Does DBT work if pwBPD doesn't know they have BPD?

[Littleleft]

I've posted this on the undecided board but didn't get any responses so I hope you don't mind if I post I here too:

My SO seems to have BPD. One of the psychiatrists he's been seeing says he is 'emotionally unstable by personality' and I think that's what he's saying without wanting to give the label (not just from that sentence but from other things he said too).

He's being referred to see a psychotherapist. He's not keen (which worries me) because one of the psychiatrists he's seen at the same mental health clinic is taking him off some meds (clonazepam, a benzo like Valium/diazepam). They're probably right to do that because he is using it like a crutch (as he has done with alcohol in the past - now in recovery- but continues to do with smoking weed).  He thinks only his sponsor can help him, because in his opinion his problems now are from being a dry drunk.

I think they will offer DBT, but was wondering how effective that can be if the person being treated doesn't know they have BPD and therefore doesn't realise the way in which is affects the .  Does anyone have any experience of someone having DBT when they don't realise they have BPD?

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[Olinda]

Good Question. 

I think that DBT can help most of us.  I am a firm believer in learning to be more mindful and a lot of the DBT steps. 

There is a great book suggested on this site: The High Conflict Couple by Frunzetti (sp?) and it uses DBT without using the word Borderline in the entire book.

Something to look into!

[waverider]

I've posted this on the undecided board but didn't get any responses so I hope you don't mind if I post I here too:

My SO seems to have BPD. One of the psychiatrists he's been seeing says he is 'emotionally unstable by personality' and I think that's what he's saying without wanting to give the label (not just from that sentence but from other things he said too).

He's being referred to see a psychotherapist. He's not keen (which worries me) because one of the psychiatrists he's seen at the same mental health clinic is taking him off some meds (clonazepam, a benzo like Valium/diazepam). They're probably right to do that because he is using it like a crutch (as he has done with alcohol in the past - now in recovery- but continues to do with smoking weed).  He thinks only his sponsor can help him, because in his opinion his problems now are from being a dry drunk.

I think they will offer DBT, but was wondering how effective that can be if the person being treated doesn't know they have BPD and therefore doesn't realise the way in which is affects the .  :)oes anyone have any experience of someone having DBT when they don't realise they have BPD?

The whole situation is complex with no easy answers.

Firstly in regards to taking him off those meds, yes he is using them as a crutch. Clonazepam, I believe is short term acting drug to relieve panic disorders, much like Xanax which my partner is currently being withdrawn from. Withdrawing from this will not be pretty, partly due to the usual physical withdrawal issues, but also because you are removing a crutch and so he will then not be blocking his issues.

Before any other type of therapy treatment can be effective he will have to become stable with this new "raw nerve" situation. at the same time not reaching for a new crutch. A patient needs to be ready, open and accepting of any type of therapy to be effective.

DBT will be useful for anyone suffering BPD type disorders, if he is open to to it. There is no golden one fix for one specific issues. There are many types of therapy and many hybrid ones. Non are 100% sucessful in all conditions. Different patients are more receptive to different ones. DBT was intially developed to address suicide idealization found in depressed women i believe, and has proven to be effective when applied to BPD. Possibly because BPD was often an underlying cause in suicide idealization.

This treatment if he is open to it, may be effective or it may not. There is no guarantee, but anything that sets him on an alternative path to blocking with drugs is a good thing.

You have to start somewhere

[Littleleft]

Thanks Olinda -the book sounds good, what a great idea to write a book using DBT without mentioning BPD given that a great deal of sufferers don't know they have it and wouldn't react well to being told!

Thanks waverider - it completely makes sense that they would want to take him off those meds before starting therapy, I hadn't thought of it like that.  I'm not sure if the psychiatrist put it to him like that, he won't say much about the appt because he's so annoyed they're taking him of those meds.  I would usually go to appts with him, but I'm away at the moment, and all he will say it that it was a cr*p meeting, they don't understand him and what he's going through and he walked out of the meeting.

He will still be smoking pot though even when he's off the clonazepam, so won't be completely free of any drug/crutch unfortunately.  Me and his sister have tried to talk to him about stopping that too, but he doesn't react very well to any conversations about it.

I am concerned about his attitude to the mental health clinic and the psychiatrists and therapists there too, as he doesn't see them in a very good light.  Even prior to this appt about coming off the meds, he's had bad opinions of most of the Drs there, even to the point where he called the clinic up and ranted about one of them going on about all kinds of things that aren't even relevant to their relationship. Also when I mentioned therapy the other day and asked if it was brought up in that last appt and if they'd said when he would start, he just brushed it off saying he didn't think they could help him and only his aa sponsor could help.  So I'm really concerned that his frame of mind towards the therapy will mean that he won't get the benefit from it, if he's not really open to it.  I hope I'm wrong.

As you say, you have to start somewhere, so at least getting him to start therapy would be a good thing.

[Love Is Not Enough]

Does anyone have any experience of someone having DBT when they don't realise they have BPD?

I do. It is strange situation to say the least. It is a long story, but in a nutshell my gf attacked me and my one requirement for me to remain in the rs was that she try therapy again. I gave her contact information to a T that I knew had DBT experience and then left it all up to her. Luckily she loves the T and the T also seems to be very skilled in dealing with BPD. I do not know if the T has ever told her about BPD. She diagnosed my gf with anxiety, OCD (I think) and something my gf couldn't remember (yeah, I thought it was strange too). Maybe she just did not want to tell me it was BPD. Either way I think the T is like a mother to her and does not make her feel like she is being judged at all. My gf has made a lot of progress the last few months and has started EMDR recently. I hope she continues to improve.

Two things came together in this situation that I think were crucial to make this work. My gf was ready for it and wanted to get better. Second, the T seems to be a perfect fit for her.

You are dealing with a very difficult situation because of the drugs and his distrust of of the MDs. A really good T with a ton of BPD experience would be much better than any MD IMHO. Ultimately he will have to find his way on his own. That is always the frustrating part. Good luck and I hope things improve for you soon.

[Littleleft]

Thanks Love Is Not Enough.  I'm pleased for you to hear that things are improving with your gf  . I hope they continue to get better.

I really hope the therapist he gets is one that he likes, as you've said, that's so important. But I am very concerned given his usual attitude towards the staff at his mental health clinic.

The other problem is how open he is to the therapy itself.  As he doesn't know he has BPD, he isn't aware of how it's affecting him, so I'm not sure how he can be open to getting help for something he doesn't see and understand.  He sees he has some problems but thinks it's all due to being a dry drunk, so I don't think he will realise what issues are truly there that the therapist could help with.

So my main concerns we the two aspects that were so important in contributing to your gf's improvement.  We shall soon see what happens! He has his first appt with them in a couple of weeks.

[Stalwart]

My wife was diagnosed at the same clinic she attends DBT therapy. So she is aware of the diagnosis. However never once has the diagnosis been mentioned to her by her therapist. Just being told that you have a personality disorder like your husband was should actually be enough. I think in some cases not mentioning and certainly not dwelling on related issues from the past as a result is the best approach. Nothing worse than feeling judged.

I hope this goes well for you and stay in touch.

[Littleleft]

Thanks Stalwart.  Im sure you're right that too much can be said and it will only make the pwBPD feel worse and give them more reason (in their mind and way of thinking) to fear being rejected or abandoned.

One of the psychiatrists he has seen has also said he doesn't think there's any point in looking to things in the past when he has therapy, but to look to the future and ways of coping and accepting things would be better. 

I'm keeping my fingers crossed that it goes well for him when he starts in a couple if weeks.

[an0ught]

DBT is a lot about learning healthy and useful behavior. In general DBT keeps the pwBPD in a emotionally safe space and is focused on the solution and not on the problem. This emotionally balanced and learning focus is so important due to tendency to get emotionally overexcited and the rejection sensitivity of pwBPD. The high sensitivity often renders other therapy approaches based on more direct feedback, self reflection and problem solving ineffective.

Quite a number of T's believe it is better not to tell and one reason is that other unhealthy behaviors could emerge if the pwBPD starts focusing on BPD dynamics - It stands to reason that these T's believe therapy is possible with the patient knowing. It is worth remembering that situations, patients and therapists all vary greatly.

[Love Is Not Enough]

Quite a number of T's believe it is better not to tell and one reason is that other unhealthy behaviors could emerge if the pwBPD starts focusing on BPD dynamics

I agree with this. One thing I left out before is my gf became very self-aware of how she made others feel when she was dysregulated. She finally saw how others began "walking on eggshells" and this made her feel badly. I also think this was her personal turning point when she knew something was very wrong and wanted to change it. She just did not know where to start. I think many pwBPD see this, but they just have no idea how to improve it and the disorder itself locks them into the downward spiral. I can see my gf struggling daily and I have seen first hand how difficult it has been for her to break out of the spiral. Thinking about this thread made me realize how hard she has been working and I am really proud of her progress so far.

Another aspect that I think has helped a lot is me focusing on being a better me. I have been more confident in myself and when using the tools. Stay positive and focus on your needs. Give him a role model to follow. If he really wants to improve himself then he will follow you. It a struggle, but I see a tiny bit of improvement everyday. If things do not work out then I will still have a better me if the rs ends.

Let us know how things go with his DBT.

[Stalwart]

Really good thread folks.

I really wish you the best of luck Littleleft and I hope you see even a small bit of the success my wife and I have since she started therapy and I started to learn more and how to change and adapt myself to the needs of having a mentally ill wife.

I can so agree with Love is not Enough on this statement: "Thinking about this thread made me realize how hard she has been working and I am really proud of her progress so far".

I was just sitting with my wife this morning prior to leaving for work and telling her how much I love her and how absolutely proud I am of her for the progress that she's made and how well it's affected our relationship together. She sure still struggles with not understanding why I'd stay and thinking that I'm upset still, or angry when I'm not.

I can see that she thinks about how she would feel if she were in my position and relates to me HAVING to think that way as well. So naturally it follows in her mind that I must consider her a cold, callous monster that doesn't deserve a good person as a partner after the indescretions of her past. She thinks I must consider her to have no morals or values and MUST not be able to even consider loving her. I really don't have the answer as to how to help her with her feelings of remorse except I did contact her therapist to ask her to ensure she focuses on those issues with my wife to try and help her get over it somehow. I'd say that maybe she could put it in her past but I already know that anything negative about the past is stored in a permanent folder and just doesn't seem to ge able to be closed.

There are some things I am unable to affect and that's a bit disheartening but on the whole our circumstances as so much more positive, close and endearing than they've ever been before.

I just hope you find the same progress Littleleft and find that for every bit of effort you've sacraficed putting yourself into your relationship that good comes from it all. It's a wonderful experience, but I'm still reserved in my optomism and just grateful for each good day.