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One of the things that's an ongoing issue with my BPD husband and me is that he agrees to go to therapy but looks for a T who deals with communication or core issues type stuff (knows he's got at least these) and then doesn't follow through (it's not the bigger part of what he needs). I believe if a T does not understand how to handle BPD they can actually do more harm than good (my experience, it has happened). The last T before we had even started got into a phone conversation with him and mentioned that I was not as interested in the marriage (was in survival mode and waiting for my Que to leave) as he had thought and this would be him alone by himself in T, very unethical and I was not too happy with her as she stepped over some lines in my opinion, if this had been a DV issue who knows what could have ensued.  Ive also seen on these boards mentioned that its best to go to T alone. In my experience he has manipulated the T who then turns the table on me and things go nowhere (they're great with the head games). So where do I proceed from here. He's in one state I'm in another looking for T what is the best solution here. I have to admit Im not very motivated to find a T due to past experience however realize what alternate is there, probably not an optimistic one! I always have to use the WE when I mention therapy due to the sensitivity and triggers this evokes in him. If I even hint at it being him without me in equal part he goes off on one. How to you steer towards a T who handles BPD, he wants us to go together which I don't mind but I refuse to waste my time with a T who does not understand this condition and knows how to treat it. How do I present this?

I think you will have to do a lot of research into the treatment of BPD.  My take on it is that BPD is one of the most difficult of all the disorders to treat.

During my research, I found this from a hand book for therapists, written by the Disability Policy and Studies office of the School of Health Professions at the University of Missouri.

Borderline Personality Disorder

The main features of this personality disorder are unstable self-image, unstable interpersonal relationships, and unstable mood.  People with this order are usually uncertain about their sexual orientation, their goals in life, the types of friends they prefer, and other aspects of self-image.  

Individuals with borderline disorder see the world as a threatening, unfriendly place. Behaviour that seems manipulative to other people, they may see as what it takes to get by or as necessary for personal survival in a dangerous world. They also may seem to live in a state of repetitive crises. They often have a history of being victims, either of some type of abuse or some type of

crime, and they view themselves as victims. However, this sense of threat and danger can be situational, which means their behaviour can also be different in different situations or in response to different stressors. Some researchers refer to this “dependency on the mood state of the moment”: the individual may be very capable of dealing with certain situations, but challenged by other situations. The individual’s medical history may show a variety of diagnoses or symptoms (depression, somatic complaints, anxiety) reflecting the variety of responses.

One of the more striking features of individuals with borderline personality is how quickly they change their opinions about someone. They tend to see individuals in absolute terms as either great or horrible and will switch from one opinion to the other quickly. They show a pattern of intense, manipulative, demanding attachment in their relationships, swiftly changing to disappointment or anger with the other person. They can be supportive and nurturing, but demand equally strong support in return. They deeply fear abandonment and may lash out angrily if when they feel dissatisfied with a relationship. One consequence of these feelings is frequent changes in doctors, counsellors and other service providers.

These individuals have difficulty controlling impulsive behaviour and may have a history of problems with debt, shoplifting, reckless driving, substance abuse, fighting, self-mutilation, and suicide attempts. The individual may also have body piercings and tattoos.

Some VR counsellors actively avoid working with individuals with borderline personality disorder because they can be so challenging and frustrating. However, experienced counsellors report that, with the right approach, it is possible to successfully provide services and find careers for people with borderline personality disorder. Counsellors who have been successful with individuals with this disorder give the following advice:

   Discuss the person and their case with your supervisor as early in the process as possible. These individuals are likely to try to manipulate the system by going over the head of the VRC, filing numerous complaints, or disrupting the office to manipulate the VRC. Having firm administrative support is crucial to maintaining control.

   Document your contacts with the individual, the things the two of you agreed upon, and the actions you have taken. This documentation will give your supervisor information with which to respond to any challenges or complaints.

   Set very clear, firm boundaries about what you will and will not do as a VR counsellor, and explain them clearly to the person. Do not become an advocate for the person beyond the role of the VR counsellor. Do not respond to their anger when you are firm about the boundaries. Eventually they will come to trust and take comfort in those boundaries, but only after testing them.

   Do not interact with the client socially or romantically. The individual may behave very friendly or seductively toward you, but involvement with any client beyond the scope of the VR relationship is both unethical and unwise.

   Expect that there will be times when the person will anger you, frustrate you, and possibly make you cry. Knowing it is likely will help you move past it when it happens.

   Try a new intervention. If possible, locate a therapist (for the person) who uses Marsha Linehan's Dialectical Behavioural Therapy approach (see below).

Treatment. Treatment of individuals with borderline disorder is always a challenge. Treatment may sometimes involve medication, but the type of medication used can vary widely depending on the individual’s situation. Individual and group therapy is a more common approach.

Recently some therapists have reported significant progress with Dialectical Behavioural Therapy (DBT). This approach was created by Marsha Linehan at the University of Washington. It proposes that individuals with borderline disorder are constantly swinging between extremes of, among other things, feeling that they must control themselves and their emotions and feeling the need to express their strong emotions to others. They also swing between seeking someone to solve problems for them and trying to appear competent at managing their life. The term “dialectical” in the name of the therapy refers to the use of these and other sets of opposing forces in framing the approach.  

DBT uses a system of structured boundaries, validation, positive and negative reinforcement, and social skills training, which is implemented in a combination of individual and group therapy settings. The goal is to help the individual better manage his or her feelings and problem-solve social situations in more adaptive ways. In addition to therapy for the individual, the therapist is engaged in his or her own DBT therapy with other therapists to help prevent burnout.

The DBT approach is getting support from many therapists and some medical schools require that all psychiatry students study it. It is unlikely that a VR counsellor will conduct DBT therapy himself or herself, but they may wish to find a therapist familiar with DBT for the individual. More information is available online at www.dbt-seattle.com.

Placement Issues. The VR counsellor needs to be aware of the “all or nothing” fluidity of the person’s attitude. The counsellor should try to be an emotional “rock” to help the person anchor the chaos of their feelings. The individual may also “muddy the water” by trying to start a personal relationship with the counsellor. It is important to maintain a clear, professional boundary. It is also important to communicate regularly with any other health care professionals involved with the individual, including doctors, therapists, and service providers. The individual may be saying different things to different professionals.  

Sometimes individuals with borderline disorder work very well in helping others who seem “worse off” than themselves. The caretaker role seems to be rewarding for them. This might include working in a retirement centre, working with individuals with mental retardation, working in a veterinary clinic, or working in an animal shelter.


Hope this helps.

MontyD

Murph33 - there is hope - Dialectical Behavioural Therapy has been known to greatly assist those with BPD. DBT has successes.

A marriage counsellor is often an invalidating environment for both you and your partner Murph33. An MC is not equipped to treat Borderlines.

Hubby needs to get into DBT and you also need some therapy - we often need to find ways to cope with our own triggers etc.

Is Hubby open to DBT? Have you enquired about DBT clinics in your area?

Hi Clearmind,

Thank you kindly for your response I found it most helpful. My husband is a high functioning BPD and very clever with a heightened sensitivity to everything going on around him. The DBT clinics seems to have direct connections to BPD and this would no doubt set him off. I have actually talked to him before about his early childhood trauma in his home of origin and connected it to present behavior patterns of his and possible development of psychotic behaviors as well as personality disorders, he was at that time very open to the possibility of seeking help for core issues and DID. He did do some type of testing with a regular counselor upon my request for DID but came up negative. I only recently linked his symptoms to BPD. So how do I approach DBT with him as he would see the connection to BPD. He is in another state from me and is not happy to go to therapy if im not involved and going to. BTW he is in pastoral counsel with someone the past 4-5 months and has gotten worse since. I have been in T for years just recently stepped back to take a break without knowing what I was dealing with only that I had symptoms of PTSD-any wonder living in a war zone in my own home!

Before I respond Murph - are you and hubby talking about reconciliation? I'm sorry I am not up on your back story.

I would imagine if you are considering reconciliation - would him seeking help be a proviso?

Hi Clearmind,

We've been married 6 years. The reason we are not together is he got orders (Military) for another state a year earlier than anticipated. The plan before he left was for my son to finish school out here (one year) and then we would go there. The plan was also that we both seek counsel and actively be involved with this. Have tried counsel in past many times and it has failed. He's presently going to pastoral counsel for regular marriage problems as in communication. In the meantime I found this forum and have for some time now began to walk out of the fog, getting the right info and gathering the right tools along the way to help me focus on me and what I need to do in the midst of all this. He's aware there is something wrong with him but thinks its core issues like anger and rejection and such. I haven't decided anything, only trying to gather my wits about me and make healthy decisions with the focus on me and my children and not him so much,

The FOG does sound like it is clearing murph. This time apart has provided you with some head space for you to really think about what it is you want for you and your son.

How do you feel the pastoral counselling is going? I would imagine you guys communicate via the phone – how does that go? Where I am heading with this is – it is was me I would need to see active change/him taking action to get better before moving across the country. What are you seeing right now?

Not necessarily... .  I know of a few MC/MFT's that are substantially better educated about BPD than many Clinical Psychologists that I work with as well as Psychiatrists.

My BPDw has been suggesting it and we are in the process of looking for a T.  I also believe that it is for her to try and get me to see her way of skewed thinking. 

Each of you need to heal and recover separate from one another.

A relationship requires both partners to be self aware of their role within the relationship.

Perhaps, but I feel that it would still be determined by the individuals and their wants and needs for therapy as well as the experience of the therapist.

Hi Clearmind,

It was a relief when he left and yes having over a year now on my own has given me ample time to clear the fog out and gather my wits. When he was here he was constantly walking out like almost every week. The pastoral counseling is I goes some type of crutch for him however I think he's gotten worse since. He says hes tried everything in his mind believes he has in my mind he hasn't. I have no intention of leaving to go there unless hes actively in therapy that is producing the results. I could not ever imagine being under the same roof for longer than 2 weeks or less. his symptoms get worse and start to really show by then and my nerves are shot lol

yes marriage counseling did nothing for us, in fact he would walk out and I'd end up continuing on my own.

Skype but mostly text is how we communicate. He prefers that as its safe (avoidance)

Murph, you have arrived at a boundary to protect you! That is good.

Maybe start to think about what improvements you need in the meantime.


Can I suggest video skype. Long distance is not easy and its even harder to gauge emotions etc.

Hi Clearmind,

Yes distance helps for sure (great instant boundary), sad but it is how it is. Ive got two kids growing up without a father, I'm working full steam ahead to get on my feet financially. I never stop working towards the goals Ive now set for myself. I cant think about this situation too much anymore as its sucked me dry for 6 years wheres there's hardly anything left. I don't know where its all going to end up. I did mention to him about the different types of therapy for BPD without mentioning the disorder and he said he was interested then has not mentioned it again. It seems the only time he will make a move is when hes in crisis mode.