marriage therapy and BPD

[zondolit]

Hi all,

Given that BPD is not a rare disorder and given that relationship conflict goes hand-in-hand with BPD, I would expect that it is not uncommon for  couples seen for marriage (and romantic partnership) counseling to have at least one person with BPD traits. And yet, from this forum, it appears many have not had a great experience with marriage counseling when BPD is involved. (My own experience was mixed.)

Maybe this is a question for the experts, but how do marriage counselors approach BPD in relationships? Is there a theory of marriage counseling when BPD traits are involved? An approach that is different than when neither partner has BPD?

Correct me if I'm wrong, but prior to DBT and schema therapy and other treatments for BPD, clients with BPD would often get worse with therapy. I'm wondering if there's a parallel here to marriage counseling when BPD is present but not explicitly acknowledged or accounted for?

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[PeteWitsend]

This is an interesting question.  Presumably, there would have to have been an affirmative diagnosis of BPD prior to marital counseling starting, and the pwBPD would have to be forthcoming about it, which are both - as I understand it - uncommon, due to the nature of BPD: it's rarely diagnosed and pwBPD are not typically very honest about it or receptive to help or admitting they may bear any responsibility for issues in the relationship.

In my own case, BPDxw was undiagnosed; people I reached out to for advice either suggested she was BPD or (in one case a friend who is a psychiatrist) agreed she was likely on the spectrum.

My own experience with MC was that it was totally useless.  BPDxw would not cooperate: she would interrupt me and make sarcastic comments when it was my turn to speak, try to shout me down/shout me into silence if I came prepared with notes about her behavior.  And on the one occasion where the counselor called her out, she argued with and yelled at the counselor (!) and then refused to ever go back.

[FirstSteps]

We just failed with our second marriage therapist. I have to say - neither was particularly great.  But I think both clearly picked up on my wife's personality, even though we played it so calm and together that you'd wonder why we needed therapy at all.  We had agreed talking points and everything.

The second did try to help her regulate a few times when she got emotional and it predictably went to hell, both in the session and then for me afterwards.  I'm sad there is no way forward with therapy for us, and I am also so so relieved that I don't have to go back into that room.

Am really accepting that I have to do all the changing and see where it all lands. 

[PeteWitsend]

... I think both clearly picked up on my wife's personality, ...

I presume in most cases they focus on doing their job, which is to help a couple learn to get along better, and not to diagnose and treat one party's mental illness. 

I like to think a competent therapist/psychologist in a marital counselor role would recognize the signs of BPD and advise the Non-disordered partner accordingly.  It's unprofessional otherwise to just keep taking their money, knowing therapy is futile.

In our case we went to three different counselors over the years.  I'd characterize them as "well intentioned but naive," "unprofessional and incompetent," and "competent."

The competent one was the one BPDxw ended up screaming at and refused to go back and see.  The other two let her essentially control the sessions by screaming or throwing tantrums when I actually spoke my mind. 

As for BPDxw herself, she treated therapy and MC sessions as a game in which her aim was to either convince me we were fine and had no problems, or get the MC on her side to blame me as the source of her misbehavior and conflict. 

[Cat Familiar]

I presume in most cases they focus on doing their job, which is to help a couple learn to get along better, and not to diagnose and treat one party's mental illness. 

Yes, a very different mission statement than individual therapy.

The competent one was the one BPDxw ended up screaming at and refused to go back and see.  The other two let her essentially control the sessions by screaming or throwing tantrums when I actually spoke my mind. 

I had to laugh when I read this. My husband, who is the most easygoing, non threatening man in public (he’s an attorney and a professional mediator), shouted at the psychologist and stormed out of sessions. A couple of years later, when I saw her for individual therapy, she told me that he has a personality disorder, but wouldn’t specify which one. She saw the NPD; the BPD he only demonstrated at home, and thankfully I rarely see that anymore.

[PeteWitsend]

...

I had to laugh when I read this. My husband, who is the most easygoing, non threatening man in public (he’s an attorney and a professional mediator), shouted at the psychologist and stormed out of sessions. A couple of years later, when I saw her for individual therapy, she told me that he has a personality disorder, but wouldn’t specify which one. She saw the NPD; the BPD he only demonstrated at home, and thankfully I rarely see that anymore.

Yeah, it was a little ridiculous.  Funny (in hindsight) even.  I recall the therapist putting her pen down and leaning back when BPDxw started in on her, and had a look on her face like "Okay, you are NOT paying me enough to sit here and listen to THIS crap"

For some additional context: We had nearly gotten divorced 6 months before that, and this was the "last chance to fix things" counseling. 

I wondered what exactly was going through her mind at this point; if she really didn't want a divorce, what she expected the end game to be of taking the approach to MC that she did.  Either she figured it was more BS and I'd never actually leave her, or because of her disorder, she simply didn't have the capacity to think it through like that.