What did it take for your pwBPD to finally take treatment seriously?

[In4thewin]

I've previously seen some people on here reference how things finally got better in their relationship with, and for their pwBPD once they got the right kind of treatment. If you are one of those people would you mind sharing your related story? I'm just wondering how long it took your pwBPD to reach the point of wanting things to change enough to do the needed work and if there was a straw that broke the camels back. I'm so sad and frustrated that my daughter still isn't taking treatment seriously although she's had access to quality DBT programs going back 5 years now.

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 there Win,

I have good news and bad news for you. The good news is that BPD is treatable, provided your daughter is ready to make some changes to start to feel better. If she’s young, I bet she could turn things around relatively quickly, and not have BPD derail her entire life. The bad news is she probably has to hit bottom first.

I’m starting to think that BPD behaviors are addictive, where the addiction is indulging in negative thinking patterns and throwing tantrums, because they work for her. She releases pent up anger and frustration, blames others for her problems and probably gets some sort of concession or money out of the target of her blame-rage.  Her “addiction” becomes so strong that her maladaptive thinking and behavioral patterns become ingrained, almost automatic, because she’s rewarded for acting that way, even if she’s miserable. She becomes ruled by emotions, not logic,  to her own detriment and to that of those around her. Her victim attitude makes it hard to accept responsibility for her life, which could be why she resists treatment. She thinks others should change, not her.

For the pwBPD in my life, her bottom came after multiple suicide attempts and multiple failed attempts to live independently. She lost all her friends and was estranged from her entire family, including extended family, except for her dad and me  Having said that, there were several periods of weeks and months when she refused to communicate with her dad, too. She only resumed contact when she needed money, shelter or other support.

I guess that the only way your daughter might decide she needs to take therapy seriously is to try living on her own. For as long as someone else is supporting (aka enabling) her, she’ll blame them for ruining her life. Only when she tries standing on her own two feet will she feel some responsibility for her situation. Maybe she succeeds on her own, and that would be progress. But if you’re on this site, I suspect she’s raging at you and blaming you for everything, and you’re at a loss for how to cope, and how to convince her to accept professional help. I think the only way she’ll get there is to hit bottom first. If you rescue her all the time, and if you are doing things for her that she should be doing herself, you are probably only prolonging your mutual misery. She needs to experience « real life » to realize she needs extra help to cope with her emotions and negativity.

I’ll add that the pwBPD in my life eventually warmed to the notion of getting professional help, because it validated her narrative that she was « abused » by everyone around her—parents, ex-friends, roommates, siblings. She could frame therapy as helping her get past her abusive childhood.

Just my two cents.

[SoVeryConfused]

Hi,
My person is not in treatment, but I've dealt with other MH challenges in loved ones. There's little we can do to get someone to take treatment seriously. I had a loved one who did DBT, but I pushed for it vs. them. They did it very half-assed. Yes, they got skills from it, but it took years for them to use them. DBT is hard work and a time commitment, so they have to be all in.

I suppose you get them to take it seriously by having resources when they become tired of their life and seem open to a suggestion to improve it. DBT is truly skills training vs. being vulnerable. I wish our people, who seem to have a hard time dealing with feelings, understood that. I wonder if that would help them try it.

[In4thewin]

I'm worried about the hitting rock bottom part. I just can't wrap my mind around why she'd sooner put herself through this than just practice the DBT.

[CC43]

Hi again Win,

Well you're right to be perplexed, that your daughter seems so "committed" to her dysfunctional behavior, and that she won't accept help, or if she does, she only "goes along with it," half-heartedly, in order to get a concession out of you.  I think that therapy won't work unless she commits to it, because therapy IS work.

I think the core of BPD is delusional, negative thinking patterns.  I believe that the "delusional" part is responsible for the "borderline" in her diagnosis, i.e. being on the border between neurosis (anxiety, obsessions) and psychosis (loss of touch of reality).  Though most everyone feels anxiety and can be obsessive about some things, sometimes, with BPD these innately human feelings run at an extreme, enough to disrupt her life.  As for psychosis, I've seen it, especially when the pwBPD in my life was self-medicating with marijuana and was under a lot of stress.  But I think there's a more constant, lower-level "psychosis" which manifests as highly unrealistic expectations, bordering on fantasy.  Examples might include delusions about becoming a super model, being "discovered" as a social media star, getting an entry-level job earning six figures while working part-time from home and having no special skills or credentials.  I think she has some "delusions" about the intensity of interpersonal relationships, as she expects to fall "madly" in love, and that casual friends demonstrate their "devotion," when it's just not realistic.  The result is that she's constantly disappointed and dissatisfied.

I have this idea that pwBPD feel constantly traumatized by life, and that basically they live in fight-or-flight mode, full time.  I bet you're tired of the constant strife with your daughter, sometimes punctuated by her "flight" when she's in avoidance mode.  She might even be estranged from you for a time.  I see this as the "flight" response.

Anyway, my point is, she's not completely rational.  Her interpretation of the world is more guided by her emotions and her unrealistic expectations.  In order to function, "normal" adults have to tame their emotions to achieve their goals.  An example might be deferring gratification, such as saving up money before going on a vacation or buying a house.  Another example might be keeping one's cool when conversing with a disgruntled customer, and rather than mirroring the customer's distress, using logic to figure out a solution.  Another example is withstanding daily stresses at work, even when it's difficult or uncomfortable, because the job is a good one, and we need to earn money to support ourselves.  Another example is taking a supervisor's feedback as constructive, and learning from honest mistakes, rather than assuming that criticism is a personal affront, having a meltdown, blaming someone else and/or quitting on the spot.  Another is understanding that life isn't necessarily fair, instead of getting upset over other people's good fortune or favorable treatment.  Another is that life comes with lots of administrative tasks (buying groceries, paying bills, arranging insurance, making and keeping appointments, home maintenance, etc.), and a certain level of planning and consistent execution are needed to keep life running smoothly; but with BPD, impulsivity and disdain for life's "boring" tasks means they can be neglected.

If you accept that her thinking isn't very rational and is often emotional, then you might see why she thinks therapy is stupid.  She's convinced that OTHER PEOPLE are the problem.  Does she constantly complain how you abused her, how her roommates were bullies, how her boss was nasty and totally unfair, how her co-workers got all the breaks, how her ex-boyfriend was narcissistic and abusive, how everyone else has a nice life but hers sucks, and it's your fault?  She is resolute in her opinions, there's nothing you can do to help her interpret her life in a more nuanced, balanced fashion.  Why?  Because on the one hand, she's a bit delusional, and on the other hand, admitting the truth is too painful to her.  I think that deep down, she knows she's messed up, that she behaves horribly, that she blows up relationships important to her, and she self-sabotages at every turn.  Admitting that would be too shameful, and too painful, because in her mind, it would mean she's a pitiful loser and would be better off dead.  (Her negative attitude taints her self-perception, too.)  So it's easiest for her to maintain her narrative that everyone else is the cause of her problems.  It's also easiest when she's living with you, and when you're talking with her every day, because she'll say YOU are the one making her life miserable.  If she can't come up with a good current example, she'll just dredge up something from ancient history.  She knows you well, so she knows exactly which "evidence" to use to prove you ruined her life.