her version... Dont know if that is an option or not, but you do have to be at a stage where you are not stuck in the blaming each other mode.

You would be surprised that what she is told is not what she tells you was said.

[Akita]

Well she sent her letter.  I think she just wants help considering the pros and cons of her situation.  Last night she went and talked with her sister about meds.  Her sister is encouraging her to at least try some.  She discussed how she had to try different meds for her migraines.  This made my wife feel slightly better.  One big hang up she has is the fact that if she is on medication then that is proof that there is something wrong with HER.  She is holding on to the fact that if people treated her better she wouldn't have these struggles.  It isn't fair that she has to change. Other people need to stop their mistreatment of her.  She has been mistreated.  I don't know what she's going to do.  The new provider seemed confused as to his role according to her and wants to discuss things with her psychologist then meet with my wife again.  She picked a med and he told her to research it to see the side effects and pregnancy implications.  She is annoyed that he told her to do this instead of just giving her the information. 

Right now her psychologist says she isn't ready for me to be included in a session with her.  I don't think she is distorting what is said.  What is an example of that from your experience?  She often says she doesn't know what to talk bout or she forgets to bring up points we've discussed and I think he needs to know about.  He told her she will know what to tell him and she will know if it's relevant and if she isn't sure she should mention it and they will decide together if it needs to be discussed.  What do you do while she talks to her therapist?  Do you just quietly listen or are you a more active part of the therapy?

[Notwendy]

One reason to see someone in therapy alone is because another person might inhibit what is said- and even if it isn't true, I think it is important for the therapist to hear their client's story.

But another part is medication and management. If someone has trouble recalling the facts, then someone else could help them keep things straight.

In the case of my mother, who is elderly, an elder care social worker can communicate with the doctor about medication, dose, side effects etc, but isn't present in the therapy. I think also it is better that this person does this than I do as it avoids the family dynamics.

BPD affects the most intimate relationships the most. So it makes sense that I am way more likely to trigger ( and be triggered by) my mother than a social worker is. So I am one of the least helpful people in this situation.

This doesn't mean it can't work with a spouse- as it has with WW, but in general the emotional aspect of this is challenging. I can tell that my mother - and possibly your wife- feels a lot of shame about this- she cares what people close to her think of her and doesn't want to think there is something wrong with her. This aspect is reduced with the social worker.

I don't know what options you have, but if there is any kind of "patient advocate" - social worker, nurse, counselor, who will not be involved in therapy but who can help with the medication management, maybe this would help.

[waverider]

An example from this week. My wife has had breast cancer and is on a course of Tamoxifen, she has had some bleeding symptoms, she went to see the oncologists. They have temporarily stopped the tablets to rule out any side effects and are doing an internal examination tomorrow and then reassessing whether to continue with this med or try something else, or if there is some other physical issue as a result of previous cancer.

My wifes take.: She has cancer again, They are going to remove her uterus tommorow and she may not wake up and is likely to die, or be told she is dying tomorrow and they have stopped the tablets because they have given up hope.

This typical of misinterpretations. So my role is to make sure that she actually hears properly what is said and can then practice what she has been advised to do, rather than just hearing her needs being denied. During the sessions the therapists directly ask me what my observations where on specific issues, in order that it doesn't go off in flights of fancy and misinformation.

However, as Wendy states you need to be past the blame game of couples counselling, you need to be completely open with each other and capable of honestly talking about the issues. I find it helpful so that i can take guidance from the therapist in my daily care of my wife,  so that everyone is on the same curriculum. My wife finds it helpful as I can provide reassurance as to what was said rather than what worst case scenarios her mind is rewriting for her. But you do have to be at the right stage of understanding for it not to be counter productive.

[Akita]

I don't know if my wife misconstrues information that badly.  I sat in for a couple of sessions and she felt ganged up on with a previous counselor.  She does see things in a negative way.  I try to explain motives but that means nothing because she is still hurt.  I have no idea how this new pill guy will be.  She has deemed him useless so far.  She sent off her letter so the psychologist would have her side of what happened with the pill guy.  Guess we will see how that works out.  We are going out of town for a week so she won't see the psychologist until the 20th.  She will have all week to think about the pill conundrum.