BPD and Therapy?

[Harlygirl]

I recently came across some information that reflects on the prognosis for those pwBPD in therapy... .that suggests that because the disorder, and it's associated behaviors,  is... at it's core... .the manifestation of a victimized individual's desperate attempts to survive by learning how to MIRROR (pretend) to sustain a relationship... .that in therapy they learn what is expected of them in a Relationship... .through the therapist... .and MODEL (pretend to engage in)the healthy coping skills being taught to them... .without ever really engaging in the healthy coping skills? ... .In essence... .even in therapy... .they continue to "fake it to make it" ... .by TALKING about what is expected of them... .essentially just telling us what we want to hear.   So they continue to "talk the talk"... .Not "walk the walk".    Any thoughts ?

[Aussie JJ]

Harly,

This isn't true, just as we work with our therapists individually (those of us that have them) our progress it measured by our willingness to open up, be honest and change our thought processes and behaviours.  You can lead a horse to water but you cant make it drink... .

Psychologists with a problem such as BPD concentrate on the behaviours first and foremost.  IE: cutting, impulsive spending, impulsive eating, drinking. 

Change those behaviours that are doing the damage and the process around those behaviours.  Remember low emotional maturity, so you are teaching the pwBPD that to drink and get drunk the reaction is XYZ.  This is why it is bad for us.  To run up a debt on a credit card this is why it is bad for us, choice about action and consequence.  They have no insight, teaches them to think of the consequences to these actions. 

To work through the thought patterns is something entirely different.  Now mindfulness and radical acceptance (DBT) teaches the pwBPD to accept the thoughts, concentrate on reality and make a decision based on a taught set of values.  It still isn't changing the thought patterns, it suppresses them as long as the pwBPD is practising those skills and teaches them a set of socially acceptable responses. 

To change the thought processes is very different all together, some therapy's such as schema work on the different 'moods' and the behaviours in these moods.  remember they go from hot/cold/manic almost instantly.  It isn't pleasant for them.  Working through these different schemas changes the behaviours in these moods and also allows the pwBPD to regulate between the different moods a bit better.  In time, in theory... .all moods are balanced and their is only one mood, a sense of self is achieved through stability in mood and behaviours. 

TFP focusses on the thought processes and changing the polar opposite thought processes.  This is all good all bad (objectification) that occurs.  This is the only form of therapy that focuses on the thought processes and changing the objectification in these thought processes from all bad / all good.  Again, a painful process for the pwBPD. 

Mindfulness based therapy, ACT therapy all of them work to a certain extent.  Every person is different, every person with BPD is different.  My ex had more engulfment issues than abandonment issues.  I can see this now in a big way with what I have learnt.  How do i think this would effect therapy, she would become engulfed, a feeling of being controlled to much, loosing control, therapist was overwhelming them, making changes too quickly.  At that point, being unable to control the therapy she would then step back and go into abandonment mode, run away form it.  Now the therapist isn't going to cross that professional boundary and call her up to validate her to come back, therapy ends. 

It's a shocking cycle for a professional to deal with. 

The level of change that a pwBPD has is entirely dependant on their willingness to work through the pain associated with those thought processes.  A lot of psychologists don't tell there clients they have BPD or will label it as bi-polar or anxiety and treat them with DBT to fix those issues or some aspects of DBT.  Everyone has anxiety etc, to tell a person with BPD that they have BPD is a very confronting thing, they have no self awareness.  A personality disorder is also a fault with your very make up, quite confronting, kicks in the shame feelings.  These are very dangerous.  It is healthier for the psychologist or treating practitioner to treat the behaviours, this keeps the pwBPD coming back to therapy and lets those destructive behaviours be changed, validate them so they feel good and work slowly on the behaviours.  This builds up self awareness and in time the pwBPD may be aware of these issues and it can be opened up.  This I don't believe is often, as this self awareness builds, the pwBPD gets engulfed, abandonment behaviour kick's in and boom therapy ends. 

Trust me, if a pwBPD is in therapy and working through those issues and acknowledges that they have BPD, they have my respect no matter what therapy they are doing.  That pain for my ex meant she was in the fetal position on the floor unable to respond to anything, uncontrollable agony. 

[AG]

Harly,

This isn't true, just as we work with our therapists individually (those of us that have them) our progress it measured by our willingness to open up, be honest and change our thought processes and behaviours.  You can lead a horse to water but you cant make it drink... .

Psychologists with a problem such as BPD concentrate on the behaviours first and foremost.  IE: cutting, impulsive spending, impulsive eating, drinking. 

Change those behaviours that are doing the damage and the process around those behaviours.  Remember low emotional maturity, so you are teaching the pwBPD that to drink and get drunk the reaction is XYZ.  This is why it is bad for us.  To run up a debt on a credit card this is why it is bad for us, choice about action and consequence.  They have no insight, teaches them to think of the consequences to these actions. 

To work through the thought patterns is something entirely different.  Now mindfulness and radical acceptance (DBT) teaches the pwBPD to accept the thoughts, concentrate on reality and make a decision based on a taught set of values.  It still isn't changing the thought patterns, it suppresses them as long as the pwBPD is practising those skills and teaches them a set of socially acceptable responses. 

To change the thought processes is very different all together, some therapy's such as schema work on the different 'moods' and the behaviours in these moods.  remember they go from hot/cold/manic almost instantly.  It isn't pleasant for them.  Working through these different schemas changes the behaviours in these moods and also allows the pwBPD to regulate between the different moods a bit better.  In time, in theory... .all moods are balanced and their is only one mood, a sense of self is achieved through stability in mood and behaviours. 

TFP focusses on the thought processes and changing the polar opposite thought processes.  This is all good all bad (objectification) that occurs.  This is the only form of therapy that focuses on the thought processes and changing the objectification in these thought processes from all bad / all good.  Again, a painful process for the pwBPD. 

Mindfulness based therapy, ACT therapy all of them work to a certain extent.  Every person is different, every person with BPD is different.  My ex had more engulfment issues than abandonment issues.  I can see this now in a big way with what I have learnt.  How do i think this would effect therapy, she would become engulfed, a feeling of being controlled to much, loosing control, therapist was overwhelming them, making changes too quickly.  At that point, being unable to control the therapy she would then step back and go into abandonment mode, run away form it.  Now the therapist isn't going to cross that professional boundary and call her up to validate her to come back, therapy ends. 

It's a shocking cycle for a professional to deal with. 

The level of change that a pwBPD has is entirely dependant on their willingness to work through the pain associated with those thought processes.  A lot of psychologists don't tell there clients they have BPD or will label it as bi-polar or anxiety and treat them with DBT to fix those issues or some aspects of DBT.  Everyone has anxiety etc, to tell a person with BPD that they have BPD is a very confronting thing, they have no self awareness.  A personality disorder is also a fault with your very make up, quite confronting, kicks in the shame feelings.  These are very dangerous.  It is healthier for the psychologist or treating practitioner to treat the behaviours, this keeps the pwBPD coming back to therapy and lets those destructive behaviours be changed, validate them so they feel good and work slowly on the behaviours.  This builds up self awareness and in time the pwBPD may be aware of these issues and it can be opened up.  This I don't believe is often, as this self awareness builds, the pwBPD gets engulfed, abandonment behaviour kick's in and boom therapy ends. 

Trust me, if a pwBPD is in therapy and working through those issues and acknowledges that they have BPD, they have my respect no matter what therapy they are doing.  That pain for my ex meant she was in the fetal position on the floor unable to respond to anything, uncontrollable agony. 

I agree with you it is definitely not easy for them in therapy. The ones that do engage fully in therapy have my respect also. It definitely isn't an easy road I tip my hat to anyone who has BPD who actually accepts what they are doing and genuinely works towards change. I just wish they all would do this.