BPDFamily.com

My BPD husband is currently in once/week psychodynamic therapy.

I think he is in dire need of medication and DBT.  He has major anxiety issues and chronic insomnia on top of his BPD symptoms.

I tried calling his therapist (with his permission) to discuss the fact that I think he has BPD (I don't think she has diagnosed him this way, as he is fairly high functioning) and discuss other therapies.  She said she has a rule against discussing a patient's diagnosis or treatment unless the patient is present.

My husband said if I had a question for her, I can tell him and he will ask her.

He is seeing her TONIGHT.

I wrote a letter outlining what I see as his symptoms and I basically just listed all of the DSM IV criteria for BPD (he exhibits every symptom), so that hopefully it will be obvious to her what I am saying.  And I asked her if she can use her expertise to think about whether there are other treatments that would be appropriate for him.

I'm afraid to just write "my husband has BPD and needs medication and DBT, talk to him about it!" because I want her to be able to read the letter to him and be transparent, but I feel kind of passive aggressive writing in code.

I'm just afraid that if I am direct and say straight out to my husband (even through his therapist) that he has BPD and needs medication and DBT that he will lose it.  I feel like he will obsess over the "diagnosis" I have given him and tell me I am putting him in a box and treating him like he is the problem and he won't get additional treatment just to stick it to me.  Or, he will agree to treatment, but constantly tell me that it is not working and that he is doing everything for me and I do nothing for him.

Thoughts?

I feel like I want to scream this out to the world, but I feel like I can't tell anyone.  Can't tell our families, because it would be embarrassing and my family would tell me to leave him and would think less of him.  Can't tell our friends, because they would not understand and might judge him.  Can't tell him, because he wouldn't take it the right way.

Help!

My experience with talking with W's therapist backfired.  I don't regret talking to her therapist, because even in hindsight my reasoning was sound - my wife had attempted suicide and I was thinking of leaving the r/s.  I was simply wanting to give T the heads up.  T sold W I had called, and W exploded over this.

Interestingly, I took W to her T last Thursday because she was feeling suicidal.  Both W and T wanted me to sit in on the session. 

Also last Monday in my group trauma therapy, I shared how stressful the past week had been because of my wife's suicide talk.  The two Ts in the group suggested I look into petitioning my wife for hospitalization... .

It's a tough road.  Obviously you want to help him, but getting involved will be taxing on you, and stands a good chance of making things worse in the short term.

Hi tm

where I am there is a very deep stigma around the diagnosis of BPD.   Even other neuro atypical patients tend to look down on and ridicule the BPD sufferer.   In some places this is changing.   It hasn't reached where I am yet.

There are other more complicated reasons why a therapist might hesitate to give a diagnosis of BPD.  They are nicely summarized in this link.   One of the very good reasons is that once the diagnosis is given it can act as 'permission' for the sufferer to act further out of control.   

Why are therapists hesitant to give a BPD diagnosis? (https://bpdfamily.com/message_board/index.php?topic=68149.0)

telling some one that they have any serious mental disorder can be a risky thing to do.   my partner is diagnosed Bipolar 1 and EDD (BPD).   She is fairly comfortable discussing the Bipolar.   The emotional dsyregulation not so much.   She will never use the term BPD, it is shameful for her, and so neither do I.   We discuss symptoms and concentrate on improvements. 

PERSPECTIVES: Telling someone that you think they have BPD (https://bpdfamily.com/message_board/index.php?topic=76633.0)

Unfortunately it takes time for a therapist to develop a relationship with a patient, and for progress to happen.   That can be difficult to hear when crisis after crisis is going on.   

How are you doing?   Are you taking care of yourself?  Eating?  Sleeping?   I understand that with all the focus on him it's easy to over look your needs.   

'ducks

Many Ts are very wary to make a call of BPD due the stigma, a bad reception by the client and insurance often doesn't cover BPD.  Even if they suspect they may call it mdd or ptsd which a BPD  can better accept.  They frequently leave that formal BPD call to Drs.  Your husband's Ts response to you is something I've heard many times before.  You can share information with his T unsolicited, but the T will likely share it with him.  If you do want to share, just describe some of the behaviors you described in your posts, like face punching, throwing self down stairs and others, that you're scared,  and how should you deal with them and not mention BPD.  The T might not be hearing that stuff from him and could cause them to discuss. This has worked for me and seemed to get the T alittle sacred too that she misjudged her client and the risk her client was in.  It opened alittle more communIcation, I saw alittle more action and now BPD is discussed.  It took awhile though.

You absolutely should not ever ever ever talk to another person's therapist.  I can cite 300 reasons for this and on top of the list is that it breaks the trust that the doctor is trying to establish with the patient.  (The Federal rights to privacy are another issue too.)  Think about this from the doctor's perspective.  The doctor does not know you from Adam.  You may be the one with the problems, not the patient.  You may be the one who is projecting.  You may be the one who is dysregulated and abusive.

The doctor patient relationship is sacrosanct.  Your well intentioned intervention will do nothing but violate it.

The doctor will be able to assess the situation without your help.

Your attempts to tell the doctor just help you alleviate your own anxiety... .for that purpose, use us.  Come here and talk to us... .and rant, and rage and argue and get mad... .we are the safer outlet.

YES.  For sure.  If you are wanting to steer the sessions in any way or encourage the T - best to not get involved.  The only reason I got involved was NOT to discuss my wife's diagnosis or treatment, but to let the T know wife was in the hospital.  T then asked how I was doing, and I said that I was considering ending the r/s. 

If I listened to that advice my wife would be dead and my kids would be orphans.  My wife has the proper diagnosis and is in DBT now. So I guess it accomplished alot more than screwing around like the previous few years.  No apologies here.  I wouldn't waste to much time worrying about violating Federal privacy rights or the sacrosanct doctor patient relationship if there is a safety issue involved.  I never got the feeling a T or Dr viewed our marriage as sacrosanct. 

Let me first say that I feel typical therapy, especially psychodynamic therapy, and DBT therapy for the treatment of BPD are two different things.  With regards to typical therapy, I think what pallav stated is true.

What I have realized lately, is that BPD cannot be effectively treated in a bubble.  Individual therapy, with no involvement with the patients closest support system, is going to be very ineffective.  How can a therapist treat a patient whose traits often involve minimization, blaming, projecting, lying, and manipulation without observing, or discussing, their interactions with others?  Please do not think therapists are “that good” that they can pick up on these things all by themselves.  They are not that good and there are far too many bad, or inexperienced, therapists out there who have too much pride and arrogance to admit when they are in over their head.

As I mentioned in a previous post, when we meet with out couple’s therapist, her DBT therapist comes in the room as well.  If I start getting “sucked in” by her, admittedly suttle at times, manipulation, she chimes in and points it out.  She reminds my wife how to be more mindful and reminds me how to look for the warning signs that I am being sucked in, and how to better respond.  I have gotten more out of this method of treatment than any book I have ever read.  All four of us have gotten more from this method than we ever would have using the “vacuum” approach of not involving everyone.  Keep in mind this method requires all parties involved to accept the BPD traits are present, even if not the diagnosis.

IMO, if the therapist is not willing to consider the diagnosis and not willing to involve you, treatment progress will be stagnant, if not do more harm than good altogether(if only I could get those years back).  That said, if they are not willing to consider BPD or involve you, you can only change you.  What are you willing to do about it?  In my situation, I had to detach and move out for me.  After moving out, my wife was suddenly willing to look at herself, which is still just step one.  If she had not been willing to look at herself, which would have never happened if I just kept repeating the same behaviors(threats to leave, demands, ultimatums, etc.) then I still would have been better off than before.  We would not be together, but I would be better off.

... .

teepay, I agree with you in that when there is a life-threatening emergency, the situation changes.  Then it is your duty to notify the doctor.  The doctor can not only intervene immediately as needed but also use the information for a proper diagnosis and treatment.

I meant contact in a different way, to tell the doctor what we know, rather than letting the doctor formulate his/her own judgement.

Sorry, when you wrote "You should absolutely not ever, ever , ever talk to another person's T", I interpreted that as meaning "You should absolutely not ever, ever, ever talk to another person's T".  I didn't realize by that statement you actually meant that sometimes it is okay and a duty to talk to another person's T.

Hope12345, you hit the nail right on the head.  Awesome set up you got there.

babyducks has it right, in my opinion. I am not a mental health expert. I am told that many mental health professionals simply don't want to tx BPD patients for a variety of reasons. BPD is complicated and challenging, and I am told that some T's simply don't have the training or qualifications to deal with a BPD. In a private session with my BPDs's T, I raised the issue. The T had kind of a blank stare. The T just coddled her. Nothing ever came of it. I can't imagine my BPDw ever being diagnosed. If diagnosed, I can't imagine her being open to TX. My guess is that she would find another therapist. When in therapy, she says all the right stuff and they are "making progress". I suspect they spend most of her time in therapy talking about how to deal with me, an insensitive, uncaring man who just hides in his cave when she wants to be "engaged", which the T thinks means emotionally attached to me but I know engaged means in battle. It is a very difficult situation.