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Author Topic: Difficult Therapy  (Read 391 times)
KoalaBear92
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« on: September 21, 2017, 08:34:13 AM »

Hello All,

My twin sister was diagnosed with BPD last month, and her therapist has now advised she is to do DBT
I've done a lot of research and while I understand its a great therapy with great results, the result has made her have to leave her job (basically she is being fired for not having enough time for them)
When she told her therapist this, she basically kept repeating that other people with BPD didnt have jobs, or where on the social or had part time jobs or their jobs understood.
Like I get that, but shes not other people, shes here and now she is intensely stressed, and suicidal again. I'm at a loss, I'm trying to sort another job for her, but considering her therapy is slap bang the middle of a Wednesday and all day Thursday most places dont want this inflexibility.
Did anyone else come across this problem?
The main issue is money,she has a large car loan, rent and just got into college so college fee's to pay for.
I'm far to angry at her therapist but I cant tell her this because, well she seems to love her. But I personally feel the therapist is being incredibly difficult to deal with and unmovable on simple solutions.
Please help, because I'm so worried she is going to hurt herself.
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Sunfl0wer
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Relationship status: He moved out mid March
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« Reply #1 on: September 21, 2017, 08:52:31 AM »

Sounds like your sister has the good sense to seek treatment for her issues.  :)BT is the preferred treatment for BPD and it takes a commitment that many with the disorder do not seem to have to stick with it... .and do all the work involved.  I am not surprised her therapist is encouraging her to put her treatment at a priority in her life.

I would be careful in "blaming" therapy or a therapist for your sisters ability or lack of ability to cope.  Being her twin and caring for her, I only imagine it is tempting to feel protective and understandable to want what is best for her and emotionally tugging to see her struggle.  (My own sis has BPD :/)However, your sister is now in charge of her recovery and calls the shots.  Not her therapist, not you, or anyone else.  She alone is responsible for her decisions and use of coping skills.  It is easy for someone with BPD to "blame" a therapist for their decisions, yet, ultimately, we are left with ourself, our decisions are ours.

Also, personally, in my therapy as we uncover things, trauma, etc... .sometimes things get worse before they get better.  Yet, even so, my therapist expects me to be responsible to maintain a certain level of functioning for us to dig deeper.  We work this out together.  Therapy is NOT someone telling me what to do but is us exchanging ideas together and working together.  It is not a replacement for my free will or thought.  Just saying. So maybe your sis has a decent therapist, or maybe not, idk.  But I would caution you to "getting too involved" in what is going on as it can be a "drama triangle" (read up on that, good and important stuff to be gathered from lessons on drama triangle) that your sister is reverting to playing out with you as a "rescuer," her a "victim."

Have you considered attending a NAMI meeting or Codependents anonymous group or therapy yourself to learn best how to manage your own dynamics while watching your sister struggle with her illness?

Not suggesting you are doing anything "wrong," just saying that part of your sisters illness is usually evident in the dynamics of her close interpersonal relationships and seeking help for yourself can help you learn the best way to support her without enabling her difficulties and it sounds like you are a big and important part of her life... .therefore could be a meaningful endeavor to all if you had some 3D support in your re-creation of more effective relational dynamic with sis.  Because if she is to be changing for the better, so will your relationship with her undergo some overhaul.
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How wrong it is for a woman to expect the man to build the world she wants, rather than to create it herself.~Anais Nin
KoalaBear92
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« Reply #2 on: September 21, 2017, 09:04:29 AM »

Sounds like your sister has the good sense to seek treatment for her issues.  :)BT is the preferred treatment for BPD and it takes a commitment that many with the disorder do not seem to have to stick with it... .and do all the work involved.  I am not surprised her therapist is encouraging her to put her treatment at a priority in her life.

I would be careful in "blaming" therapy or a therapist for your sisters ability or lack of ability to cope.  Being her twin and caring for her, I only imagine it is tempting to feel protective and understandable to want what is best for her and emotionally tugging to see her struggle.  (My own sis has BPD :/)However, your sister is now in charge of her recovery and calls the shots.  Not her therapist, not you, or anyone else.  She alone is responsible for her decisions and use of coping skills.  It is easy for someone with BPD to "blame" a therapist for their decisions, yet, ultimately, we are left with ourself, our decisions are ours.

Also, personally, in my therapy as we uncover things, trauma, etc... .sometimes things get worse before they get better.  Yet, even so, my therapist expects me to be responsible to maintain a certain level of functioning for us to dig deeper.  We work this out together.  Therapy is NOT someone telling me what to do but is us exchanging ideas together and working together.  It is not a replacement for my free will or thought.  Just saying. So maybe your sis has a decent therapist, or maybe not, idk.  But I would caution you to "getting too involved" in what is going on as it can be a "drama triangle" (read up on that, good and important stuff to be gathered from lessons on drama triangle) that your sister is reverting to playing out with you as a "rescuer," her a "victim."

Have you considered attending a NAMI meeting or Codependents anonymous group or therapy yourself to learn best how to manage your own dynamics while watching your sister struggle with her illness?

Not suggesting you are doing anything "wrong," just saying that part of your sisters illness is usually evident in the dynamics of her close interpersonal relationships and seeking help for yourself can help you learn the best way to support her without enabling her difficulties.

Hello,
Thanks for your reply, I'm not so much blaming the therapist, I get that her illness is going to be priority to get better.
The main problem is, the decisions the therapist is asking her to make, are very difficult when you have to have a job. We are a low income family, so my parents cannot really afford to support her.
I'm happy for her to not have the job, but it was a job she genuinely loved so having to leave it is actually making her worse and more self destructive. When she explained this to her therapist she pretty much got a "well nothing we can do about it" answer.
I more just wanted to make sure that this was the correct way her therapist should be approaching this, as it seems very extreme to basically tell someone that they either quit their job or go away.
Also I have gone through therapy and CBT before ( I have/ had quite severe depression) so I unfortunately do not have the time to go to therapy again as I am now trying to save money for both myself and her. She is not aware of this and I wouldnt tell her as she doesnt want to be a burden, and she isnt.
The therapist is asking for family therapy, but she is asking for a whole day once a week for 12 weeks, which none of our jobs will allow, and we can't all quits our jobs for this unfortunately.
We are all just at a loss because we really want to help, but the therapy basically involves being a free agent to do this and nothing else.
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Sprinkledinkles

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« Reply #3 on: September 21, 2017, 11:59:04 AM »

Her therapist sounds out to lunch. Or you aren't getting the full story. I'm just saying becoming a waif isn't below a person suffering with BPD. No realistic therapist would demand this, suggest it with the understanding that most working class people wouldn't be able to do it. Maybe you could ask how you can help without going. Suggested websites, evening support groups, ect. Either you go or don't go and suffer the consequences just isn't reasonable.

Your sister needs help finding her own means with out a job right now. That's already been established. It's sort of like rehab. Putting yourself first cut off from the real world so she can take care of herself and her future. So temporarily taking social assistance is in place for times like this. Don't let the ones who abuse it leave a bad taste in your mouth. You could help her set up an appointment with them and maybe if she needs help advocate for her but I'm pretty sure they wouldn't be open weekends and evenings so might want to check that first.

As for her stressing I would think letting the process happen without you trying to save or fix things would be easiest on both of you. Listen when she is venting and validate her feelings but don't fix. It's hard but worth it.
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Sunfl0wer
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« Reply #4 on: September 21, 2017, 12:18:44 PM »

Excerpt
The therapist is asking for family therapy,
Have you spoken to the therapist?
Or is the information that you are emotionally reacting to... .heresay?

Not saying your sis is lying, however, persons with BPD often hear things differently than they are communicated, infer things not intended by speaker, gather/induce/deduct/reason differently than another person would.

I would say, before deciding to go or not got to family therapy... .
Why not commit to go once (if you have not) to gather info, see for yourself what therapist is going to say to you.

For all I know from my perspective, there is no way to determine if the therapist is asking for an extreme commitment.  Some pw BPD NEED therapy 1x a week, some 2, some even more! Some even attend day programs, half day programs, some need inpatient for many weeks to gain the stability needed before being able to cope with weekly therapy sessions.

It is possible your sis is scape goating the T so she does not have to admit how deep she is struggling to cope atm.

Seeing as your sis is currently NOT coping well with this amount of therapy well, it could possibly be that she needs more intense therapy first to learn stabilization tools to do the work to come.  Some people may need inpatient first before doing the work or may need inpatient and med management.  Maybe your sis only needs twice weekly atm, idk.

You see that your sis is struggling to cope... . usually this is a sign of needing more support even if this is a temporary acute situation... .otherwise, she could easily get herself back to baseline.  Part of therapy could be testing boundaries, learning that when we fall, we need to pull ourself up.  Learning tools to do so consistently.  Some folks can learn this out patient once a week, yet some need more.

It is not the job of the world to ease her burdens so she can cope... . things don't work that way.  It is not the therapist job to not mention resources to her in fear ahe may persue them.  It is sis job to learn coping skills... .decision making skills, etc. 

All therapist can do is offer options and a means to acquire them.  Sis has to choose to use them, halt on therapy and avoid this, or move forward trying to comply and participate in whatever way she can.  It is still her choice. (And idk what is the right one)  If she chooses to loosen up on work hours to persue treatment, maybe she has a good reason for that?  Maybe she is preventing a hospitalization or further decomposition mentally.

(I would caution in not mistaken coorelation with causation.  Just because she appears decompensating as a result of therapy does not necessarily equal therapy being a bad thing for her.)

Or maybe her blaming the therapist is her way of asserting what she wants... .but atm is afraid to take ownership of her choices so is hiding behind the idea that it is therapists idea and choices... .but she really wants therapy but doesn't want the guilt that comes with such a decision.  Idk really... .just throwing thoughts out there to show other possible perspectives.

This is not a black/white issue.  Therapist is not out of line to suggest a pwBPD attend DBT.  This is not an outragous thought at all.

Yet seems you are stressed over the ramifications.

Everyone will need to learn better boundaries if her treatment is to be successful.

So far... .
I find it hopeful that your sis is committed... .admitting she needs help, and being consistent about getting it thus far.
That is my whole vibe about this... .fwiw.
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How wrong it is for a woman to expect the man to build the world she wants, rather than to create it herself.~Anais Nin
Woolspinner2000
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« Reply #5 on: September 24, 2017, 09:46:04 AM »

Hi KoalaBear92

Welcome!   Thank you for joining us and for sharing this post with us. I can only imagine how complicated and out of control the situation is spiraling with your twin sister, you and your family. There seems to be a lot on her plate and on yours as well.

I think it is very good that you are asking questions.  Doing the right thing (click to insert in post) We should never be afraid to ask them, even if they challenge our belief sytem and what we have learned to consider normal.  Questions allow us to rexamine what we think is right and take a second look to either verify or to consider a new and different way If it is better.

Excerpt
When she told her therapist this, she basically kept repeating that other people with BPD didnt have jobs, or where on the social or had part time jobs or their jobs understood.

Excerpt
I more just wanted to make sure that this was the correct way her therapist should be approaching this, as it seems very extreme to basically tell someone that they either quit their job or go away.

I am not very informed about DBT except that I know it is considered one of the best ways in helping someone who has BPD and that it has been very successful. I also know it takes time and commitment. Here is a link that speaks about DBT:

Treatment of BPD

All that being said however, I have a few questions myself. Have you gotten the information about what the T said from the T herself or from your S? If your S is the one sharing, do you know if she is prone to triangulating? Here is a link about that:

Escaping Conflict and the Karpman Drama Triangle

My mom was an uBPD so I well understand and have experienced triangulation all my life. It was easy for me to see her as the victim whenever some really difficult things triggered her. It is challenging and hard to see those we love going through a tough time like your S is right now and the difficulty is shared all around. I cannot imagine the fear and worry your S is going through as she considers DBT because it could easily be quite threatening to her, the unknown. Do you feel you can be or are a solid person in her life and not step on to the drama triangle? You sound as if you are a great sister who wants to see her get healthy and soon!  Doing the right thing (click to insert in post) Kudos to you!

Also is it possible for you or family members to ask questions of the T? If she has suggested family T, then perhaps you can call to ask questions and become more informed directly from her about what the T hopes to accomplish and confirm the time frame. You need solid answers in order to make the best choices. Seek those answers yourself. It would not be a violation of privacy to ask questions about what the family's commitment would be since the T seems to want to include all of you.

 
Wools

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