How to address the elephant in the room

[Violet Hope]

Hi there,

My sister has never been formally diagnosed with BPD but when reading the diagnostic criteria she meets almost every one. She has been in therapy for about 2 years and I worry her therapist is getting “conned” by her and she is not telling her therapist the full story/whole truth. I feel like we can’t make progress if we don’t actually name our concern with her. Would you all suggest telling her what we believe she is suffering with, and if so, how would you go about doing this?

Thanks.

[Notwendy]

Do you mean telling the therapist or telling your sister?

As to telling your sister, the general consensus from what I have read and what I have experienced with a BPD mother is that, telling them they have BPD is likely to backfire and not be effective.

As to telling the T, I doubt the T is able to speak to anyone else without their client's consent. I have read that therapy with a pwBPD is a challenge as they can be invested in denying and hiding their true situation, so the T may be working on other aspects- anxiety, depression, while not being able to address the BPD. The T can only help as much as the client is willing to work on.

[zachira]

I am glad that your sister is getting therapy. Do you know if her therapist is trained in DBT, the most recognized therapy for people with BPD? You could contact the therapist with your sister's permission, otherwise the therapist cannot acknowledge that your sister is her client, as this is a legal violation of confidentiality. Your sister can give two kinds of permission: one that is only one sided in which you can share with the therapist and the therapist cannot disclose anything about your sister, the other in which the therapist is allowed to disclose some of her work with your sister. How did your sister get into therapy? I hear your concerns about the therapist getting conned. I have several disordered family members, some who surely meet the criteria for a BPD diagnosis, and it is terribly frustrating how they are so charming to outsiders, and mostly only demonstrate their erratic BPD behaviors with those people who are closest to them.

[beatricex]

hi VioletHope,
I understand how incredibly painful it is to see a relative with BPD go through this, then how a family might get their hopes up once the person gets into therapy...only to find the therapy is not helping.  That is frustrating.

There are many reasons a therapist will not diagnose someone.  Including
1. Ignorance.  2. Belief that people shouldn't be "labeled"3. So the person won't get stigmatized or refused treatment by other professionals who look in the chart4. To get insurance coverage 5. So the person with BPD won't have their feelings hurt, see themselves as unloveable, use the illness as an excuse, etc. From Randi KregerThe Essential Family Guide to BPD

As far as telling your sister she likely has BPD?  I have both a mom and step daughter who are likely BPD'd and I have no desire to tell either that they have it.  I don't even want to tell someone to tell them.  I did send my step daughter some articles about Narcissitic mothers, and gently suggesting getting into therapy...  She threatened to file for harrassment.  So, in my experience telling them anything is probably not a good idea, and anyways its not our job    my job is to take care of me

   post more if you are able to

b

[Choosinghope]

Hi! Normally I hesitate from giving direct advice because every situation has so many factors. However, I strongly suggest not getting involved in your sister's therapy unless she requests it. I also suggest not telling your sister about your concerns. From personal experience, it doesn't end well, and it does more harm than good. Up until this past year, I've spent my life believing that I can "fix" my mom and that I'm responsible. Neither of those are true, and I have since transitioned to taking care of myself. And now that I've switched focus, I'm realizing that I have plenty that I need to work on! I'm sure it is frustrating watching her fool her therapist, but that isn't on you.

[Methuen]

Looking back over the years, every time I tried to talk things out rationally in a caring way with my mom, it blew up in my face.  And each time the blow up was worse than the last.  But I never felt the need to bring up BPD, and I’m glad I didnt.  I suspect that doing so could boomerang back in ways we couldn’t imagine.  Instead, I have invested a lot of time energy and therapy working on me.  I have learned tools to communicate with my mom.  I no longer have expectations of her.  I simply accept her for who she is.  I am so much happier for it.