Is DBT a non-negotiable?

[Zosima]

No children with my uBPDw, married <1 year, met 2 years ago. My wife has unraveled significantly over the course of the last year and I’m struggling with the decision to stick with her or not. She started DBT a little over 4 months ago but in the last 5 weeks she stopped going to the skills/tools class and is just going to the talk therapy sessions. She had lots of excuses for it, but it comes down to a choice and prioritizing. She has said that those classes trigger the most shame because they seem pathetic. It also comes down to very specific actions—you’re either trying the tools in a spiral or not. She can’t avoid the ambiguity as well with that. Since I found out I’m having a harder time justifying all of the effort I’m putting in. I’m validating and validating, communicating with the SET-UP method, keeping clear, compassionate boundaries, getting therapy… Carrying the weight of this dilemma (compassion vs self-preservation) is brutal, and it’s harder still when she is avoiding treatment and accountability. She’s still very resistant to structured treatment or groups of any kind. She even suggested dropping the frequency of DBT to once every other week. It makes her pleas for me to be patient and insistence that she’s trying everything ring hollow.

Does anyone with experience have any insight as to how important DBT is? I know that if she’s not ready to face it, merely attending won’t help much. But are her hopes for practical things like a job and social circle being the catalyst for change realistic? Or is it just stalling/deflecting? I can hang with her if she’s on the pat past the point of surrender, but I don’t know that I can stay when it’s just enabling avoidance and costing me more than I can afford, financially, emotionally, creatively…

[Notwendy]

Does anyone with experience have any insight as to how important DBT is? I know that if she’s not ready to face it, merely attending won’t help much. But are her hopes for practical things like a job and social circle being the catalyst for change realistic? Or is it just stalling/deflecting? I can hang with her if she’s on the pat past the point of surrender, but I don’t know that I can stay when it’s just enabling avoidance and costing me more than I can afford, financially, emotionally, creatively…

I think each person has to decide on their own deal breakers- what is non negotiable for you. This is your relationship to decide on. If your decision is based on what the other person is doing- that may change, vary, and be confusing.

In the case of therapy for BPD (and for anyone in therapy)- the person needs to be self motivated to do the work. Doing it, going through the motions to meet someone else's deal breaker or expectation is not self motivation. It's also not a fast process. Change takes time. DBT is considered a main therapy for BPD but for any therapy to be effective, the person needs to be willing to work with it.

So rather than focus on DBT as a non negotiable, consider what are your non-negotiables in this relationship in order for you to want to remain in it. At the moment, being recently married without children- the decision to stay or leave is less complicated. Emotionally it's not easy regardless.

Base these on you, not the "you must be in therapy in order for me to stay in this marriage". Her looking at work, or making friends as a catalyst for change- these are external things that neither of you have control over. When she gets a job, when she makes friends- these are not based on your feelings and boundaries.

It is possible for someone to pull it together quickly when motivated, out of fear of losing you. But this isn't long term change. One suggestion is to stop negotiating her staying in therapy with her. This is between her and the therapist. If she's negotiating with you, coming up with reasons to not go to therapy in discussions with you- you aren't the one to make her go. If she wants to stop- she has that choice. But you also have the choice of deciding what you will do if she does. One response might be "honey, I care about you and would like to see you get help,  but whether or not you want to continue therapy- this is between you and the therapist. It's your choice to make".

Look instead at what your non negotiables- a discussion with yourself, not your wife. Don't discuss them with her as they'd sound like threats or ultimatums.

One of yours might be "I need to see her make her own commitment to working with therapy and some kind of progress over the next 6 months" and then reassess. If she's quit therapy and has made no changes- then you can see that too.

Or, you've decided enough is enough at any point, or that you want to have a longer interval to decide. It's actually up to you.

[CC43]

Hi there,

I agree with NotWendy that change is hard, and for change to stick, the motivation should usually come from within.  A constructive internal dialogue for your wife might look like, I'm really unhappy . . . I love my partner and want us to be happy together, but for that to happen, I need to be in a good place first. . . I should give therapy a try because nothing else has seemed to work very well for me, and it's up to me to do this for myself, because I'm worth it, I just need some extra support and tools right now.  BPD is treatable if I have the right attitude, and DBT has a good treatment track record, provided that I give it a chance, and therapy should be my priority right now.

However, the BPD internal dialogue often centers around a victim narrative, which means that she thinks that others are the cause of all her problems.  As a victim, she doesn't need to change, but other people do.  She might agree to "go along with" therapy for a short time, but just to get some sort of concession out of you, and not because she's committed to the process, because her core belief is that she's a victim, and others are perpetrators.  The sad part about this narrative is that she feels helpless, stuck and very unhappy.  After reading these boards, it seems that many BPD sufferers have to "hit bottom" before they are ready to change.  And hitting bottom is not pretty--these boards will have tales of complete alienation from family, substance abuse, couch surfing, evictions and encounters with police. 

[kells76]

To focus on a detail:

Does anyone with experience have any insight as to how important DBT is?

While DBT is one effective modality for BPD, there are others, as well. McLean Hospital's website discusses a couple of other treatments:

McLean’s expert treatment focuses on these proven care models. Our BPD care utilizes dialectical behavior therapy, mentalization-based treatment, transference-focused psychotherapy, and other therapies.

Dialectical behavior therapy (DBT) is the gold standard treatment for BPD. DBT emphasizes the development of four skill sets. These are mindfulness, interpersonal effectiveness, emotion regulation, and distress tolerance.
Mentalization-based treatment (MBT) helps patients stabilize their sense of self, with the goal of improving interpersonal and relationship skills and reducing self-destructive behaviors.
Transference-focused psychotherapy (TFP) focuses on a patient’s contradictory sense of identity. This is associated with problems with interpersonal relationships, self-esteem, and mood regulation.
In addition to therapies that address BPD, group and individual therapy cover a broad range of topics. These can include mindfulness, interpersonal effectiveness, distress tolerance, emotion regulation, and family issues.

They also have a brief discussion of GPM (General Psychiatric Management) as another option.

So, I would maybe not frame the question as "DBT or nothing", as like Notwendy highlighted,

In the case of therapy for BPD (and for anyone in therapy)- the person needs to be self motivated to do the work. Doing it, going through the motions to meet someone else's deal breaker or expectation is not self motivation. It's also not a fast process. Change takes time. DBT is considered a main therapy for BPD but for any therapy to be effective, the person needs to be willing to work with it.

it's less about "how can I make her stick with DBT specifically" and more about "I want for her to be engaged with and trusting a competent therapist, of her own volition".

I'm curious if you've looked into DBT clinic guidelines and client rules? Here is an example -- might have some helpful insights about what's realistic to expect, as you are deciding what you are OK with in your life and relationship:

https://www.lenapevf.org/wp-content/uploads/2020/06/DBT-FAQs.pdf

[CC43]

Sorry, I didn't mean to end my reply on a dour note.

Anyway, I've found that with the BPD and NPD in my life, progress doesn't happen in a straight line; rather there have been some baby steps forward and some setbacks, too.  I find that it has been helpful to think in terms of being "on track."  In other words, the direction of movement is more important than speed.  At first, positive change can be slow, but I looked for baby steps in the right direction.  An initial sign of staying on track would be to set and KEEP therapy appointments (i.e. not skipping therapy or dropping out of programs).  Another baby step might be improving one or two daily habits (like observing regular bedtimes, making the bed in the morning, eating at mealtimes, getting exercise, tending to plants or pets, etc.).  Then a baby step might be refraining from meltdowns/lashings out/self-harm, leading to a period of relative stabilization.  After stabilization, another baby step might involve the social sphere, like making a friend or engaging in a social endeavor from time to time.  Then I've seen some baby steps in the academic/professional sphere, like taking an online class or training program, or starting an easy part-time job.  I guess my point is to allow her to tackle one or two small changes at a time.  In the case of the BPD person in my life, once she made a few small changes, she built up her self-confidence and positive momentum, and bigger changes came seemingly quickly after that.  Now, I'm not saying she's conquered BPD completely; she still has high emotional reactivity and negative thinking patterns.  Sometimes temporary "derailments" happen, but the key is that they have been temporary.  I think she realizes now how to counteract those derailments before she spirals out of control into a pit of despair, because she doesn't want to go back there.  Sometimes we remind her, don't ruminate on past grievances, you did that miserable victim routine for years, and that has nothing to do with your life NOW, right?  Today, she's better able to reflect, rely on her DBT tools/strategies and get back "on track" much faster.  Does that make any sense?

That's a long-winded way of saying, thinking in terms of being "on track" might help you in your decisioning.  In other words, BOTH of you should be working towards a happier relationship, not just you.  That likely involves therapy in the short term, but it could take some time to find a therapist your wife trusts, and therapy might not last forever.  I like how NotWendy put it:  I need to she her commit to therapy and make some progress, and then in X months I'll reassess . . .

All my best to you.

[Zosima]

Thank you all so much for your thoughtful answers. My main takeaways were:

- focus more on my needs and just observe if she is doing that, rather than trying to encourage her to do it

- look for signs that she is "on track," leaving room for small setbacks

I fear that I can't afford to be in this dynamic for years (emotionally, financially, and in terms of the cost to my energy and career). If she was at least at the point of acceptance/surrender and was committed to a program I could hope more and believe we're in it together. But she's still deflecting a lot and resists acknowledging the reality of the problem, and it leaves me holding this together alone.

I've already been observing her with DBT for 4+ months and she's excusing skipping skills classes and talking about wanting to do DBT only once every other week. It was interesting to read those DBT clinic guidelines that kells76 shared. They said that if a client skips 4 consecutive classes or 6 total they are dropped from the program because regular attendance is necessary for progress. I often second guess myself, so it was nice to see my opinion mirrored by an official source.

I think it's absolutely true that real change comes from within when someone is ready for that, and I respect her personal path. I have hoped that she was ready and I have tried to support and encourage as much as I can, while caring for myself to be able to endure for as long as necessary. But the refusal to acknowledge the reality of the problem and deflect to ambiguous, inconsistent practical solutions is so at odds with the kind of clarity and honesty that I seek and am drawn to, it feels like that's my non-negotiable. I can respect that she may still be on "the path," just at an earlier stage, but it's very uncomfortable for me to walk on eggshells and be complicit in her self-deceit. I understand and empathize, but it's the opposite of what I've been longing for and working toward my entire life, and at 38 I don't feel like I have the time, not to mention the energy, to wait for change without signs of commitment.

[Notwendy]

I fear that I can't afford to be in this dynamic for years (emotionally, financially, and in terms of the cost to my energy and career). If she was at least at the point of acceptance/surrender and was committed to a program I could hope more and believe we're in it together. But she's still deflecting a lot and resists acknowledging the reality of the problem, and it leaves me holding this together alone.

I don't think there's a " specific time" to make the decision to leave the relationship if that is what you are considering. You are looking at her progress at change to determine this. "If she did this" or "if she doesn't do that".

IMHO, I think you will need to determine when or if it's time- you're running low on finances, patience, and don't want this for the long run. Both decisions- to stay or leave are challenging. The default- do nothing- and wait - is also a decision. What you are saying is that you don't want to remain in "default" for long but you also will be the one to determine when/if that changes.

It may help for you to get some counseling- someone to work through your own feelings with you and emotional support as you arrive at the decision of your choice.

[ForeverDad]

I had been married for over a decade and experienced my spouse going from a happy person to one increasingly troubled over the years by perceived hurts and Borderline-like traits.  Like most here, I didn't have confirmation of a diagnosis so I was left to make my own conclusion, which is why I use the generic phrase "BPD traits".  That is as far as I can go, that something sabotaged my marriage.  (As I look back, I concluded that what made it worse and triggered a sooner showdown of sorts was when I cluelessly had the otherwise wonderful idea that if we had a child then she'd be happy again watching a new life discover life.  I didn't realize that one of her biggest traumas was with an abusive stepfather so when I became a father she couldn't separate her experiences with me as a husband from her experiences with her stepfather in her childhood.)

That is why I recommend during this time you are observing whether she reaches a sufficient measure of recovery from BPD perceptions and behavior... please be the one to be in charge of contraception.  If she has your child before you are confident the marriage has a future, then you'll feel more obligated (stuck) with her.
BPD FOG = Fear, Obligation, Guilt

To my knowledge, my ex has never had therapy.  Although eventually one of our court magistrates wrote that she needed counseling, it was never ordered.  Family courts are there to referee management or ending of these relationships, they're not there to "fix" mental health issues.

Marsha Linehan developed much of the DBT therapeutic approach.  Late in life she surprised everyone when she revealed that with guidance and effort she had overcome BPD.

https://www.nytimes.com/2011/06/23/health/23lives.html

[BlueNavigator]

This is something I went through with my spouse; her BPD behaviors were affecting the kids, and I was reaching the end of my rope. I didn't give a specific ultimatum, but, after talking it over with my parents and a religious leader, I let her know that if her behavior didn't change, I wouldn't stay. I don't think it would be helpful to connect it specifically to therapy attendance because that's not the root of the problem, it's actually the behavior that's preventing you from having a good relationship.

[Zosima]

Thanks again for more feedback. I can see how pressing for something specific can be tougher than just generally looking for behavior change and momentum.

I’m a bit shell shocked tonight after my wife had her biggest spiral by far. It started earlier in the day with typical spiral and a lot of resentment directed at me, but later she felt ashamed of herself and was trying to get me to reassure her and still perform as if everything was totally ok. When I refused she tried to block me from leaving the bedroom, sat in front of the door stomping her feet yelling and crying that she can’t take the tension anymore. Then she was following me through the apartment as I gathered some things to go out (setting a boundary because she won’t stop escalating and take a break)begging me not to leave her, jumping up and down and stomping on the floor. She said she wanted to take 10 sleeping pills to erase the day and skip to tomorrow. The sound of her wailing and stomping or hitting stuff as I closed the door behind me gave me chills. I truly felt terror like I’ve never felt before during this whole thing. I’m afraid to leave now. 

I did notify her DBT center about the sleeping pills comment, talked with my therapist, and sent her the suicide crisis number, and made it clear that I will call them the next time myself. It was the first time she’s said anything like that.

Still in a daze a bit. Not to dramatize it so much, I’m sure people here have been through much worse… But it was frightening and so so sad.

[ForeverDad]

I feel for you, I am so reminded of the last couple years of my marriage.  I lived with the rants, rages, sobbing, slammed doors, many late night ultimatums "we will fix this, now!", destroyed computers and cables and mice, blocking me from moving around or leaving the house, shaming me with sexual taunts, badmouthing me to our toddler, etc.  Yet friends and family outside the privacy of our home or car never saw but the edges of all that.

My then-spouse could control herself with others but not me.  That's a hallmark trait of Borderline... the closer the relationship, the more intense and impactful the dysfunction.  BPD is a disorder most impacting to close relationships.  Others on the periphery may only see something "off" but it doesn't impact their lives very much.

My ex didn't have the benefit of therapy, she refused it outright and no one supported me in getting it started, not even after we separated.  The tensions grew and grew in those final months until, for the first time, I called the police.  Of course she tried to blame me as the problem person, I was almost carted off* until the officers realized my preschooler wouldn't leave my arms.  It really was a lifesaver that I had a recording of her death threats that day, it prevented her from alleging I was the aggressive one .

* The police will not "fix" the problem either.  Their concern is to address the immediate issues of the conflict itself.  That's to separate the ones in the "incident" so they'll hopefully calm down.  Likely you know that it's the man who gets carted off, either elsewhere or to jail.

Continuing my story, there were two surprises.  Once we separated and I eventually realized it was time for divorce, we never lived together again.  And I never again saw her sobbing and moaning ever again, as though a switch was flipped.  Whether she ever did that with other people, I don't know.  Of course I was painted as Mr Evil Personified for many years until we got a parenting order that worked and my son was in middle school.  (I concluded that her issues were that I had become a father, reminding her of her childhood traumas.  Your spouse's traumas, triggers and issues may be different.)

My second surprise was that for the first week after separation I had our preschooler with me - I had a protective order and she was facing Threat of DV charge - and I was surprised that the little tyke never sought his mother.   In fact, when I was clueless again (that dang sabotaging fairness instinct we here have) and mentioned his mother when we were making cookies, he redirected me to keep mixing the batter.  He knew I wasn't the cause of of the chaos and conflict.  I was his safe place in her stormy life.

What your experience turns out to be cannot be predicted.  She may manage to reach a measure of recovery.  If so, good.  But I wouldn't hold your breath.  You have a slight advantage over me, you have established a history of her mental health issues to the professionals.  But even with that you still need to protect yourself legally, financially and emotionally.  It is so easy for disordered women/mothers to allege DV or child abuse/neglect and men are too easily cast as the default perps.  I recorded my interactions before and after our lives together and though she did make allegations, those recordings managed to minimize the worst of her claims until she lost most of her credibility.  Be aware and beware.