Training info for therapists working with BPD; sounds familiar, doesn't it?

[Beware of Junk Psychology...]

This  written for a clinical audience about a CE course on the topic. Still, isn't interesting that whether you are a relative, spouse, or clinical professional... . it is still all about boundaries, taking care of yourself, and staying OUT OF the rescue role.[/i]

You Are One Borderline Away From Losing Your License*:

Dr. Ofer Zur

In my forensic/expert witness practice I have encountered the most fascinating and intriguing cases where BPD clients have gotten their (otherwise solid and ethical) therapists to give them money, adopt them, move in with them, regularly text with them at 1 or 2 AM, do drugs with them, and, of course, have sex with them.

Without doubt, it is a therapist's responsibility to maintain clinically appropriate boundaries with all clients. However, that is not always easy with many BPD clients.  BPD clients are so desperate for attachment that their fierce need can draw a therapist in. At the same time, many BPD clients have learned not to trust those very attachments they demand and crave. Thus, therapists can find themselves caught in their BPD clients' conflicting desires.

A growing body of research clearly indicates that BPD clients can be treated successfully and effectively with psychotherapy. Understanding the interpersonal power that BPD clients exert on the therapist is essential both for effectively treating BPD clients and for protecting psychotherapists and counselors.  

What one should do to prevent boundary violations with BPD clients:

•Recognize the potential dangers/hazards when working with the BPD.

•Understand the powerful intra- and interpersonal dynamics at work in BPD therapy.

•Exercise extra caution with boundary crossings with BPD clients. As examples, boundary crossings might include gift-giving, leaving the office, communication outside of therapy, texts or e-mails, home visits, touching, etc.

•Watch out for a dangerous cognitive trap often encountered with the BPD clients:  "If I only agree with this last demand he/she will settle in, let go, calm down, or finally realize that I do care." Trying endlessly to appease or avoid the rage of BPD clients is how therapists end up violating boundaries.

•Consult, consult and . . . consult with peers and experts.

•Attend training, such as our online CE course on BPD.

•When appropriate, document relevant boundary crossings, non-standard procedures, unusual encounters and, when necessary, include your therapeutic rationale for such boundary crossings in your notes.

•Know and practice the common principles of effective BPD psychotherapy, which cut across virtually every therapy modality.

•Learn to navigate the narrow channel of caring, compassionate therapy without getting sucked into the BPD client's emotional vortex.

•Learn how to keep clinically and ethically appropriate boundaries without becoming disconnected, rejecting or cold.

[MaybeSo]

This  written for a clinical audience about a CE course on the topic. Still, isn't interesting that whether you are a relative, spouse, or clinical professional... . it is still all about boundaries, taking care of yourself, and staying OUT OF the rescue role.[/i]

You Are One Borderline Away From Losing Your License*:

Dr. Ofer Zur

In my forensic/expert witness practice I have encountered the most fascinating and intriguing cases where BPD clients have gotten their (otherwise solid and ethical) therapists to give them money, adopt them, move in with them, regularly text with them at 1 or 2 AM, do drugs with them, and, of course, have sex with them.

Without doubt, it is a therapist's responsibility to maintain clinically appropriate boundaries with all clients. However, that is not always easy with many BPD clients.  BPD clients are so desperate for attachment that their fierce need can draw a therapist in. At the same time, many BPD clients have learned not to trust those very attachments they demand and crave. Thus, therapists can find themselves caught in their BPD clients' conflicting desires.

A growing body of research clearly indicates that BPD clients can be treated successfully and effectively with psychotherapy. Understanding the interpersonal power that BPD clients exert on the therapist is essential both for effectively treating BPD clients and for protecting psychotherapists and counselors.  

What one should do to prevent boundary violations with BPD clients:

•Recognize the potential dangers/hazards when working with the BPD.

•Understand the powerful intra- and interpersonal dynamics at work in BPD therapy.

•Exercise extra caution with boundary crossings with BPD clients. As examples, boundary crossings might include gift-giving, leaving the office, communication outside of therapy, texts or e-mails, home visits, touching, etc.

•Watch out for a dangerous cognitive trap often encountered with the BPD clients:  "If I only agree with this last demand he/she will settle in, let go, calm down, or finally realize that I do care." Trying endlessly to appease or avoid the rage of BPD clients is how therapists end up violating boundaries.

•Consult, consult and . . . consult with peers and experts.

•Attend training, such as our online CE course on BPD.

•When appropriate, document relevant boundary crossings, non-standard procedures, unusual encounters and, when necessary, include your therapeutic rationale for such boundary crossings in your notes.

•Know and practice the common principles of effective BPD psychotherapy, which cut across virtually every therapy modality.

•Learn to navigate the narrow channel of caring, compassionate therapy without getting sucked into the BPD client's emotional vortex.

•Learn how to keep clinically and ethically appropriate boundaries without becoming disconnected, rejecting or cold.

[GreenMango]

You Are One Borderline Away From Losing Your License*

Oh good god!

Looks like it all starts with knowing our own boundaries and sticking to them.  I'm not a therapist but that pattern - that slippery slope of not attending to the appropriate boundaries really made the whole relationship possible.  That brings me back thinking about some of those instances.  Lesson Learned.

In my forensic/expert witness practice I have encountered the most fascinating and intriguing cases where BPD clients have gotten their (otherwise solid and ethical) therapists to give them money, adopt them, move in with them, regularly text with them at 1 or 2 AM, do drugs with them, and, of course, have sex with them.

  Wow wow wow this is scary.

[MaybeSo]

I'm coming to the conclusion that if you don't have very well honed, very sophisticated boundaries,  involvement with this disorder will almost always result in a very powerful corrective experience.  It certainly has for me.

[DesertChild]

As examples, boundary crossings might include gift-giving, leaving the office, communication outside of therapy, texts or e-mails, home visits, touching, etc.

The two in bold creeped me out when my therapist did it... . I canceled and she would call, sometimes out of the blue. Or randomly extend the session. Or talk about herself in personal terms. Or e-mail me about something that wasn't related to the therapy. Was odd.

?

I did end up not returning and she e-mailed me about how it was a mistake to leave... . Ummm... .

So yeah. Anyway, I have to say that must be really hard for therapists. I saw a few videos where they said they need a support network in order to work with people with BPD.

[GreenMango]

a very powerful corrective experience

I've never heard it phrased that way.

[MaybeSo]

The two in bold creeped me out when my therapist did it... . I canceled and she would call, sometimes out of the blue. Or randomly extend the session. Or talk about herself in personal terms. Or e-mail me about something that wasn't related to the therapy. Was odd.

Not cool. And not ethical behavior for a professional. It's really suppose to be a very boundaried relationship, certainly it can be warm and empathic, and should be those things... . but the therapy 'FRAME' is suppose to be pretty ridged for a reason.  It keeps everyone safe. And it's suppose to be much different than any other kind of relationship you have had... . and it is suppose to be about YOU, not the therapist. Once in a while, if it's pertinent to the therapy and may be helpful to YOU,  a therapist will self disclose, but it's a big deal, they are suppose to do it for a therapeutic reason, there are whole trainings on that topic alone (should you ever self disclose and when? etc.)  So, when you meet a T that just blows all this stuff off and hangs loose on everything, that's a big red flag. The frame is part of the therapy, if the frame is just blown-off, they are blowing off the benefit of the therapy.    The Therapist has some unaddressed issues of their own if this is happening.

[musicfan42]

I did end up not returning and she e-mailed me about how it was a mistake to leave... . Ummm... .

I'm wondering whether your therapist had a crush on you? 

I watched this TV show called "In Treatment" ages ago-it was about this therapist played by Gabriel Byrne (he was so good looking when he was younger!) Anyways, the therapist had this patient who probably was a high-functioning borderline called Laura. (The show doesn't say that she's borderline but she just strikes me as having BPD). She told him about her sexual encounters in an explicit way, pretty much designed to seduce him. She was testing his boundaries all the time and then eventually confesses in one episode that she loves him. She's high functioning so she has a good job, very pretty and intelligent... everything going for herself aside from healthy relationships. The therapist seems to be in a bad marriage, stuck in a rut in his life and you can sort of see why he would find her appealing but it's very much a reflection of his own issues. He goes to his own therapist to work on his counter-transference issues-I think he's a psycho-dynamic therapist... not sure if other therapists do this. But anyways, he decides to just go for it anyways but as he's about to have sex with her, he has a panic attack so the relationship isn't consummated.

I agree with you MaybeSo that you have to have sophisticated boundaries around borderlines-that you have to be very self-aware... actively working on personal weaknesses* so that a borderline doesn't suss them out. In the TV show "In Treatment", Laura figures out that Paul, the therapist is stuck in a miserable marriage... that he's not happy with his lot. She's very perceptive and is able to hone in on all his weaknesses in quite a manipulative way really. She wants him and she's determined to get him... she doesn't care that he's married with kids... the ethical implications don't enter into the equation for her at all... . it's very much based on her emotions, on how she's feeling at that particular time and everything else is secondary.

I know it's just a TV show however I thought it seemed quite accurate of what therapy is like, for the most part.

*Maybe "personal weaknesses" is the wrong word there but I'm sure you all catch my drift.

[DesertChild]

Therapist was married. TMI stuff like the nature of her relationship with her husband being good. Personally, my guess is that my issues triggered her. And I kinda became a wish fulfillment?

My mom, she would say, was a milder version of her mom. (Well not in those exact terms, but to give you a sense).

So when I wanted to break and become independent from my parents she would discourage it, justifying that my mom wasn't as bad as hers. But I wasn't in a place where I could switch therapists at the time. (I was afraid I'd backslide because of the stress) I was going through really heavy things and switching in the middle would have been difficult. (She occasionally suggested I switch as a semi-threat... . ?) I was getting something out of it. I was getting labels for things I knew to be true. I also had no boundaries to speak of and was trying to learn some. I had real issues saying no.

Looking back, it turns out that 3 months into the almost 2 year therapy that I wanted to break from my parents and she actively discouraged me every time. Also kinda discouraged me from having goals to reach with the therapy. (I'd raise what I wanted to talk about/goals I wanted and she'd cut me off or change the subject) When I wanted to find a job which would make me independent of my parents, she'd also discourage me. She'd also say occasionally, "Now that's real abuse." (So apparently my Mom putting me down for finding success wasn't real abuse) too... . so... . yeah... . sometimes I wasn't sure who was the therapist... .

From the client side seeing someone violate boundaries is hard. Therapist side must be really difficult if that's a specialty. I can see why a support network must be necessary.

[myself]

"If I only agree with this last demand he/she will settle in, let go, calm down, or finally realize that I do care."

WOW.

Where does the circle end and where does it begin again?

We can get lost even with the best intentions.