How effective is therapy?

[littlebirdcline]

kthomas posted about their family member they suspect has BPD who has been diagnosed bipolar, and it brought up something I've been wondering about for awhile... .

I have absolutely zero hope that my BPDm will go into therapy, but I have wondered if she did, if it would even work.  She is very good at manipulating and appearing "normal" to people outside the family.  When I told my friends about all this in the last year, those who have known her for years were shocked (except for my best friend).  I feel certain if she went to therapy, she would not answer truthfully, and if no one was there to present an opposing view, she could "game the system". 

My therapist also told me that BPD is a giant red flag for most therapists.  She said if she called a colleague and said she had a patient she'd like to send them with BPD, they would say they didn't have the time; but if she called them a "trauma victim", they would take them.  Apparently, most therapists find BPD so frustrating they don't even want to try. 

Thoughts?

[Kwamina]

Hi littlebirdcline

Thanks for starting this thread. The unfortunate reality for many children of BPD parents on this message board, is that their BPD parent often doesn't admit to any wrongdoings and/or refuses to seek help. There are however also many people with BPD who through therapy have learned to better manage their difficult thoughts and emotions. As a result they have been able to improve and sometimes drastically improve their behavior. For this to happen, it is essential that the person with BPD fully acknowledges that he or she has a problem and is fully committed to working on his or her issues (through therapy etc.).

When you consider your own mother, do you feel like she in any way has ever acknowledged that there might be something wrong with her behavior? Has your mother ever hinted that she would be willing to at least consider going into therapy?

My therapist also told me that BPD is a giant red flag for most therapists.  She said if she called a colleague and said she had a patient she'd like to send them with BPD, they would say they didn't have the time; but if she called them a "trauma victim", they would take them.  Apparently, most therapists find BPD so frustrating they don't even want to try.  

I am familiar with similar stories. There is no denying that BPD is a very challenging disorder also for the therapists treating patients with this disorder. That's why it's very important that therapists treating patients with BPD are specifically trained to deal with this disorder so they are prepared and know how to handle the difficult situations that might occur. BPD requires targeted treatment and that requires targeted training for the professionals administering the treatment.

[littlebirdcline]

Kwamina-

My mother has flatly refused to see a therapist.  She has a fear of all doctors, and therapists most especially.   She thinks it's ridiculous that I see one.  She believes it's just that our "personalities clash" and I don't allow her to just be herself.  She sees nothing wrong in her behavior at all.  She has made it very clear that I am the bad guy in the situation.  My brother believes that if she went to therapy it would "break her", so even though he acknowledges to me that she is ill, he will not confront her.  My father just says whatever he has to so that she doesn't turn on him. If she ever did go to a therapist, I think I would seriously pass out.  

Her belief that she is always right and everyone else is out to get her is so entrenched I cannot even do the techniques with her.  Any attempt on my part to alter the parameters of our relationship is seen as an attack- even just avoiding an argument by saying, "I have to go; I'll talk to you later" is seen as confrontational.   If I want to have a relationship with her, I will have to apologize, take all blame, say that I was wrong about her, and then grovel and have it thrown up in my face for the rest of my life.  The thought of that makes me nauseous, so I have basically given up on trying to fix it.  I know that's not the ideal, but I just don't see any other way at the moment.  

I would add that while I know that people can have BPD that had very normal childhoods, my mother has had tremendous amounts of trauma in her life, and I completely see how it would make her the way she is.  My brother and I have used that as an excuse for her our entire lives.  We felt so bad that she had such a terrible childhood that we felt sorry for her and let her go.  I feel guilty that my compassion for her seems to have run out, or at least diminished to the point that I cannot make excuses for her anymore.  I am so sorry that she had to go through all those things, but I was not responsible.  I cannot be responsible for filling that void for her.  I can't sacrifice my mental health- and my husband and son's happiness- because she is trapped at the emotional level of a small child.  And even as I write that, I feel a pang of guilt because I am abandoning her just like everyone else has done.  It is a vicious cycle.

Sorry for all the rambling.  Thanks for all your help and feedback.  

[clljhns]

  littlebirdcline,

She thinks it's ridiculous that I see one.  She believes it's just that our "personalities clash" and I don't allow her to just be herself.  She sees nothing wrong in her behavior at all.  She has made it very clear that I am the bad guy in the situation.  My brother believes that if she went to therapy it would "break her", so even though he acknowledges to me that she is ill, he will not confront her.  My father just says whatever he has to so that she doesn't turn on him. If she ever did go to a therapist, I think I would seriously pass out. 

I see the same in my uBPDmom. I also felt sorry for her for many years and gave her many outs because of her abusive childhood, so I understand where you are coming from. I had to make a choice for me. I chose to be healthy and sought out therapy. I did feel guilty for wanting to be apart from my parents and choosing to get healthy without them. But, if I had not done this, I truly believe that I would still be in an unhappy place.

I am so sorry that she had to go through all those things, but I was not responsible.  I cannot be responsible for filling that void for her.  I can't sacrifice my mental health- and my husband and son's happiness- because she is trapped at the emotional level of a small child.  And even as I write that, I feel a pang of guilt because I am abandoning her just like everyone else has done.  It is a vicious cycle.

I hear how much you love and care for your mom. I am glad that you see that you are not responsible for her well being. This is her choice. As much as it pains you to watch this, you are making the right choice to take care of yourself and family.

Wishing you all the best. 

[Kwamina]

Hi littlebirdcline

I have basically given up on trying to fix it.  I know that's not the ideal, but I just don't see any other way at the moment.  

It's a harsh reality indeed, but is what it is. You didn't cause this 'problem' and aren't responsible for fixing it. You can help but ultimately, your mother will only change if she wants to. If she's able to reach a point that she acknowledges her issues and is willing to commit to getting better. I say if 'she wants to', but another important thing to also keep in mind is that BPD is a disorder and people with this disorder basically lack certain skills or abilities which would allow them to handle situations differently. It isn't even always that they want to behave in a certain way, but also that they lack the skills to behave in a more productive manner. This doesn't change the fact that the behavior of our BPD family-members can still be very unpleasant, but I do think that looking at it like this does help us get a better understanding of what we are dealing with here.

I would add that while I know that people can have BPD that had very normal childhoods, my mother has had tremendous amounts of trauma in her life, and I completely see how it would make her the way she is.  My brother and I have used that as an excuse for her our entire lives.  We felt so bad that she had such a terrible childhood that we felt sorry for her and let her go.  I feel guilty that my compassion for her seems to have run out, or at least diminished to the point that I cannot make excuses for her anymore.  I am so sorry that she had to go through all those things, but I was not responsible.  I cannot be responsible for filling that void for her.  I can't sacrifice my mental health- and my husband and son's happiness- because she is trapped at the emotional level of a small child.  And even as I write that, I feel a pang of guilt because I am abandoning her just like everyone else has done.  It is a vicious cycle.

I think it's great that you've been able to have compassion for your mother and recognize the traumatic experiences she's been through. But as you state yourself, you weren't responsible for those experiences. Taking good care of yourself is very important to help yourself get through all of this. It might feel like abandoning your mother, but if you didn't take good care of yourself, you could also say that you were abandoning yourself. Would that also make you feel guilty? Was guilt perhaps something your mother used to get you to do what she wanted? Or do you feel like your guilt comes more from your knowledge of all the traumatic experiences your mother has had and the people that actually have abandoned her?

[Turkish]

My mother went into nervous breakdown mode as I was about to leave the house. Despite losing a nice 25 acre parcel of land in foreclosure (after having had to "short sell" our home in the city less than two years previously) due to her depression and losing her job, she coped for a few more years. I moved out on my 18th birthday. That was a horrible summer. I remember she coming to me in tears and telling me to hide her Prozac, because it was messing her up even more.

I left, and the years went by... .I knew she was still in therapy. She told me later that she went through about 7 therapists before she found one that she liked. I had moved an hour away, then 2.5 hours away, so I was unavailable mostly. She told me about being diagnosed as a "high functioning" depressive. She scoffed at the "high functioning" label (as did I... .in a validating way). I think this was because while she had SI, she never made a suicide attempt as far as I knew. That was over 20 years ago.

I know that eventually she was put on a med cocktail that seemed to stabilize her for the most part. Just this past summer, she shared with me things about her father that I never knew (like the thing about him moving in prostitutes into their home after her mom died---- the older siblings had all long left the house, leaving my mom alone with her sexual predator father). She talked about BPD, having said about my Ex, "of course she's BPD!" My mom's a registered nurse. Then a few months later, she shared that her T had given her a book about BPD. She thought at first to understand her likely BPD father, but then my mom realized that the T was suggesting in a gentle way that my mom was BPD. My mom accepts that she is BPD now, but not being officially diagnosed, isn't in treatment AFAIK.

She's utterly computer illiterate, so I can't even point her to online resources like dbtselfhelp. She went Full Waif (never go Full Waif) when a local computer coach, who had a good reputation in the small town for being able to teach elderly computer illiterate people how to use PCs. The guy basically said, "I can't teach you," at least that's what she told me. So I guess it wasn't just me, which she told me years earlier when I tried to have her do simple web browsing. 

So, my mom copes, going from barely surviving emotionally to doing ok. I don't know how much she still goes to therapy. Logistically, her life is a mess, being a hoarder, but I can't fix that, even if sometimes I think I should take a video and send it into that tv show.

[Harri]

Hi Littlebird.  

My therapist also told me that BPD is a giant red flag for most therapists.  She said if she called a colleague and said she had a patient she'd like to send them with BPD, they would say they didn't have the time; but if she called them a "trauma victim", they would take them.  Apparently, most therapists find BPD so frustrating they don't even want to try.

I have heard and read this too, though it does seem the tides are changing a bit.  

I always have two questions regarding therapy:

1) since there are over 200 (256?) possible combinations of behaviors that can cause a person to be diagnosed with BPD (according to the DSM V) are there certain criteria that are more responsive to treatment than others?  For example, is suicidal behaviors or threats easier to treat than say impulsive behavior?

2) If someone only ticks off 4 of the 9 diagnostic criteria after treatment, are they really 'cured'?  It seems to me that depending on which 4 criteria a person has, they can still be quite disordered making life for them and those who interact with them quite unpleasant at the very least.

I feel guilty that my compassion for her seems to have run out, or at least diminished to the point that I cannot make excuses for her anymore.  I am so sorry that she had to go through all those things, but I was not responsible.  I cannot be responsible for filling that void for her.  I can't sacrifice my mental health- and my husband and son's happiness- because she is trapped at the emotional level of a small child.  And even as I write that, I feel a pang of guilt because I am abandoning her just like everyone else has done.  It is a vicious cycle.

Perhaps, rather than having run out of compassion, your compassion has moved into a more healthy arena?  One that acknowledges she had a rough childhood, but also acknowledges that she does have the power and the ability to change and heal herself?  One that allows you to let her be who she is while taking care of yourself and giving yourself as much if not more love and compassion even if that means she is left to deal (or not deal) with the consequences of her own behaviors?

[Suzn]

My therapist also told me that BPD is a giant red flag for most therapists.  She said if she called a colleague and said she had a patient she'd like to send them with BPD, they would say they didn't have the time; but if she called them a "trauma victim", they would take them.  Apparently, most therapists find BPD so frustrating they don't even want to try. 

My T told me something similar. She treats patients with BPD though. She said she can only treat a couple at a time because it's too draining.

I feel guilty that my compassion for her seems to have run out, or at least diminished to the point that I cannot make excuses for her anymore.  I am so sorry that she had to go through all those things, but I was not responsible.  I cannot be responsible for filling that void for her.  I can't sacrifice my mental health- and my husband and son's happiness- because she is trapped at the emotional level of a small child.  And even as I write that, I feel a pang of guilt because I am abandoning her just like everyone else has done.  It is a vicious cycle.

Perhaps, rather than having run out of compassion, your compassion has moved into a more healthy arena?  One that acknowledges she had a rough childhood, but also acknowledges that she does have the power and the ability to change and heal herself?  One that allows you to let her be who she is while taking care of yourself and giving yourself as much if not more love and compassion even if that means she is left to deal (or not deal) with the consequences of her own behaviors?

Littlebird I can totally relate to you feeling the loss of your compassion. That is exactly how I am feeling right now. I have a hard time thinking of her crying and now being too angry to fix it like I've done in the past. Total codependent behavior on my part prior.

And Harri I am so glad I saw your comment tonight, very well written. Wow, I needed to hear that. Thank you.