What does it mean for a pwBPD to be working on improving?

[flourdust]

My BPDw has seen a variety of mental health workers for pretty much her whole life -- for depression, anxiety, post-TBI recovery, and most recently for BPD.

She's currently in a DBT group that meets for nine hours/week as well as spending an hour with her own therapist. She claims to be working "incredibly hard" to make changes. As my posts here have shown, I haven't seen any noticeable improvement in her interactions with me.

When we talk about BPD and her program, she becomes belligerent and defensive. She says she's working incredibly hard, that she is making hundreds of changes while I don't have to change anything about herself, and so on.

I tend to think that while she is certainly going to her appointments faithfully and probably participating fully, that doesn't mean she's actually recognizing what her problems are and working to address those problems. I think she's comfortable in the therapeutic environment, speaking the language, talking about the skills with her group, but is resistant to using them where they matter.

Is it fair to say that in order for pwBPD to improve, they need to not only a) accept their diagnosis and b) participate in treatment, but c) be able to recognize their responsibility for harmful behaviors, and d) be working on changing those harmful behaviors? I usually see a & b described here as the conditions for improvement, but my wife seems to be doing a & b but denying c and avoiding d. Thoughts?

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[AsGoodAsItGets]

Wow, you are bring up a great topic.  Wish I could add something of value to it.  My ex did get help, but it really just helped her take less risk, and function in society better, not much with love or empathy. 

[EaglesJuju]

Hi flourdust,

I can imagine how frustrating to feel as if your wife is not improving with all her treatment. 

To your wife's credit, she is taking the initiative to work on herself. I do not know how long she has been going, but it takes awhile to fix behavior that you have engaged in your entire life. It a process of baby steps.

Recognizing her problems is something that she is most likely working on in her DBT group.

PwBPD tend to have problems with shame. Someone who feels so much shame tends to avoid things that make them feel shameful. That is something that gets addressed in DBT. That may take awhile as well.

Do you see any positive improvements?

[flourdust]

Honestly, no. She's mentioned how she has used DBT skills in other settings. I can't confirm or deny that. Her major problem right now is her emotional regulation and cognitive distortions with me and D10, and there we haven't seen any improvement.

[EaglesJuju]

Honestly, no. She's mentioned how she has used DBT skills in other settings. I can't confirm or deny that. Her major problem right now is her emotional regulation and cognitive distortions with me and D10, and there we haven't seen any improvement.

One of the hardest things for pwBPD is close relationships. I wager she is able to use her skills in other settings because she does not have the emotional attachment like she does with you and your daughter. 

How long has she been going?

[flourdust]

Honestly, no. She's mentioned how she has used DBT skills in other settings. I can't confirm or deny that. Her major problem right now is her emotional regulation and cognitive distortions with me and D10, and there we haven't seen any improvement.

One of the hardest things for pwBPD is close relationships. I wager she is able to use her skills in other settings because she does not have the emotional attachment like she does with you and your daughter. 

How long has she been going?

You're most likely correct. Her mother wants her to go to an inpatient or partial hospitalization program in another state, where she can work on her therapy without returning to the home environment every night.

She's been in DBT for about six months -- and in individual therapy of various flavors for many, many years.

[maxsterling]

A couple of thoughts spring to mind - are you absolutely sure she is going, and not just telling you that?  I'm not insinuating anything here, but pwBPD are known to "bend the truth" to try and please others.

Have you noticed any improvement - at all?  Even something small.  What got her into DBT - was there a particular behavior or incident?

Change for someone with more severe BPD probably takes a loong time.   Think of it this way - a person with BPD tends to carry behavioral characteristics of a 5 year old child.  It takes that child another 15 years to really act like an adult.  It may take years, not weeks, before things really start to change.  

My wife was in intensive DBT for over a year.  This began after a lengthy hospitalization following a suicide attempt and extreme drug abuse.  She claims this made a huge difference for her.  If that is the case, I can't imagine how bad she was before, because she still easily meets all 9 criteria for BPD diagnosis.  But there has been one very significant change - she has been sober for 12 years.  That's a pretty major accomplishment.  Other than that, she still hasn't manage to hold a job, still gets in financial trouble, still can't make and keep friends, and still thinks of suicide.  

I know how badly you want to see major progress.   I think it may help to lower expectations and look for smaller changes, and do your best to stay out of her business regarding therapy.  She needs to progress at her own rate, and nothing you can do or say on your end will change that.

[flourdust]

A couple of thoughts spring to mind - are you absolutely sure she is going, and not just telling you that?  I'm not insinuating anything here, but pwBPD are known to "bend the truth" to try and please others.

Pretty much. I suspect she skipped one day, but I get the itemized bills, so if she was missing a lot of days, it would appear in the paperwork. The DBT also has a strict attendance policy and will put people on various punitive contracts if they're engaging in "treatment-interfering behaviors" like tardiness and absenteeism.

Have you noticed any improvement - at all?  Even something small.  What got her into DBT - was there a particular behavior or incident?

Well, she knows the DBT language now and sometimes says that she is using her skills to avoid blowing up at me at a particular moment. She does blow up at me practically every day, nonetheless, and I can't see that the frequency has notably decreased.

She entered the program last spring on the recommendation of her psychologist with my support. We had been through about six months of worsening problems with her mental state, dysregulation, conflict at home, etc. that I thought might be due to medication changes. BPD wasn't really on my radar, but I thought she was dealing with TBI anger and possibly bipolar disorder. We also started marriage counseling on her insistence at that time. I didn't really learn about BPD until she was given that diagnosis at intake, and it wasn't until a few months later that I actually started to research it.

I know how badly you want to see major progress.   I think it may help to lower expectations and look for smaller changes, and do your best to stay out of her business regarding therapy.  She needs to progress at her own rate, and nothing you can do or say on your end will change that.

True, although she is likely to "graduate" from the DBT program in a few months. They like to get people out at 9-12 months, and she portrays herself as being viewed by the program staff as very successful.

[teapay]

Flourdust, I can usually relate to your posts greatly.  Our wives sound similar and are at similiar stages of recovery in therapy and DBT  Although she says she is working hard and therapy has helped her alot, I can't say I've received alot of benefit from it, but I guess it could be much worse.  Her long time therapist finally asked her not to return a few weeks ago, because they were fighting and she was not making progress according to the T, so it's hard to make much sense of it.

My expectations of therapy tend to be on the low side for the marriage relationship, because I see the DBT and other therapy mainly for her and not the r/s.  It is kind of a wild card for the relationship.  It could pull it together or drive it apart.  My wife entered the marriage with alot of extreme mirroring and other hefty classic BPD baggage we were both ignorant of.  She has journals of our courtship and earlier marriage that are fascinating to read.  Wonderful entries during courtship, then about week 3 after the wedding it changed.  She's entering how she is attacking me, doesn't know why, can't stop, pleading to God for help to stop, doesnt know who she is.  It has been like that for the last 12 years.  I think the woman who we both thought entered the marriage didn't really exist.  I look at the DBT as a hail Mary to calm the internal storm, so the trauma, shame, insecurity and identity issues can maybe be resolved.  The person that emerges from that still won't be the woman that ended the marriage, so it hard to say whether the relationship can Isurvive that.  Even though my expectations are low, my hope is that we can just stem the tide of constant crisises.  Another trip to ER 2 days ago for a bad cut.  I'm still waiting for lull that to happen.

[Heartbroken5]

flourdust I usually read posts occasionally reply as I am still so emotionally exhausted from my relationship.On reading your post I could identify with a lot things you said so i would like to share some of my experiences as if  ihad known way back what i know now I would have saved my energy for me... I was with my husband 30 years stood by him through a lot of challenging ,explosive situations with his family of orgin,myself and the children always came last but despite this i loved /adored him always felt our day would come that he would put us first.We lived next door to his families farm where he worked -minded his abusive father who had dementia until he died.I always made excuses or believed his lies why he was moody,angry,withdrawn I always felt sorry for him that maybe if he could express himself better ,get therapy etc... .Well when I eventually had to ask him to leave as he had started to get physically abusive this was following years of emotional and psychological abuse he moved next door to the farm house where he has lived ever since .We recycled 3 times with each recycle he became less respectful more passive aggressive even though he engaged in therapy ,marraige counselling,family therapy and under went a stay in a psychiatric hospital for 6 months he has now withdrawn completely from my live ,he sees the children when it suits him ,doesnt involve them in his life manipulates them with money ,functions very well socially ,works but refuses to give me money towards the childrens maintenance.Sorry for making this so long winded but I feel i have helped him become a better person for someone else to benefit from it .My husband at one stage apologised to me for all he had put me and the children through when i asked him to give me an example he wasnt able to tell me because he didnt genuinely feel remorse he had heard someone else say it in therapy.he learnt a whole lot of ways to express himself but was still using it to manipulate so instead of how he use to orginally react eg... aggressively,dismissive ,avoidant he was now able to sound rational and logical but he didnt mean what he said .Trust your gut instinct ,know that if someone really loves you and wants to be with you they will do whatever it takes to do so ,we should not have to spoon feed them.I stayed for so long hoping he would change not believing for a minute that he would discard us like he has ,the hurt and pain is imeasurable.IN the process I was making him a better person.Mind yourself you deserve so much more.

[maxsterling]

Another thought here - I sometimes feel my wife uses what she learned in DBT in reverse.  It's basically given her more reasons to blame others.  She now "expects" other people to validate her.  If they don't she paints them black.  She also uses the fact that she goes through all this therapy as a way of pointing out other's flaws.  "I am capable of doing all this work on myself, what are you doing?".  She projects.  She tries to claim her dad is depressed and miserable and needs as much therapy as her.  I don't see it.  In other words, years of 12-step programs and T only helped my wife see the ways in which other people have problems.