BPD symptoms not showing up in therapy

[In4thewin]

I'm very concerned and frustrated. When my daughters symptoms first started to make an appearance in middle school, I was completely caught off guard and utterly confused about what was going on. Then after a couple years of attempting various therapy WITH her, all therapists came to the conclusion, for one reason or another, that they just couldn't help.... whether because my daughter's issues required advanced/specialized treatment or my daughter just wouldn't comply with treatment (DBT) once BPD was highly suspected. Now she is 19, was diagnosed with BPD last year by a therapist who holds a Masters in Clinical Health, and was just discharged from a 4 month online IOP (they were informed of her BPD diagnosis), and is showing no signs of improvement. Also the group portion of the IOP was DBT focused, my daughter is clearly still not even attempting to use the skills. Most concerning, she has had two personal therapists in this program, and both did not believe that she even had BPD based on her weekly 1-1 interactions with them..... until they attempted to do a family session with me and my daughter was completely out of control with no provocation, and no way for the therapists to calm her down. I'm talking about yelling, crying, cursing, name calling, not allowing me to say anything without continuing the previous---  hearing things I didn't say, and not hearing things that I did. Flat out refused to stick to the basic "rules" of effective communication that DBT teaches and/or are commonly considered to be acceptable.

The first personal therapist had worked with her for about a month and a half before bringing me into the mix.... and told me thereafter that she had "never seen that side" of my daughter, was shocked, and wanted to work with her again for a couple more sessions before trying to bring me in again. That happened, and the same thing blow-up ensued when I returned. My daughter ultimately "fired" that first therapist a week or two later, telling the IOP that she wanted to start working with someone else, and she withdrew her ROI from the program so I couldn't communicate with anyone. So.... enter second therapist. Same exact thing happened: She worked with my daughter for about a month and half 1-1, I was brought into the mix, and WHAM. The next week, (which was my daughters last week in the program), the interaction was better in that the crazy explosion didn't happen, but she was still not really able to effectively communicate, she wasn't really reasonable, and there was crying. Thereafter, the therapist spoke to me privately (by this time my daughter had signed a new ROI), and she also told me that she had never seen the side of my daughter prior to our family session, that she now believed that my daughter had BPD.....and she thought that she really needed residential.

My take is that my daughter really isn't "honest" with her therapists and doesn't address her real issues. Perhaps it's just too painful or embarrassing. I don't know. I believe that my daughter has BPD because I've lived it every day since the 8th grade and I know things about her aside from any interpersonal problems that we have (major understatement) that she's apparently unwilling to discuss with any therapist to date. Again, I don't know if this is out of embarrassment or if she doesn't see certain things as a problem. At this point she is going to be seeing a new therapist weekly, and has agreed to also do weekly family therapy with me--- but she doesn't want the same therapist doing both. I looked that up and it seems to be "best practice" to not use the same therapist to avoid bias. But in this situation, I really think we'll be going through the motions and my daughter won't end up getting the help/counseling she really needs because her new personal therapist won't see "that side of her", and my daughter won't even discuss what's "really" going on.

I can't force my daughter to do anything due to her age, and even if that wasn't a factor, any program will be pointless until she's willing to face her really problems and actively work through them. At this point she's claiming to not believe she has BPD (apparently her last therapist told her before seeing her interactions with me that she saw no signs of it), but she also mentioned that BPD can't be gotten rid of--- so I think feelings of hopelessness are driving her denial. I can't even talk to her new therapist or send medical records etc. because she won't give me authorization, so it's very doubtful the therapist will even understand my daughter's clinical background. I feel hopeless as well. I just don't understand why my daughter isn't taking treatment seriously and I'm so worried that she's going to get herself into some real trouble and/or just continue to decline. My only real mind-bender is how he can keep the BPD symptoms away from therapists so long as I'm not around. Does she really NOT have BPD but some other disorder(s)?

Our objective is to better understand the struggles our child faces and to learn the skills to improve our relationship and provide a supportive environment and also improve on our own emotional responses, attitudes and effectiveness as a family leaders

[CC43]

Hi Win,

I understand your frustration.  You want your daughter to commit to therapy, and yet unless you're present, she's not being fully honest with the therapist.  I think you should trust your gut, because you know your daughter much better than a therapist can after only a few sessions.  You've seen how your daughter acts over a lifetime, while the therapist only sees your daughter a few hours in a controlled, clinical setting.

Maybe this isn't a fair comparison, but when my dad was suffering from cancer, he had all sorts of ailments, and he'd complain about many issues at home, prompting a visit to the doctor.  Yet once in the doctor's office, my dad wouldn't give an accurate description of what was going on.  He seemed to trivialize his pain and various ailments, and he'd leave the office without the right treatment plan or medications!  Moreover, he wouldn't tell the truth about his diet, lack of mobility and non-compliance with medications.  This was very frustrating indeed.  I suspect my dad didn't want to seem like a wimp in front of the doctor.  And it's possible that the clinical setting made him nervous and/or forgetful.  He might have had a plan to tell the doctor certain things and ask certain questions, but when the time came, the doctor controlled the conversation, and my dad got confused and maybe forgot to mention what he had originally intended.  I know that has happened to me, too, and it doesn't help that the visits seem so rushed as well as uncomfortable.  It may be that a similar phenomenon is happening in therapy with your daughter.

Anyway, when it comes to BPD, it does appear to me that my adult stepdaughter can see-saw between acting completely "normal" and a second later, launching into a rage.  Once in a rage however, she tends to take a while to stabilize.  Alternatively, she can swing the other way, and retreat and isolate herself.  Yet whenever there's something she wants to do, like go on a fun trip, she ALWAYS seems able to "pull herself together" to go, no matter how terrible her life appears to be at that moment.  She could be in the hospital the day of a suicide attempt and argue about wanting to attend a party that very evening.  Thus I can't help but wonder if she's perfectly able to act "normal" whenever she wants to.  One question I'd ask is, has your daughter behaved so dangerously that you were compelled to call the police, and yet when the police arrived, she seemed to flip a switch, and suddenly she appeared calm and convinced the police to leave?  That to me would indicate that your daughter does have some control over her emotional outbursts.  It's just that when she's with you, or with other people close to her, she INDULGES in her emotional outbursts.

I'm not a psychologist, but I can't help but think that sometimes, BPD behaviors appear to be an act of indulgence, in the sense that she wants to do what she wants to do NOW, and she doesn't care about any consequences.  She's angry and she wants to unleash her anger, no matter how irrational or how hurtful she knows she's being.  I'd say it's an immature response, like that of a very young child, who doesn't want to wait or even understand the consequences.  It's like your daughter is saying, she has needs, they aren't being met, and she is demanding that you meet her needs NOW!  But once a third party is in the mix, like a therapist or someone she respects, she decides, she shouldn't throw a tantrum like a little girl, and she'll clean up her act.  But if you are present, she can't help but indulge her impulses.  That alone tells me how important you are to her, no matter how much she says she hates you.  If you were truly unimportant to her, she wouldn't think about you or react to you at all . . .

I bet that with the therapist, your daughter is telling stories about how horrible and abusive her childhood was.  The therapist might be trying to build trust by validating her feelings.  It's very possible that your daughter is exaggerating, or telling outright lies.  I have a hunch that your daughter has ruminated so much about her horrible childhood that she actually relishes telling someone the stories, and she has re-told them in her head so many times that she has become master storyteller.  My stepdaughter has never been so eloquent in her life as when she recounts her stories of supposed childhood abuse; about almost anything else, she's generally inarticulate.  Even so, it may be helpful to process these feelings in a therapeutic setting.  But here's my question.  I can't help but wonder if the constant rumination and reliving of past negative experiences serves to blow them out of proportion.  Might it be that they are "exercising" part of the brain so much that they are strengthening their negative muscle memory?  Does it seem that the more they do talk therapy, the more stuck in the past they become?  Maybe that's why DBT or cognitive therapies are recommended, to teach how to accept and tolerate feelings, and eventually MOVE ON.  But sometimes I think my stepdaughter gets so stuck in the bad memory itself that it becomes routine, almost comforting.  When she faces stress or disappointments, I suspect her brain immediately recalls a couple of negative childhood experiences, and she dredges them up as a DISTRACTION to her current problem.  Does this ring any bells for you?  Perhaps worse, she has spent so much time in therapy that she hasn't really lived a normal adult's life.  By remaining on the sidelines of her life, in the name of reducing stress, she feels "behind" her peers, and her identity is in shambles.  When her primary focus is getting therapy, who is she, really?  I understand why she might be tired of therapy, and why she would dislike the notion that she's mentally ill, as that's what most of her adult life has revolved around.  It's very depressing indeed.

I'm not sure what to counsel you except to say that my BPD stepdaughter also just "went along" with therapy to get concessions out of her parents (e.g. allow her to go back to college).  She had to hit bottom in order to start to take therapy seriously.  A key turning point was when she authorized her dad to have access to her doctors and records.  This may have been a mistake, I'm not sure.  She might have granted access when she instructed doctors to send her dad the bills.  In my opinion, you could have some leverage if you are paying for your daughter's treatment, or even her insurance.  You might say to your daughter, You're free to do what you please, but if I'm paying for your treatment, I need to know what is going on, and I need to be adequately informed about the treatment options.  One thing my husband said to his daughter was, Until now, you've done whatever you wanted concerning your treatment, but that hasn't worked, has it?  If you want my help, from now on, you need to do exactly what the doctors recommend--therapy, programs, medications, etc., and I'm going to make sure you do it.  That was a critical turning point, because on the one hand, it relieved my husband from coming up with solutions.  On the other hand, it gave my stepdaughter a choice (to follow doctors' orders or go her own way), and at that point, her choice was an easy one.

All my best to you.

[ForeverDad]

Remember too that Borderline is a disorder most evident in close relationships.  Others on the periphery or infrequent contact may notice something "off" but it's not a major issue because there's a distance most of the time, the pwBPD can manage to keep much of it below the radar of others and maintain a public persona.

Why don't therapists see the worst of the behaviors?  Because they're trained to NOT have a close personal bond with their patients, especially when Borderline is involved.  So likely their sessions are only dealing with minor issues they see since the deep issues and triggers aren't exposed.

Distance does reduce the poor behavior.  It may seem they're better but their core issues can still be there.  Resume the close contact and that will decide whether they're truly recovering or not.