Can a therapist immediately tell?

[Depression = 72% of members]

My BPD bf decided to seek therapy 4 weeks ago and we have had no contact for 3 weeks now (per his therapist).

I just came across this site yesterday, so I had no idea BPD existed and that it matched everything as far as my bf goes and his behavior.

And I'm assuming he did not even know he has this... . so I'm wondering, does a therapist immediately know what s/he is dealing with and can see that it is BPD with a patient? Because I have had no contact, I don't know what is being discussed in these sessions. We only spoke in week 1 of his therapy where he told me that he talks about me. YET, he told me he has issues from his past that he needs to deal with in order to move forward. Assuming he was talking about me in order to find a better way to deal instead of running away... .

But I'm wondering if a therapist can immediately know it's BPD (if that is what it truly is) since who knows what the patient is telling the therapist... . ? Because if they do immediately know, then they can use the treatment time to better assist the patient and guide them... . hoping therapy is actually working though... .

[LoveLove]

My BPD bf decided to seek therapy 4 weeks ago and we have had no contact for 3 weeks now (per his therapist).

I just came across this site yesterday, so I had no idea BPD existed and that it matched everything as far as my bf goes and his behavior.

And I'm assuming he did not even know he has this... . so I'm wondering, does a therapist immediately know what s/he is dealing with and can see that it is BPD with a patient? Because I have had no contact, I don't know what is being discussed in these sessions. We only spoke in week 1 of his therapy where he told me that he talks about me. YET, he told me he has issues from his past that he needs to deal with in order to move forward. Assuming he was talking about me in order to find a better way to deal instead of running away... .

But I'm wondering if a therapist can immediately know it's BPD (if that is what it truly is) since who knows what the patient is telling the therapist... . ? Because if they do immediately know, then they can use the treatment time to better assist the patient and guide them... . hoping therapy is actually working though... .

[RELATIONSHIP PROBLEM SOLVING]

RELATIONSHIP PROBLEM SOLVING This is a high level discussion board for solving ongoing, day-to-day relationship conflicts. Members are welcomed to express frustration but must seek constructive solutions to problems. This is not a place for relationship "stay" or "leave" discussions. Please read the specific guidelines for this group.

[maxsterling]

My experiences:  When I went to a T and started describing issues I had with my GF, within 30 minutes my T was suggesting that my GF had BPD.  And our couples T - I think she was clued into the BPD by the second session.  I can tell by the way the T interacts with my GF.  My gf was just re-diagnosed BPD the other day after an hour session with a nurse practitioner.  I think she has had the BPD diagnosis probably a dozen times by now.  Yet, last fall when she was feeling suicidal, they diagnosed her bipolar and put her in the hospital.

I am guessing that therapists who are familiar with BPD are quick to see it.  But Ts/psychs that specialize in medications or other disorders are probably more likely to diagnose the pwBPD as having something else - anxiety, depression, or bipolar - simply because those are illnesses that can be treated medically.  My gut feeling is that the first time a pwBPD seeks therapy, if they aren't one to meet all the criteria that scream BPD, they are likely to simply be given medicine and talk therapy to try and help with their depression or anxiety issues.

[LoveLove]

Maxsterling,

Thank you so much for sharing! Well the problem here is is that I myself am diagnosing him with BPD based upon everything that I've read here and what others' stories have been. There are simply too many similarities and signs here that match to ignore.

Yet, because I have had NC with him, and I don't know what he has told the therapist. I'm wondering (and hoping) that she was able to spot it right away like you mentioned. The "treatment" is suppose to take 12 weeks - very INTENSE treatment. With talking 2 days or more per week, at 2 hours each time. And then after the 12 weeks, the sessions lessen apparently.

I don't know the correct treatment needed for BPD, but I'm wondering if it's just "talking" - if that will "solve" anything for a pwBPD?

When we were still talking, he asked if I would be here at the end of his therapy... . so I now know he fears abandonment. But I've also read here that most pwBPD also are good at lying. So I'm not exactly sure what to believe... . and hoping he can't "get away" with lying in therapy.

Any thoughts?

[Cloudy Days]

My husband was going to therapists his entire life, they never gave him the BPD diagnosis until he was hospitalized during a Bipolar Manic episode that was caused by taking medication. The doctor at the hospital diagnosed him with Bipolar disorder and BPD, the only reason he was able to diagnose him with BPD was because he spoke with me and I described his usual every day behavior. I had no idea what BPD was at that time. He had been seeing a therapist for two years and she never came up with anything other than OCD and anxiety issues. Even after he got out of the hospital his doctors only wanted to put him on medication and didn't care about actual therapy. I eventually took it upon myself to find a therapist that specializes in BPD so that he could get actual treatment other than a pill. I saw the most improvement in him with the therapist that specialized in DBT therapy and PTSD. Interestingly enough this therapist is the only one that diagnosed him with PTSD and started giving him EMDR as well.

I think it is important to know that without interviewing someone who lives with the person with BPD. The BPD could easily be overlooked. I know that my husband focused a lot of his time talking about trauma and did not like to focus on any of his actual behaviors. When we tried couples counseling he spent the entire time telling the therapist what I was doing wrong. From talking to me I think she could have came up with the diagnosis but she never did. I focused a lot of my time trying to get him to stop accusing me of cheating on him.

Talk therapy doesn't really do much for the BPD, they need to learn coping skills to learn how to deal with their intense emotions, that's what DBT therapy is for. However I think the fact that he is trying to get help is a good sign. I can't say that the talk therapy will work but it's at least a start.

[LoveLove]

Cloudy Days,

Thank you for sharing your story as well, it's very much appreciated. I can completely understand what you are saying. And that is my fear - that either the therapist doesn't recognize his true issue (BPD in my opinion), or does not know how to deal with such an issue if it is not her specialty.

What exactly is DBT?

And because there is a No Contact rule intact right now, I cannot ask him, nor tell him... . and I don't even know who his therapist is to make a suggestion. So my hands are tied... . I just know that the 12 week therapy treatment plan is pretty intense (2 days per week or more, with 2 hours per session) - so I'm assuming the therapist may have an idea that there is a deep problem that needs fixing... . *praying*... .

[DontPanic]

DBT stands for dialectical behavioral therapy... here is some info from wikipedia.

"is a therapy designed to help people change patterns of behavior that are not effective, such as self-harm, suicidal thinking and substance abuse. This approach works towards helping people increase their emotional and cognitive regulation by learning about the triggers that lead to reactive states and helping to assess which coping skills to apply in the sequence of events, thoughts, feelings and behaviors that lead to the undesired behavior. DBT assumes that people are doing the best that they can, but either are lacking the skills or are influenced by positive or negative reinforcement that interfere with one’s functioning."

Hope this helps

DP

[LoveLove]

DontPanic,

Thank you, that helps greatly! Although, I don't know of him having suicidal thinking or having the need to self-harm... . yet, he would make comments such as "if I'm not here, no one would care." So there is this feeling of unworthiness... . deep depression.

So DBT is more "talking" and guiding them to better deal with their feelings... . are you aware of how long this treatment plan is?

[Cloudy Days]

From my experience its a life long process, But the actual program takes about a year to get through, but they may need to continue doing it for several years. It's both talk therapy with an individual therapist and a group therapy where the skills are basically taught to a group of people suffering from similar issues. Every person is different and it really depends on how invested they are in changing their attitudes and behaviors. A lot of the time they go and are just going to please someone else so they don't do the actual work that needs to be done, But it does work it just take some time.

[LoveLove]

Cloudy Days,

That's comforting to know, thank you. And I agree, it depends on the individual and how badly they want to "fix" their issue. In my case, it was a huge step that he took to even go to therapy (although I myself am diagnosing him with BPD because he fits everything that is listed). So I suppose time will tell... .

[Cloudy Days]

There are also varying degrees of the disorder, some are more high functioning than others. My husband has been diagnosed with other mental disorders obviously so he seems to be more low functioning. His brother was also diagnosed with BPD and he seems to be much more high functioning and attends regular therapy for it. So success rates are very individualized.

[patientandclear]

LL, I want to suggest that you read The Buddha and the Borderline, a book written by a woman who is diagnosed with BPD and who has made an unusual effort to seek and maintain treatment and change her relationship dynamics.  It may give you a deep appreciation for how profound a challenge this is.  She is at the far far end of the continuum of acceptance of the diagnosis and willingness to let go of counterproductive coping skills, and yet even after years of work, it was very hard for her to fundamentally shift her reactions and behaviors.

Also want to underscore that self-reporting of behaviors by the pwBPD is very unlikely to include a lot of information that would assist a T in diagnosing BPD.  There is a lot of denial, rationalization and projection and this makes it very hard for a T to immediately elicit facts that would support BPD as opposed to other dynamics.

Finally ... . let's say your guy is unusually open, self-perceptive and disclosing with the T.  She identifies BPD, he accepts that and they get right down to it.  He has a lightening fast progress through DBT or another treatment program and gains a lot of insight.

You have to bear in mind that his realizations will apply to all his relationships, not just yours.  You said he had a long term ex who recently was in touch with him asking about trying again.  I think you have to consider the possibility that he will look back on that and other relationships with new eyes if he develops insight about his own r/ship behaviors -- or may want to have a fresh start to apply new skills.  Often pwBPD select partners based on the partners' fit for their unhealthy idealization and coping behaviors -- these are not necessarily the partners they would choose if they were approaching the idea of love in a different paradigm.

I say all of this so you will be realistic as you "wait."  I waited as my ex began to work on these issues with a T.  I believe he bailed before she could get very deep into dealing with his r/ship dynamics, because he suddenly decided the real problem was that he was still in love with his ex before me.  There are many many layers of denial and self-protection at work here if he is BPD.  I would not expect this to be a linear, brief process in which he figures out how to be with you without panicking and you two are able to just pick up where you left off.

Anything could happen, but this is much more complicated and difficult than any of us would prefer.

[LoveLove]

Patientandclear -

Thank you for your insight, very much appreciated. I WAS waiting, however, after reading and talking to people here - I've moved to a "let's see what happens" approach.

However, I will say this, he has not been diagnosed and he doesn't match EVERY trait of BPD as I have continued to read further. For example, fear of abandonment - he didn't want to stop talking to me and for us to part ways, but because of his T's advice, he decided (and was extremely torn in what to do) that he had to follow her advice and do NC. So it has now been 3 weeks since we have had any contact. He even told me that he does not want to make me wait, and that I deserve the best and he hopes I find what I'm looking for. In no way did he make me feel guilty or blame me for what he's going through. He even said "I want to follow through with my therapy, and have a lot of work ahead of me to fix MY issues." - so he acknowledges that it's his issues.

And there was no sudden mood swings... . more so where he became depressed due to freaking out and feeling "trapped" and it slowly went downhill... .

And in week 1 of his therapy (4 weeks ago) he was talking a lot about me in therapy, and hence why the therapist pretty much pushed me out of the picture so that he can focus... .

So the only traits that I'm seeing that fit is that initial start to a very intense relationship full of love... . but then other things aren't completely matching. He expressed to me that he's very "depressed" - and said "I don't know what's wrong with me, but I need help." ... . and a lot of it stemmed from his abusive long term relationship... .

I don't know exactly what to think and don't want to place a label on him since I'm not a professional, but after talking to more and more people here, I feel better about understanding what it MIGHT be... .

And yes, he is very talkative and expressed to me in that first week that his therapist had made him open up about a lot of things he didn't think he was going to talk about. And he chose to go to therapy because he didn't want to run and replace like he had done prior to me... .

Because of NC in place, I don't know his progress and/or how long he'll remain with the T... . but I can only pray for him and hope he gets the help that he needs. There are so many similarities with depression, bipolar, and BPD... . and probably other disorders of the mind... . so I don't want to jump to conclusions either... .

[KateCat]

LoveLove,

I couldn't help but notice that in your introductory post, two days ago, you wrote this: "A number of weeks ago, I met the most amazing man!"

Do you have a sense of why you are so heavily invested in this relationship already? Do you think the "forbidden" aspect in place at the moment might be influencing your emotions? Or do you have your own pattern of quickly establishing strong romantic connections? (Maybe you just "LoveLove," and won't be all that devastated should this current relationship quickly run its course.)

This forum is a great place for us to explore our own patterns and behaviors. You may find one day that this personal exploration becomes even more interesting than all the ins-and-outs of this elusive new fellow.

[LoveLove]

KateCat -

Thank you for your post. I guess I could have written that better and I know misunderstandings can occur through text. I should have written I THOUGHT that I had met the most amazing man - because of that initial and intense love they give.

And yet, my intuition told me that something was off. Yet, another part of you wants to hope that it is genuine. I had my guards up, yet, I went along for the ride. But as I've told others on here, in my case, not all of the traits are met by my ex... . so I do not want to label him since I'm not a professional.

He is in therapy and I can only hope and pray that he is getting the help that he needs for whatever it is that he is suffering from.

Still chilling to know that others experienced similar situations. I'm still trying to learn and understand... . it's definitely not easy.

[KateCat]

 

His therapist might not want him to communicate with the brand new love if he came for treatment for lifelong patterns of poor relationships, but then proved reluctant to discuss his own painful issue and instead said, "Yes, but a number of weeks ago I met the most amazing woman!"

Therapist might want to nip that sort of talk in the bud, because it seems a form of denial rather than tough, productive work. Because whatever happened with past relationships will happen--maybe more quickly--with this new one. And this new one has a good chance of being a fairly minor one in the scheme of his relationship history, you know? The new one is in "Stage One," which is the blissful stage.

My concern for your pretty unique situation (with respect to this communication prohibition) is that you may have experienced "idealization interruptus" -- such that you expect to return to a honeymoon state at some time in the future. You may not even have seen enough  to have a realistic idea of what the  might be for this man.

[LoveLove]

Oh no, no honeymoon period - especially after he is going through therapy now. And I don't even know if I'll hear from him after. I'm content with where I am and simply praying that he gets the help that he needs.

I do understand that the therapist took me out of the picture in order to have him focus on what he needs to "fix"... . at the same time, someone can't completely tell another how they "actually" feel/felt... . whether you're "normal" or have some type of disorder (my opinion).

At the end of the day, he needs to "fix" whatever he needs to "fix" in order to reach a healthy state of mind for his own sake and for his own future.

[KateCat]

Sounds good!

You had also written: "I am waiting." That made me a bit concerned for you.

[LoveLove]

Oh no... . not "waiting" in that sense. More like waiting to see if he receives the help that he was so desperately seeking. And again, I don't even know if he has BPD (since he only matches some traits). So I don't want to label him... . I do care for him, yes. However, it is out of my hands as far as what happens... .

I greatly appreciate your support and words... . it makes it easier understanding what's happening and also helps moving forward. 

[kfifd196]

It all depends what the patient tells the T... . My uBPD wife said Bipolar runs in her family and her mother always hinted to me, that my wife may have that, so that's the first thing, if anything she would mention to a T and the T would probably not even consider BPD then.  Second, I went to 2 T's with my wife for marriage counseling.  I didn't know a thing about BPD prior to being separated, but when we went to the T's, she blamed ME for everything!  The sad thing is the T took her side!  She never once told the T about her rages, abandonment issues, etc.  I brought them up, but they were quickly disguised as being brought on by me.  So, unless the patient comes out and tells the WHOLE truth, nothing can be done.

I work in a firehouse.  Guys send pix of the sports illustrated swimsuit models around by text, etc.  My wife is very beautiful, but very insecure and it triggers her rage tio the point she bit me, did $1000 in damage to the house, etc.  Now she wants a divorce over it.  She's tried to make me stop talking to friends I've had for 35 years, etc and I've only known her for 6 months at that point.  Instead of the T's asking WHY she is triggered so badly, (her reactions don't fit the 'crime', they attacked me and said I HAVE A PROBLEM!  Amazing!  I am the most loyal, caring husband around.  I am a true gentleman... . I hold the  car door everytime, bring flowers, write love notes EVERY morning and do everything MOST women dream of... . And, I never ever considered cheating and have always give her my undivided attention.  So, her fears about me cheating, while may be valid in HER mind, due to her past, are not valid in MINE.  I eventually got tired of incessantly being labled a cheater, porn addict, etc by her, over a few pictures (happened 3-4 times), that I got mad and said hurtful things.  She would go off on a tangent for 24-48 hours over it and finally I would say something back.  (I didn't want to rock the boat).  When I finally reacted, she labled me Passive Aggressive and said I didn't validate her feelings, told the T this and once again, it was MY fault!  She has had problems for 20 years before she met me!  Bad relationships, insecure of other women, abandonment issues, MAJOR Trust issues, etc.  But the T's never pick up on it.  I almost feel like I have to go spell it out for them!  Only 1 T got it and unfortunately we were separated by then and my own T couldn't do anything about it... . Got to get her to a T that knows about BPD... .   Also, I went to another T recently to 'try him out' and he didn't know a thing about BPD... . I had to school him on it!

[LoveLove]

Kfifd196 -

Wow, I'm so sorry - that's incredibly frustrating. You would think that the therapist would know better. I mean they are "trained professionals" - are they not? Hm... . I have my own questions about therapists - but separate topic.

I got a lot of "well my therapist said this about you and it has come true" and "according to my therapist, you are controlling/manipulative"... . um really?

It's unfair because we aren't there to defend ourselves and the patient unfortunately will twist things around to his/her advantage. It's a vicious cycle and you can only hope that the therapist they have chosen is one that can recognize the truth. And the patient fails to take any blame... . everything is our fault apparently.

And wow... . again I'm so sorry for what you went through. I can only imagine what that was like. They create many distorted stories in their own minds. THEY even initiate certain topics, and then say that it was YOU who brought it up and are trying to control things. It's insanity! And unfortunately, most "professionals" actually are not educated in most things (which I would assume they should research if they are in that field). It is like banging your head against the wall over and over again - simply makes no difference.

I cannot understand how in your situation the T wouldn't take your side into consideration. As though the T had an agenda to almost be "friends" with your wife instead of helping her... . hm... .

[kfifd196]

I do tend to think the T will side with the main person or the person that initiated treatment. i.e.  my wife had been going to the T all along and had signed us up with a marriage counselor as well and met with him alone, before we went together.

I wrote my wife love letters every morning, without fail.  I work a 24 hour shift as a firefighter.  I spent a Thursday shoveling snow and working our side biz from home till 2am, then our infant was up all night, so I got up with her to let my uBPD wife rest.  I got up for work at 5:25am after 1 hour of sleep and kissed my wife good by 5 times and left a 7 sentence love note.  Before I left, she said I was being "Cold" at which point I said, "No hun, I'm just exhausted."  I went to work and she laid into me that I was ridiculously cold and I don't validate her feelings, I don't love her, etc... .   She told the T this and I was blamed for not validating her.

A few months before, we went to a family party.  We hadn't argued in 2 months.  On the way home, SHE suggeste we stop at the local Adult Store and buy some toys.  She looked at a few items, suggested Anal Toys (even though she doesn't like anal play) and we went home and had an amazing night.  She didn't complain at all, was in bliss and fell asleep in my arms.  I woke up to her kissing me, still in my arms, saying how great it was to wake up in my arms and how much she really loves me and how happy she is!  I was thrilled.  We had an appointment with our MC and we drove there at 11am... .   We were singing in the car, holding hands, etc.  We sat down in the MC's couch and he asked how things were.  I said "Great!  We haven't argued in 2 months and we're very happy".  My wife's head spun like the Exorcist, she jumped up in a RAGE and screamed at me, "We are?  We are? I should say you raped me last night!"  I almost had a heart attack hearing the word "rape"!  She ranted and the MC stood up and YELLED at her twice, to "Sit down and Shut up"!  I was shocked to hear HIM say that!  She grabbed her stuff and stormed out, leaving me shaking... . She at least waited in the car to drive me home, but we didn't speak for hours!

It came out of no where and that's what's scary   Unfortunately, the MC didn't recognize her as BPD and said we should get divorced.  I didn't like his solution and wished he had referred her to someone else or something.

I went to another MC on my own after we separated and SHE is the one who instantly figured out the BPD.  From that point forward, I read Stop Walking on Eggshells, this site, etc and she is to a TEE BPD!

Now, I just have to get someone to listen to me, to postpone breaking up this marriage.  My wife's biological dad died when she was 7.  He was a drug addict and my wife became an alcoholic, recovered 5 years now.  I think she may have relapsed, cause she said recently, "I've worked so hard to not be this person and now YOU'VE undone all that!" Blaming me... . It was her own insecurities though.   I couldn't go to the hardware store with out a problem or if I didn't answer a text within 5 minutes, she thought I was up to something. 

All she wanted was for our daughter to have a stable loving home and 2 parents, a nuclear family.  She has self-sabotaged "US" and now our daughter won't have that opportunity.  She has split me black and I want to do all I can to save "US".  If I bring up all of the great times we had, she says I'm trying to manipulate or control her.  She's the one doing the controlling, trying to say WHO I can be friends with, control where I am, how long I have to respond to texts and what I can do.  Now she's using the law to control me.  HOW does no one else see this?

[Cloudy Days]

I am currently reading the book "Why does he do that, inside the mind of controlling and abusive men" and I think I know why the Therapist will take the woman's side in some of these cases. When a man is abusive he will throw huge fits and then blame it on the woman, but in public or anywhere else, the man is calm and will act like she has the problem. It comes off almost exactly how a therapy session with a BPD woman would look like. She's the upset one, blaming everything on her partner, makes her partner out to be terrible because she is good at telling the story of how everyone is against her and then the guy is sitting there looking like the sane one and the therapist reads this as him being the abuser because of how the woman is acting. An abusive man holds it together and the woman who is being abused usually acts a bit like a basket case because she's been manipulated and abused for so long, she can't really keep it together. At least that is my theory after reading this book. It says in the book over and over again that Men are rarely abused by women and I'm thinking the entire time, you have not met a BPD woman. But they are mainly focusing on abusive men without mental disorders. I can imagine that the men on this board have had terrible problems dealing with this kind of stigma against them. I honestly think if a therapist is not well versed in BPD behaviors they could deal with them and be oblivious to who they are dealing with. So to me it's important to ask the therapist how much they know about BPD.

[antjs]

after the break up (i have already been through hell at that point) i talked to a very good friend of mine and told him the whole story with all its details. after a whole hour of narrating my story his answer was "i am really sorry antony. google borderline personality disorder and try to read a lot about it. I have been through similar stuff with a girl." I did started reading about BPD. Two weeks then, it was my first therapy session. I told my therapist my whole story without mentioning anything about BPD or what i have been reading. His answer was "first of all i dont want you to blame yourself at all. your ex is psychologically disordered. she has something called borderline personality disorder." I started laughing and crying at the same time and i informed him that i was suspecting so.


BPD is a challenging diagnosis. my therapist (one of the best in the country) told me that they are more of hopeless cases. DBT work for a small percentage of them. Even when successful it can make them suppress their intense emotions. it is not a cure. He told me that counselling with BPD is very hard AS THEY TRY TO MANIPULATE AND SEDUCE THE THERAPISTS.

for god's sake really ! you do try to use techniques on a person that has a phd of the science of these techniques.