Why do therapists shy away from making a BPD diagnosis?

[disillusionedandsore]

Thanks HtH,  I hadn't seen your previous post when I posted.  I got so much from that one statement  "alcohol being the solution" alone. I have found it hard to get this aspect validated also... .

Its so true about well meaning friends and family, I was mostly getting a ' I wouldn't like to take sides'  type of response.  It felt further invalidating,  like there are two sides so to speak.  Thank God I found this place,  as tough as it is now,  I have some hope reading others accounts,  cannot imagine what I'd be like without it,  still confused I guess.  On that note thanks to all here. 

[Reforming]

Hi all,

Good thread. I'd just like to chime in with Heeltoheel

Infared I understand your point about facing the truth and taking responsibility for our actions and choices. I think we should all strive to do that, but I think that it be challenging even for people who don't have PDs.

My understanding is that therapists work with pwBPD over an extended timescale to help them develop the resources and skills to take responsibility for themselves.

As many here can attest encouraging someone with a PD to commit to and stay in therapy can be enormously challenging for both partners

As Heeltoheel says I think there are many therapists who believe that confronting a pwBPD with a diagnosis in the early stages of therapy is counterproductive because they either feel stigmatised (shame) or use the diagnosis as another way of deflecting responsibility for their behaviour elsewhere.

I asked my Schema therapist about this and she felt that labelling a patient was often counter productive. She felt that many therapists feel that effective treatment is more important than sharing a diagnosis - though as Heeltoheel says they may share a diagnosis later when the patient developed the resources and coping skills to deal with it.

I realise how traumatic and confusing these relationships can be. Understanding and making sense of your experience can be such a huge relief, but I think the question here is whether an accurate diagnosis is more important to us NONs, who want our experience validated with the certainty of a diagnosis (we did everything we could - it was their fault) than to someone with BPD where effective treatment is the priority.

Does it really matter what the label as long as the condition / disorder is being treated effectively?

I think there there are also other reasons why therapists are wary of black and white diagnosis. Diagnosing a PD can be hugely challenging, even for a highly trained and experienced professional

Joan Lachkar, a highly regarded psychologist and author has worked and written about borderlines and narcissists.

In her book the Narcissistic Borderline Couple https://bpdfamily.com/message_board/index.php?topic=56788.0 she says

"I have come to recognise the ever-changing states of narcissistic and borderline vulnerabilities. These disorders are not clear entities, rather narcissistic/ borderline states, traits and characteristics tend to vacillate"

She also notes "diagnosis can be elusive"

I think a PD diagnosis can also bring another layer of complexity for couples

If one partner is diagnosed with a PD, there's a danger that the other partner can conclude that all the relationship problems are caused by the pwBPD.

I'm not defending BPD behaviour or excusing them of responsibility for their behaviour. I know how profoundly destructive and hurtful it can be, but both partners play a role in these relationships and unless both understand their own part it's hard to move forward and heal.

Reforming

[Infared]

Hi all,

Good thread. I'd just like to chime in with Heeltoheel

Infared I understand your point about facing the truth and taking responsibility for our actions and choices. I think we should all strive to do that, but I think that it be challenging even for people who don't have PDs.

My understanding is that therapists work with pwBPD over an extended timescale to help them develop the resources and skills to take responsibility for themselves.

As many here can attest encouraging someone with a PD to commit to and stay in therapy can be enormously challenging for both partners

As Heeltoheel says I think there are many therapists who believe that confronting a pwBPD with a diagnosis in the early stages of therapy is counterproductive because they either feel stigmatised (shame) or use the diagnosis as another way of deflecting responsibility for their behaviour elsewhere.

I asked my Schema therapist about this and she felt that labelling a patient was often counter productive. She felt that many therapists feel that effective treatment is more important than sharing a diagnosis - though as Heeltoheel says they may share a diagnosis later when the patient developed the resources and coping skills to deal with it.

I realise how traumatic and confusing these relationships can be. Understanding and making sense of your experience can be such a huge relief, but I think the question here is whether an accurate diagnosis is more important to us NONs, who want our experience validated with the certainty of a diagnosis (we did everything we could - it was their fault) than to someone with BPD where effective treatment is the priority.

Does it really matter what the label as long as the condition / disorder is being treated effectively?

I think there there are also other reasons why therapists are wary of black and white diagnosis. Diagnosing a PD can be hugely challenging, even for a highly trained and experienced professional

Joan Lachkar, a highly regarded psychologist and author has worked and written about borderlines and narcissists.

In her book the Narcissistic Borderline Couple https://bpdfamily.com/message_board/index.php?topic=56788.0 she says

"I have come to recognise the ever-changing states of narcissistic and borderline vulnerabilities. These disorders are not clear entities, rather narcissistic/ borderline states, traits and characteristics tend to vacillate"

She also notes "diagnosis can be elusive"

I think a PD diagnosis can also bring another layer of complexity for couples

If one partner is diagnosed with a PD, there's a danger that the other partner can conclude that all the relationship problems are caused by the pwBPD.

I'm not defending BPD behaviour or excusing them of responsibility for their behaviour. I know how profoundly destructive and hurtful it can be, but both partners play a role in these relationships and unless both understand their own part it's hard to move forward and heal.

Reforming

You bring up a lot of thoughtful and valid points, Reforming.   There are no blanket answers that work in all situations... .and especially with BPD... .the symptoms vary, change and are hard to nail down.  My observation in my situation would be that ... .she thinks no therapy is required... .she sees nothing wrong with herself and her actions. So there will be no change there in that instance.  For me... .if I never have to spend one second in the presence of a pwBPD, I will be a better person.  Too much damage was done (I had no idea I was dealing with a personality disordered person until well after the abandonment)... .I am not sure if I will ever heal all of it... .but, for this guy... .I do not ever want to get near the flame again... .let alone stick my hand in it!  

Her sickness is her problem... .thank God its not mine any longer.

[once removed]

i think its also worth noting that if it were easy, more pwBPD would start googling symptoms, self diagnose as BPD, and presumably then seek treatment.

some of them have even done so, but still not sought treatment.

[disillusionedandsore]

Reforming,  would you explain what you mean by "but both partners play a role in these relationships" for me please?

[Invictus01]

Personally, I don't care if a T officially and formally diagnoses a pwBPD, but from the human point of view, I think a T would do a huge favor to a non by pulling the non aside and kinda explaining what he thinks he is dealing with and the options the non has. Would a non stick around if he or she knew that his/her life partner needs 5-7 years of intense therapy with little chance of doing too much good and during those years the non should expect to be treated like an emotional tampon, to be cheated on, to be a parent in the relationship? Forget that, what if the T sees that it's not a BPD he is dealing with, that he is dealing with a flat out sociopath or narcissist? Simply from a human point of view, how do you NOT pull the other half of the relationship aside and say "GET OUT! RUN!"?

[disillusionedandsore]

Absolutely.  Doctors have an oath,  first do no harm,  and therapists are sworn to confidentiality except when there is a danger to self or others... .Surely all the stories here on the LEAVING:DETACHING (not the staying board) are evidence enough of real and present danger to others?

[fromheeltoheal]

To respond to several posts, we were all willing volunteers in these relationships and could have walked away at any time.  For some everything was completely rosy for a while and then they were blindsided by dysfunction, but for most of us, myself included, there were red flags I ignored from day one, and eventually plenty of abuse and disrespect that I tolerated and shouldn't have.  And my needs were never met more than at a very low level.  So does it really take a mental health professional to tell us that?  Would labeling the set of behaviors as a personality disorder have changed those behaviors?  We were as complicit as what we put up with, and to be fair, I was far from perfect myself, I triggered her abandonment fears without knowing it more than once, but I did the best I could in the face of chaos, and it's probably safe to say we all did.

[disillusionedandsore]

I dont really see how if you were groomed to accept more and more abuse,  it can be said that you are complicit in it? It has become a power greater than you no?

[fromheeltoheal]

I dont really see how if you were groomed to accept more and more abuse,  it can be said that you are complicit in it? It has become a power greater than you no?

People will only treat us as badly as we allow them too, and sure, borderlines with their need to attach and conviction that everyone will eventually abandon them get very good with the manipulation and control to prolong or avoid it, because they don't see another choice, plus the attachment provides a place to off emotions they can't deal with, projection.  All of that wears on our self esteem, which is why it's so painful and sites like this exist, although think about it, a totally healthy person would walk away at the first sign of dysfunction, abuse or disrespect, and we stayed, some far longer than we should have.  So it's a combination of what we bring to the relationship, experience, maturity and mental health-wise, along with our attachment style that determines our complicity.  And that's actually where the growth is after these relationships end; what if a borderline entered our lives for a purpose, because there were lessons we needed to learn, and striving to get out of our own pain is a great motivator?  At some point it's helpful and necessary in detachment to shift our focus from our ex to ourselves, so that in the next relationship we enter our partner gets a better, wiser version of ourselves, on our way to creating a truly healthy one.

[disillusionedandsore]

I get all that and I am committed to that I just think it's a bit if a myth that 'a healthy person would have walked away'. I often say this but my ex was like Jesus of Nazareth when he came back, he was so shiny,  full of wonderful stories about his growth,  his evolvement,  he had been in this group and that... .I regularly used to say to him actions speak louder than words.  I confronted my ex on his behaviours,  I articulated my feelings,  I gave him my terms and conditions,  I insisted we see a counsellor together and then later than he get a psychiatric evaluation.  He convinced me and several therapists he was trying... .his attendance,  financial investment in therapy matched that... .I thought he was a little misguided on certain things,  I didn't know he was delusional and possibly a pathological liar until I came here and I certainly had no idea how futile my forgiveness was.  I understand attachment,  we were working with an Attachment therapist.  In the absence of a label and factual knowledge about BPD it was nuts going along with all the traditional couple advice that counsellors give,  it's good to argue,  it clears the air! God help me.

[Infared]

I dont really see how if you were groomed to accept more and more abuse,  it can be said that you are complicit in it? It has become a power greater than you no?

In the end it is our responsibility to recognize this and do something about it for our selves.  We are responsible for ourselves in the end... .no one else.  We cannot control another's words or actions. Only our own.   That is why many of us coming out of these relationships took responsibility for ourselves and went and found a therapist, self help groups, this forum, etc... .to work on ourselves.  We recognized that we had a part in the dysfunction.  My exBPD blames everything on anyone. She is incapable of self-introspection. She just seeks out another "vulnerable" victim, like ourselves or the way I "used" to be.  They are experts at picking us out to manipulate.  I do not know if they do it consciously or sub-consciously... .but boy... .oh boy... .are they good at it.

[once removed]

if you want to focus or learn about your role in this relationship i recommend the posts of 2010

https://bpdfamily.com/message_board/index.php?action=profile;u=38193;sa=showPosts;start=0

[fromheeltoheal]

I get all that and I am committed to that I just think it's a bit if a myth that 'a healthy person would have walked away'. I often say this but my ex was like Jesus of Nazareth when he came back, he was so shiny,  full of wonderful stories about his growth,  his evolvement,  he had been in this group and that... .I regularly used to say to him actions speak louder than words.  I confronted my ex on his behaviours,  I articulated my feelings,  I gave him my terms and conditions,  I insisted we see a counsellor together and then later than he get a psychiatric evaluation.  He convinced me and several therapists he was trying... .his attendance,  financial investment in therapy matched that... .I thought he was a little misguided on certain things,  I didn't know he was delusional and possibly a pathological liar until I came here and I certainly had no idea how futile my forgiveness was.  I understand attachment,  we were working with an Attachment therapist.  In the absence of a label and factual knowledge about BPD it was nuts going along with all the traditional couple advice that counsellors give,  it's good to argue,  it clears the air! God help me.

Yeah, me too disillusioned, I ended up finding this site by Googling "psychopath" after I left her.  I didn't even know what a psychopath was, turns out she's not one, but that search led me to something that described her to a T, BPD, and this site, where we read story after story we could have written.  So we didn't know, and all of our own stuff kicked in in the face of dysfunction, but I'll bet that never, ever happens to us again, at least those of us who stick around here long enough to learn the lessons and grow.  I'm sorry you went through that, it sounds very painful, and let's keep creating our bright futures.  Take care of you!

[disillusionedandsore]

I did that single handedly.  No therapist led me there... .But they kept taking my money, I could still be there trying to implement their stupid advice except that I was relentless in looking for answers.  At no stage was I not looking at myself,  I knew I was unhappy,  getting exhausted and truly fed up with the unresolvable nature of the conflicts,  I was setting more and more boundaries,  I was detaching and working on getting out.  I just couldn't understand how something so promising,  with all the help we were getting could be going so wrong... .

[once removed]

and by the way, i agree with all three of you:

"People will only treat us as badly as we allow them to"

"So it's a combination of what we bring to the relationship, experience, maturity and mental health-wise, along with our attachment style that determines our complicity.  And that's actually where the growth is after these relationships end; what if a borderline entered our lives for a purpose, because there were lessons we needed to learn, and striving to get out of our own pain is a great motivator?  At some point it's helpful and necessary in detachment to shift our focus from our ex to ourselves, so that in the next relationship we enter our partner gets a better, wiser version of ourselves, on our way to creating a truly healthy one."

"I just think it's a bit if a myth that 'a healthy person would have walked away'." i dont think its a myth per se, but i dont believe theres such thing as a totally healthy person, in the sense that we all, not just members here, have our issues, and life is kind of a lesson in self improvement.

"In the end it is our responsibility to recognize this and do something about it for our selves.  We are responsible for ourselves in the end... .no one else.  We cannot control another's words or actions. Only our own." 

[disillusionedandsore]

Oh it will never happen to me again because everyone that I like I will be running a lie detector on, hiring a P. I. and doing some serious personality profiling! I am only joking,  no I've learnt the hard way to listen to my Gut! No that is not something I ate it's a warning signal something is off.  Yes pain is very curative. Thanks for your contribution guys

[Suzn]

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