Therapist Won't Use BPD Diagnosis

[Hopeless777]

My wife has been in "therapy" for 8 months, 2-3 hours per week. Every other week its couples therapy for 2 hours. I see the therapist for an hour or so every few weeks. Wife scores 8 out of 10 on BPD scale (per my calculation.) All behavior is classic BPD. Therapist even admits to using DBT on wife in her sessions. Therapist refuses to label wife as BPD, to me or her. Wife states that therapist doesn't think that she has a mental problem; only that we have "communication" and "trust" issues. Because of this I believe my wife is minimizing her condition, which is doing untold damage to our 25+ relationship (see my story elsewhere in this forum.) I believe that unless my wife understands the seriousness of her mental condition we will never have any life together further. How do I get therapist to really confront her? Has anybody else run into this issue?

[maxsterling]

Interesting.  From what I have heard, the BPD label has negative connotations.  The T may be trying to avoid scaring your wife, and avoid giving you a reason to say, "see!  You have BPD, it's you, not me!"  Not saying you would do that, but I am sure some people would. 

I've got another couples counseling session with my GF tonight, which will be the 3rd with this new therapist.  The T seems pretty perceptive to me, and the way my GF has behaved in session almost seems like the T has no option to conclude my GF has BPD.  For example, my GF will go on and on about how she worries I will "dump" her.   I'm curious to see if our T will suggest treatment for BPD, but last session when my GF said she got into a DBT group, the T said, "that's great!  that will really help you!"  My gut says the T won't bring up BPD, even if she suspects it.  But she may try and persuade my GF to open up or elaborate that direction. 

Remember, BPD is diagnosed as a collection of symptoms anyway, and it's not like there is a specific drug or surgery that will correct it.  So, all a T can do is treat symptoms.  BPD is simply a label, and if the T feels that your wife could be better helped if she doesn't have that label, so be it.  My feeling is that pwBPD have problems with authority, so once someone labels them as BPD, the pwBPD will close up and label the T as a quack who is only trying to call them "crazy".  My GF has already had issues with 2 therapist in 6 months for this exact reason. 

As for your feelings - I feel the same way.  My relationship cannot progress until she admits fully her issues and the pain they bring to me and others, and seeks treatment.  In other words, "I agree to not pressure you into marriage or children until I feel stable."  Right now, she still seems to search for that magic pill or answer, and won't stop and say "I have BPD, my behavior is at the core of my problems."  Right now, it's all about bipolar, depression, PTSD, medications, and no progress.

[seeking balance]

A diagnosis may not be in your wife's best interest for several reasons.  It might actually remove the trust and the progress her T is making and the T is incorporating DBT, so that is good.  Another issue could be insurance related, this is not a favorable diagnosis to many insurance companies.

I know it is likely frustrating for you - heck, I was in your same shoes at one time (T for us both, MC, P for her, sound familiar) and all I wanted was a diagnosis.  What I had to realize is what I really wanted was a functional marriage, the diagnosis or not wasn't going to change that fact.

I believe that unless my wife understands the seriousness of her mental condition we will never have any life together further.

I want to challenge your thinking on this a bit, your wife is averaging 3-5 hours per week on Therapy... . how much more serious do you think she can get?  Have you seen any changes (even slightly) in her behavior? 

How do I get therapist to really confront her?

Why is this so important to you - my T asked me "do you want to be right or do you want to be happy?"  Pushing too hard may not be in either of your best interest.  I imagine after 25 years, there is a lot of build up, so 8 months probably feels like forever, but that isn't a lot of time based on the patterns of behavior you both have established over all these years... . I know that might be a hard pill to swallow right now when feeling frustrated and stressed... . I am sorry this is not going quicker for you.

I remember advice I got on here - let your wife do her T, you do yours and use the MC for creating strategies for your conflict resolution.

What would it look like for you to have her take this seriously?

[Hopeless777]

Thanks Seeking Balance. To answer your inquiries:

"Have you seen any changes (even slightly) in her behavior?"

No. The situation has continued to deteriorate. I can't be in her presence for more than an hour without her starting her BPD behavior.

"What would it look like for you to have her take this seriously?"

How about if she made the following statement to me in all seriousness: ":)ear, I love you and want you to come home. I realize that I have some issues that I am working on and that I have often failed. I am sorry for treating you the way I have and ask that you come home now. You will see that I am changed. I love you and miss you and want you here with me."

Seems like a very simple statement of love and respect. Do I think I'll hear that: no way. I'd consider it a miracle from god.

[seeking balance]

No. The situation has continued to deteriorate. I can't be in her presence for more than an hour without her starting her BPD behavior.

specifically, what type of behavior and specifically how are you responding or using boundaries?

How about if she made the following statement to me in all seriousness: ":)ear, I love you and want you to come home. I realize that I have some issues that I am working on and that I have often failed. I am sorry for treating you the way I have and ask that you come home now. You will see that I am changed. I love you and miss you and want you here with me."

Seems like a very simple statement of love and respect. Do I think I'll hear that: no way. I'd consider it a miracle from god.

Are you familiar with the 5 Love Languages?  Sounds like your love language may be words of affirmation and she might be demonstrating in a different way than you "hear" it.

Does your MC have a goal or objective in your sessions?

[Cipher13]

Hmm I'm about to go to a new T with uBPDw and I was wondering the same thing if the signs that are visible will eventually be visible to the T. I know she can surpress them but not forever. The T we went to years ago was completely shocked when I began telling her about her behavior and showed her the emails and texts I get on a near daily basis.

I have been told that couples T is a near waste of $ to correcting or fixing anythign that deals with BPD as its not the focus not intended area the T will go for. I don't want to contiune to be blamed for everything anymore and the few things I am guilty of are eithe old or so minor that it should upset a "normal" person. If I have a bad day and don't feel like being as cheery as Mr Rogers then I should eb able to do that not have to beg for forgivnes for treating her liek the worst peice of explative there can be. Especially when nothign can be further fromt he truth.

[Love Is Not Enough]

I have been told that couples T is a near waste of $ to correcting or fixing anythign that deals with BPD as its not the focus not intended area the T will go for.

I share this opinion. I tried, but our T would never call her on her bs and I held back because I didn't want to deal with the aftermath of being "too honest". The T was very laid back and knew beforehand that I believed she was a BPD. I think he was afraid to push her too hard and I am sure he could tell I was holding back. She did blow up a few times, but I didn't even say 10% of what I wanted to. So I do not think MC is useful until they have learned better coping skills and are able to communicate with you in a reasonable way.

A diagnosis may not be in your wife's best interest for several reasons.  It might actually remove the trust and the progress her T is making and the T is incorporating DBT, so that is good.

Seeking balance is right. The label does not matter, learning and using the skills does. I finally got my gf to go to an experienced T that does DBT without telling her about BPD. The T has not told her about BPD and I suspect that she will not bring it up unless my gf does. Her T has not worked with her long, but the seed of understanding has been planted. My gf's behavior has already improved from looking at things in a new light. It really comes down to if they are self aware of the pain they are causing and really want to change. Luckily my gf has progressed to that point.

How about if she made the following statement to me in all seriousness: ":)ear, I love you and want you to come home. I realize that I have some issues that I am working on and that I have often failed. I am sorry for treating you the way I have and ask that you come home now. You will see that I am changed. I love you and miss you and want you here with me."

Seems like a very simple statement of love and respect. Do I think I'll hear that: no way. I'd consider it a miracle from god.

It would be since you know will never hear this. Even if you did, you would have a really hard time believing it. All of it comes down to their behavior. That is what you want to improve and that is more important than words. You have to LOWER YOUR EXPECTATIONS and accept that she will never be able to interact with you in this way. If she goes from raging at you daily to once a month, then that is measurable progress. The best you can do is change your behavior. Look at how you interact with her and set boundaries. Do the best you can and if she does not do the work to use the skills being taught to her then you may have to consider leaving. We all have our limits.

[hergestridge]

Hopeless, I recognize this all too well. The "discrete" approach that the T is attempting only results in your wife thinking she's not ill. And since the T doesn't clearly states that she had BPD and how fundamentally it affects her realationship to you, she will only think that the T is helping you with some kind of general marriage counceling unrelated to her illness.

It's wishful thinking on everyone's part that BPD people are able to read between the lines.

[waverider]

How about if she made the following statement to me in all seriousness: ":)ear, I love you and want you to come home. I realize that I have some issues that I am working on and that I have often failed. I am sorry for treating you the way I have and ask that you come home now. You will see that I am changed. I love you and miss you and want you here with me."

This wont happen as a result of being told because she has BPD. One day it might when she is ready, that is the time she is ready to hear the diag.

It's wishful thinking on everyone's part that BPD people are able to read between the lines.

The only lines a pwBPD can read are their own until they are sick of reading them by themselves. As long as you read their lines and debate them they will still be focused on them