current behavioral therapist is not helping

[NOVAnonBP]

My wife has BPD as diagnosed by a doctor who was providing marriage counseling for us several years ago. This site has been a real encouragement. Uncanny descriptions of my own home and experiences.

Although initially reluctant, my wife agreed to see a separate (from the marriage counselor) therapist in order to receive cognitive behavioral therapy for her numerous, habitual, cognitive distortions.

After several years of her meeting the therapist 2 hours per week, her symptoms aren't any better and in many ways are worse.

How can I find a therapist with actual experience and success with BPD? The suggestions in the Appendix of "Walking on Eggshells" would require weeks of work searching - but perhaps the only way. I haven't found any online directories that were of much help.

I'm located in Northern Virginia, 30 minutes south of the Washington DC beltway.

[PLEASE - NO RUN MESSAGES]

PLEASE - NO RUN MESSAGES This is a high level discussion board for solving ongoing, day-to-day relationship conflicts. Members may appear frustrated but they are here for constructive solutions to problems. This is not a place for relationship "stay" or "leave" discussions. Please read the specific guidelines for this group.

[Notwendy]

It may help to look into reasons why the therapy doesn't seem to be working. Therapists see what their client "presents" to them. I have a mother with BPD and one reason therapy has not been effective is that she presents the situations through her own perspective, which is that she is somehow a victim of other people's behavior. Since pwBPD can behave differently with people outside their immediate family, the therapist might not be seeing how it's not working if your wife doesn't reveal insight to her own behavior.

Sometimes it is also effective for the partner to have therapy, for support, and also for insight into potentially enabling behaviors. Not to blame the partner but to become more aware of behaviors that may be impacting improvement. Since this pattern between partners is similar to addictions, 12 step groups such as CODA may help for the partner.

It's also possible that she needs a different therapist but it may help to look into why the therapy isn't helping when making that choice.

[NOVAnonBP]

Thank you Notwendy.  VERY true!

It may help to look into reasons why the therapy doesn't seem to be working. Therapists see what their client "presents" to them.

This is part of the problem . . . that the therapist only gets information through the BPD patient.  I was hoping that over time, the therapist would begin to realize that "things are not what they seem."  I think that perhaps the therapist is just not experienced or skilled enough -- or perhaps candid enough to say to the patient, "After two years and 150+ hours, things don't seem to be getting better. Perhaps you should work with someone else."

Anyway, I'm prepared to navigate the conversation with my BPD wife in order to arrange for a new therapist.  That will be hard.  I just need to find a therapist who is good enough at BPD treatment in order to be worth that painful journey and many painful conversations.

You're also right about therapy for the non-BPD.  Therapy has been helpful for me and I'll continue, on off as the temperature fluctuates.

[Notwendy]

Whatever the reason is, it's clear that what is being done isn't working- so not much sense in doing the same thing over and over if it isn't working.

Personally, (and I am not a T but I have also read this), I think BPD is one of the more challenging conditions- and with my mother as an example- she has strong "sense of self" protective mechanisms- which are dysfunctional in relationships - but they work for her to shield her from any sense of shame or accountability. Reading about Karpman triangle dynamics helped me to understand it. Victim perspective is one way to avoid shame and accountability- you don't blame the victim- and in her perspective, she is the victim, not the one with the problem, everyone else is to blame.

Projection and denial are strong mechanisms. When she rages, and projects her feelings as being caused by someone else, she dissociates so much that, I think in the moment it absolves her from anything she has done. She really doesn't see her part in any issue. Saying something to her directly will trigger this. It just doesn't work. If a T were to address anything she may be responsible for, she would walk out the door and that would be the last session.

With hope for your wife- more is known about BPD nowadays. My mother is elderly. She's had a lot of therapy and much of it was in an era where less was known. I do hope the outcome is better for your wife.

[NOVAnonBP]

Thank you Notwendy.

It is encouraging and even a little crazy to hear you describe my own experiences and my BPD's perspective EXACTLY. 

This has already happened with more than one therapist . . .

. . . If a T were to address anything she may be responsible for, she would walk out the door and that would be the last session . . .

Still hoping for the best, and for my wife and I to be the beneficiaries of some modern, "new and improved" BPD therapy and strategies.

[outhere]

From what I've read DBT is the only therapy approach that has any type of success with BPD.  Perhaps try and find a DBT program or a therapist with DBT knowledge.

[Notwendy]

I agree that DBT seems to be the therapy recommended. So far, there isn't a known method to "cure" BPD. There may be treatments for associated behaviors like addiction or depression. Outcome also depends on the person and their ability/willingness to work with the T. I think that has been a factor with my BPD mother, she does not/can not see herself as having a part in the difficulties in relationships.

Being in a large metropolitan area, there are likely some good resources. I think I'd look for a counselor who mentions that they treat clients with BPD on their website- and ask them about their experience with it.

The other side of the issue is the enabling. Any behavior, if it's reinforced, will continue- functional ones and dysfunctional ones. My father enabled my mother's behaviors- not to blame him for that as I think he believed he was helping her, and in many ways, he did help her, a lot. Not only him- but we, as older children, also were expected to enable her in ways.

A therapist may see a client a couple of hours a week and if the family is enabling the rest of the time, I don't think this would have much impact. This is why I think that focusing on the pwBPD- as the "problem" in the relationship may be a narrow approach. The dynamics in a relationship with someone with BPD are similar to addictions, which is why groups like CODA and ACA can help family members as the 12 step programs look at these issues as involving partners and family members.

I had a naive view of the situation, as it was not discussed in my family. My BPD mother's behaviors were the most obviously disordered and I assumed that it was her who had "the problem" and my father was the "normal" one who was somehow a victim of her behavior- and at times he did deal with difficult behaviors. It was when a counselor pointed out my own enabling behaviors that I began to understand this part in it. While this information has not directly changed my mother's BPD, it has helped me to manage my own boundaries better.

One one hand, therapy may not have helped my mother much, and while some of it may be because of a lack of knowing about therapy for BPD at the time, there are other factors- her own ability/willingness to work at this and the enabling.

If therapy isn't working, I think it would help to speak to the counselor about what has been done and their perception of the situation if you have consent to do so. If it's not working, then it makes sense to do something different, but the information about what is going on might be helpful.

[Rev]

Hello all,

Fascinating conversation - and I'd like to add/echo some of what I am reading here, especially the advice about understanding why therapy may or may not be working.

I think that one of the illusions that we place ourselves under is that therapy will "fix" something.  In fact, therapy will more than likely reveal a whole host of inconvenient truths - especially where personality disorders are concerned.

I often liken psychotherapy to physiotherapy. Physio to repair an physical injury - psychotherapy to repair a psychic injury.  Borrowing on this analogy, it remains possible (and I would say likely in the case of DBT) that a person will always "walk with a limp".  Without wanting to extinguish hope, I am suggesting that a cautious realism is in order.

When therapy is "not working", on average there is more likelihood that an unconscious "resistance" (i.e. a maldaptive psychodynamic  pattern) is trying to make itself seen. I like to call this - lipstick on the lapel. (Borrowed from the cheating husband who unconsciously wants to get caught because he can't fess up.)

Some therapists believe that up to 85% of the success of therapy depends on the quality of the "alliance" between therapist and client. Given that pwBPD have core challenges in forming relationships to begin with, successful therapy can be very hit and miss. It is one on the reasons why, therapists who specialize in treating people with BPD often need therapists themselves to continue their practices.

All this to say, in solidarity with people hoping to get help, it's so easy to become despondent and/or discouraged. That's why coming here to resource your energy can be such a good thing.

Hang in there,

Reach out any time.

Rev

[kells76]

Hi NOVAnonBP;

Good feedback from other members on this thread. I see it similarly, that there are two intertwining things going on -- one is the "what" side of finding a modality and therapist that could be most effective, and the other is the "why" side of how it all works, what success means/could look like, therapeutic relationships, etc.

I can comment briefly on the "what" side in terms of where to start with finding a T -- you can try the psychologytoday.com "find a therapist" feature at the top of their home page. Enter your zip code or city and click Search. A list will pop up, and it'll have some sub-menu filters (i.e. for insurance, issues, age, price, etc). Under "issues" you can click "borderline personality disorder", or under "types of therapy" you can click "dialectical behavior". Either of those routes can help narrow down practitioners who focus on BPD.

The "why" side is really important to talk through, and it's been a good discussion here. For T to be effective, the person has to want to be there at some level. When someone feels "forced" into going to T, it can be less effective. So, your W may have to want to try something new for her own sake. It'll be important to think about the dynamic between you and her in regards to therapy -- does she see you as someone "on her team" who can help problem-solve, or is she resistant to suggestions from you about T?

Hope that info helps;

kells76

[NOVAnonBP]

Wow. Thank you all.  I'm overwhelmed with good info:

• Consider DBT as a methodology/specialty advertised by T.
• Recognize the role of family in enabling/facilitating the problem or bad behavior.
• Maintain realistic expectations. Probably won't ever leave this behavior behind.
• Until my W recognizes the problem and accepts some responsibility, it will take a miracle to get her moved to a more effective T. She currently sees me as the source/cause of all her problems and so any suggestion coming from me will be "poorly received."

I will continue to . . . every day I ask God to:

• Help my wife find healing.
• In the mean time, please give me strength and wisdom for each day.
• Please hurry up.