Thread Drift

[spokewench]

((Indy )) - Just hang in there and don't feel guilty - you are doing nothing wrong!

[indysteel]

Your sister will never change.
Hold your boundaries and care for yourself.
Sadly, although you cannot diagnose a personality disorder until someone is 18, I am treating a 13 year old who is exactly like your sister.

My sister never behaved normally. She was abused by my mother for one thing and the mental health genes in my family did not help matters. Of course, my parents never did anything constructive to help her. Rather, they simply reinforced her attention seeking behaviors. Meanwhile, I did everything in my power to be her exact opposite and, as a result, I got/get no attention from my parents. They don't respond to healthy behaviors.

I hope you're able to help your client. My understanding is that BPDs are very difficult to treat. My own therapist avoids them.

[indysteel]

Hugs right back, Muirenn. Family, sigh....

[OakLeaf]

(((((Indy)))))

[Owlie]

(((Indy)))

[lph]

Aw, I'm sorry Indy. Isn't it amazing how we know people like this are impossible to deal with and we know to keep our distance and not get involved, and they STILL manage to **** up our heads. I guess that's what's empathy, voluntary or not, does to you...

[Crankin]

Indy, right now I am just trying to get her to stop self destructive behaviors. She just came out of the hospital. This is a case of neglect, abuse, family history, adoption, and attachment problems. Her adoptive mom is wonderful, but it's a horribly stressful situation for her. I practically live at their home... two 1.5-2 hour visits a week.
You are right, most therapists avoid treating this diagnosis. it's a known "joke" in my profession. Especially psychiatrists, it seems. I've actually had a couple of clients who fit this description, although they were diagnosed as Bipolar Disorder.

[indysteel]

Yikes, Crankin. Your client certainly has all the triggers for BPD. How very sad. I hope you and her adoptive mom can make a difference. I've often wondered what might have happened if my sister had gotten help at some point in her adolescence or young adulthood.

[jobob]

A couple of years ago, I deliberately disengaged and eliminated all contact with my birth family. I thought I was very unusual in that respect, but perhaps I'm not.

Hugs to you, Indy.

[shootingstar]

I slept like a log. I haven't slept deeply and through the night for last few months. But when it happens it's like drinking a deep long glass of water after a long hard bike ride. I didn't ride far yesterday since it started to snow. But did some art while playing some classical music.

[goldfinch]

It is unsettling to me that there are therapists that avoid BPD or diagnose it as something else to avoid the issues the diagnoses brings. It feels like an oncologist who doesn't want to help people who have pancreatic cancer because it is too hard. I suppose if they are referring people to therapists that are better equipped that would be fine.

My niece has BPD. She is tough to deal with and I take breaks. She also is bipolar. Her social worker believes that the BPD diagnosis is wrong. I think she believes that simply because of the baggage the diagnosis brings. We have had a few discussions and I think her social worker spends too much time trying to be my niece's friend rather than being a social worker. She wants to be on my niece's side and I think that colors her view of reality. The SW is very inexperienced. Once a week the SW picks up my niece and takes her out for coffee. I She doesn't go inside my niece's apartment. You can tell a lot just by seeing the current state of her apartment. She needs to see that to know that my niece's son is safe and being taken care of. I am blabbing about this because I think I need to talk to someone in charge. Her old social worker was excellent but she retired. Ah well.

At least she has others on her mental health team.

[indysteel]

My own therapist gave up treating BPDs because she found that CBT did not tend to help them. They also tended to exact a huge emotional toll on her, by the very nature of the disorder. A pancreatic cancer patient may be difficult for an oncologist to treat, but not in the same way as a BPD. The extreme love/hate poles that BPDs tend to fluctuate between can be extremely taxing, especially when combined with self injury.

But it's really the first point that's worth emphasizing. CBT may not be the right treatment for BPDs. From what I've read, dialectical behavior therapy may be more effective, but not every therapist offers that type of therapy.

[Crankin]

You are correct, Indy. CBT does not generally help BPD/O. The standard treatment is dialectical behavior therapy, which is a combination of mindfulness training and some cognitive behavior therapy. However, to bill yourself as a DBT specialist, you really need to have taken the special training and not everyone can do that. I, would love to do it. I have found that I am good at keeping boundaries and I expect BPD/O people to test me, as well as some with Bipolar D/O. But, not everyone is like me.
It is very hard to to deal with someone who is continually self-injuring. My client told me she "loves doing it." (cutting). I bought a book for teens that uses some DBT to decrease mood swings and enhance emotional regulation. I'm not certified in DBT, but I can use this. I do have the training in Mindfulness, as I took the official U Mass course at my local hospital.
Goldfinch, it's hard to treat someone who "tests" you consistently and shows little hope of improvement. I just look for stability and functionality. However, your niece's clinician sounds totally off the mark. Taking her out for coffee? This is what a therapeutic mentor does, not a therapist.

[OakLeaf]

The other thing is that in some states, insurance coverage is much more favorable for certain diagnoses than others. Depending on where you are, a therapist might tailor a diagnosis to allow the client the maximum insurance coverage, and choosing a mood disorder over a personality disorder is a prime example of that.

[Catrin]

The other thing is that in some states, insurance coverage is much more favorable for certain diagnoses than others. Depending on where you are, a therapist might tailor a diagnosis to allow the client the maximum insurance coverage, and choosing a mood disorder over a personality disorder is a prime example of that.

This makes a lot of sense, insurance being what it is. I've always had a problem with the term 'personality disorder'... it seems such an...unfortunate term though I know it isn't meant that way.

Somehow the term seems to hit at a different level than a mood, thought, or emotional disorder. Perhaps that indicates the challenges presented by them for both the individual and those trying to help them and others around them.