Hey CD, good to hear back.
she’s been doing it for a few months though she has had a suicide attempt in the middle of it - so who knows if it’s really doing her any good or not.
As odd as it sounds, I wouldn't necessarily say that because she had a suicide attempt mid-therapy, that the therapy isn't working. (I also wouldn't conclude that that means that the therapy is working, either, FWIW.) It's possible that what you're seeing is "how the process looks", which is certainly not to minimize suicide attempts as "just something that happens" or "not a big deal". I think where I'm leaning is more that this is going to be a long haul, and there won't always be a 1:1 correlation between being in T (or being in T more often) and things going better. You've seen a snapshot of part of the process, and it's possible that only time will tell if that's a fluke or a trend. I know that isn't a super specific answer. I guess my thought is also -- you guys are 2 months in to her trying EMDR, and she's had a lifetime of issues. Sometimes things get worse before they get better, so if you can, give it some more time. Of course, if she makes more suicide attempts, more than she had before the EMDR, then that would be concerning.
Her big issue of not wanting the therapy is that she doesn’t want to do it twice a week - but twice a month.
Forgot to mention this in my earlier post, but after one session of EMDR, I was noticeably tired the next day. Could be that she has hit her limit for what she can manage with T. One way to reframe this could be, instead of disappointment that she isn't going more (and I'm with you there, it's disappointing that she wants to do less), there could be a way for you to validate her staying in it at all -- which I think we both agree is a lot better than her dropping it cold turkey.
So that could look like: "Honey, I'm confident that even though some days will be hard, you can stick with EMDR at a frequency that you and your T decide works for you, whatever that is."
That could help make therapy frequency not a hot-button topic and could reduce conflict about it between you guys. If she senses that you aren't pressuring her to do T one way or the other, that may help decrease what I've sometimes heard discussed here, about Pathological Demand Avoidance (some pwBPD, when they sense that someone wants them to do something, dig their heels in and resist, even if they actually want to do the thing).
You could consider turning any convo/discussion of T between you guys into a "validation target" opportunity, where instead of it being a conflict of "she wants to do less, I think she should do more", you can thoughtfully consider what there is in what she's saying that's valid, and validate that.
For example, it wouldn't be valid to tell her "You're absolutely right, you don't need that much therapy", or "anything you think is best, is obviously best". It could be more valid to affirm that if she and her T agree to every 2 weeks, you support that professional decision, and are so glad she is choosing to stay in T (or whatever sounds most like your words).
Basically, I wonder if there are ways to reduce relational conflict surrounding her therapy, so that it's one less area that is a conflict area, and so that she also doesn't just stubbornly drop it "because you are always forcing her to go" or whatever perception she might have.
You bring up a very good point - navigating things if she drops therapy or drastically reduces it. It’s hard to say. I’m not really sure it’s doing her any good because she still has not been told by either her therapist or psychiatrist that she has it. How can you get treatment for something you don’t think you have - or even know what it is? Makes no sense to me. So I’m not too worried about therapy per se - I’m worried about her not even being aware of BPD.
That's really interesting that you raise that question in the context of EMDR. In my one session so far, the T made it very clear that this was not a "you have to talk about what happened" kind of modality. I could share with her if I wanted, but EMDR also works, as far as I can tell, with absolutely no content disclosure between the T and client. As long as the client is actually willing to think of a memory or feelings, and then report on "before and after" levels of intensity, it can work with zero discussion of symptoms, traits, behaviors, actions, etc. Now, that is the sticky wicket -- is your W authentically participating -- and ultimately that is something only she can know, not you, and not even the T. But if she's still open to going, that may indicate that there is something going on inside of her that she doesn't like and wants to change, and that's hopeful.
Where I'm at in my process is that I think there are things that happened in my past that I don't want to remember. I am running into some pretty huge hurdles that are getting bigger and that are getting associated with even going to therapy. But I know there's something going on. It is hard to know if it's that I
can't work on it, or that I
don't want to work on it -- and that's even with me being aware that there is resistance inside me somewhere to the process.
Even somatic work (being in touch with how the body feels, doing breathing/grounding exercises) is way too much for me right now, and that's one typical way that T's can "work around" a client not being able to remember or verbalize something. So with nothing that I can remember/verbalize, and huge hurdles to somatic work, is there anything I can do? Can I get treated for something where I have no idea what it even is?
At a meta level, yes, I think there is a lot that T's can do with clients in a "roundabout" way, without either the client needing to know/describe what's going on, or the T needing to label/diagnose. It may be that the T and psych are aware that giving your W a label/diagnosis "full on" could deeply destabilize her, or be too much too soon, or distract her focus away from improvement and towards obsessing over a diagnosis, or create too much shame for her to continue to engage, or something similar. The T & P may need to build significant trust with your W over time, to keep her engaged and coming back and not so overwhelmed with inner shame that she can't work with them. My suspicion would be that they see enough at a structural/logistical level (i.e., that they can see even from: how she makes appointments, how she emails/contacts them, what she doesn't bring up, body language, small talk, if/how she cancels appts, etc) to get a picture of what's going on with her. I think it's very possible that not diagnosing could be an intentional choice on the part of the P & T, versus "they don't see it, how can they help". It is very possible that
because they see it, they're not labeling.
Anyway, that's a lot to ponder. Hopefully some of it is helpful, and brings some hope. It's a long haul, so my thought is that if you can be patient, play the long game, understand that the T's likely do see a lot more than we think, and find ways to make sure that therapy isn't a conflict source, things can get a little better for you and your W.
Let me know if I'm off base, of course...
kells76
