Lot of great questions and stuff to discuss in your post.
My BPDw sees a therapist for 30 minutes every other week. To his credit, he was quickly able to diagnose her, as I suspected BPD for at least a decade. Regardless, I feel like this is the equivalent of training for a marathon by going for a brisk walk on Sunday morning.
I'm looking at a career change and while unlikely, there is a small chance that I may need to pass a physical fitness test. My baseline is good but many others would be starting from zero. I Googled around to see what people going into this field typically do for training to pass the test, and many replies were "do the Couch To 5K program". This takes you from a "couch potato" (unable to run, or never have run) on day 1 to jogging for 30 minutes straight in week 9... but for all of week 1, you spend most of your time walking.
So, while it's not what we'd want, 30 min of therapy EOW is a start. We get to marathons by walking.
That's not to say that she's committed to change; only time will tell what her overall trajectory is, and what her motivation is. Just to say that if she's been essentially untreated for nearly 2 decades, she can't run a marathon right out of the gates, and she might not even have the skills (that you and I have) to tolerate the discomfort of therapy for an hour once a week. If her T really "has her number" then he may be being very deliberate in not overwhelming her, and laying a strong foundation of trust before pushing. He can't help her if she isn't there.
Hard to know -- I'm not there, and you know her better than anyone else -- but not impossible that that's what's going on.
Also important to know that unless you're in the session, you don't really know what they're talking about, either. She may come back and tell you "he just asks me how things have been" but unless you are in person hearing that, it could be anything else. They could be working on some shame stuff but she can't pull herself together to tell you. Recall that pwBPD lack even basic emotional management skills -- stuff you and I may take for granted. Trustbuilding and basic skillbuilding often have to happen in therapy before the pwBPD has the tools to address bigger behaviors.
Their sessions have no apparent structure. They seem to be along the lines of, "How are things, lately?" She has gotten some coping advice, but there doesn't seem to be any structured approach toward DBT progress or even for her to really understand what BPD is.
Again, hard to say based on this point in time how things will go. It's possible she found a "yes-man" therapist who doesn't want to rock the boat... it's possible she found a really canny T who absolutely understands what the deal is, and knows to go slowly.
Either way, there's a sense in which her understanding what BPD is, is not important... not as important as her having the tools and stability to work on
behaviors that negatively effect her life and her family.
To me, that ties in to a book that I'd strongly recommend you check out (if you haven't already): "
I am Not Sick I Don't Need Help! by Dr. Xavier Amador.
While he wrote it with schizophrenia in view (his late brother had it), the concepts apply to many mental health issues, and the one that really stuck out to me was:
people get help for things that
they experience as problems, not things that
we experience as problems.
This is a problem for you, not for her:
Over the course of 6 months, she independently worked through a DBT workbook and has used techniques with a little bit of success. She has some degree of self-motivation to improve, but doesn't grasp how critically important full transformation is.
For her to be motivated, she needs to want to change things that
she experiences as problems in her life. The things that
you experience as problems (coming from her) aren't going to be what motivates her, so even though -- and I agree with you -- full commitment to DBT could be so helpful, trying to "get her to grasp" that is going to be a dead end right now, and just frustrate both of you. This dynamic often comes up with parents with BPD children -- the more the parent tries to get the child to see that "you should take a college class, you need to get a part time job, you have to enroll in therapy, you need to attend your therapy sessions", the more the child digs in and resists.
Again, these are good things! But you can't want it more than she does. There are still appropriate boundaries to have in life, but they are rules for your own life that you decide on for yourself. You are the only person who can decide if you can be married to a spouse who does 30 minutes of therapy every other week. It's not on her to do more to fix your problem... it's your choice to watch her trajectory and decide for yourself what you are and aren't able to live with, if that makes sense.
Anyway, I wonder if it might be helpful for you two, and take some pressure off the relationship, for there to be understanding that she is working on her problems, not your problems. (I'm not speaking to what she should be doing regarding how her choices impact you, only because she isn't here. There are plenty of things she should be doing, but it's not helpful to bring them up, because you're here, and she's not. I'm definitely not saying that there is nothing for her to work on, or that she shouldn't make changes in areas that you experience as problems). I'm guessing she can sense some "push" or "encouragement" from you, some sense that you want her to be doing more? What would happen if you dialed that back?
In the example below, I asked why studies say DBT is reputed for having such a high success rate, yet most anecdotal stories indicate it never really gets better. The last line is key:
1. Long-Term Remission Is Statistically Likely — But Misleading
Several long-term studies show high remission rates for BPD:
The McLean Study of Adult Development (MSAD) – the most cited longitudinal study:
88% of patients met criteria for remission at 10 years.
However, only 50% achieved sustained remission, and many still had significant symptoms (like emotional dysregulation, manipulation, and identity disturbance).
Relapse rates were around 30% after 2 years of remission.
Caveat: These statistics only apply to people who received intensive treatment (often inpatient and long-term DBT), which is rare outside of research settings.
Another interesting factoid to file away is that there is a lot of self-selection on these boards.
People generally don't join when they have a high functioning BPD spouse or family member where things are "mostly fine". And, people typically don't join when they have a low functioning pwBPD who is in long term treatment.
People frequently join when they have a "worst of both worlds" scenario -- a pwBPD in their life who isn't getting treatment at the moment and who isn't improving or a livable person to be around.
Theoretically, the "intractable" pwBPD in our lives could actually be the smaller % of all pwBPD... it's just that it's the majority of the pwBPD in the lives of members here, because the difficulty of the situation draws us to more support than we'd need with a much higher functioning pwBPD ("life is great most of the time") or a much lower functioning pwBPD ("it's difficult but I have a family support group and family therapy and individual therapy and skills group and... at the hospital my pwBPD is in").
It totally makes sense to me that 88% of patients in the study met remission criteria after 10 years,
and at the same time, it's not like 88% of 10+ year members here are experiencing their pwBPD improve. We get the tough ones
...
All that to say --
My H and I had a marriage counselor for a while, and he suspected that both my H's mom and my mom had BPD type traits. Both moms survived childhood abuse and my mom has been open about having cPTSD. Infidelity was never present in either of their relationships, so that is different, but both my H and I would agree that our moms have definitely calmed down a lot from our childhoods. Both of them had or have ongoing therapy and both have a significant spiritual support system. If they were assessed maybe 30-40 years ago they may have received a BPD diagnosis -- hard to say for sure -- but now they definitely would not, and things are not getting worse.
So anecdotally, yes, it is possible for persons with "BPD traits" to recover and go into remission. But neither of them would've been captured in the McLean study because neither needed or went to inpatient or long term DBT. And that doesn't mean that our childhoods were great or that our dads/stepdads had an easy time.
...
One more thought to toss back and forth: have you checked out the
National Education Alliance for Borderline Personality Disorder's Family Connections program? It could be a good supplementary support for you, and they have a lot of very good, clinical, up-to-date research and training material. It's focused on making family life more livable when there's a pwBPD in the family structure (whether spouse, child, parent, ex, etc). When I took it last winter, it was clear they were looping in the most recent research they could, to their teaching and toolset.
I also appreciated their
Family Guidelines for how to structure and navigate family life with a pwBPD, in a way that doesn't build frustration and resentment in you and me. It strikes a nice balance between: "OK, you're the non, so yes, there will be changes you make in how you interact" with "don't protect the pwBPD from the natural consequences of their choices". It's not all your fault...
and, it's not all their fault. It's not all on them to make the changes...
and, it's not all on you to make the changes. But everyone wants a more peaceful family life, so here are some guidelines to try.
I'd be really interested to hear your thoughts if you check out the NEABPD links and material, given that you're navigating this gray area of -- do I stay, is it good enough, do I go, the kids are older but not that old, she might be doing better but she might not. Having some guidelines to orient you could help provide you with structure as you're in a decision-making chapter in life.
None of this is easy... I get it.
