Tuesday, May 12, 2020

Psychotherapy with BPD: Another Conundrum

For therapists such as myself who also write about borderline personality disorder (BPD) for the general public, there are several ironies that make it a damned-if-you-do, damned-if-you-don’t proposition. In my post of 2/27 of this year, I discussed the issue of how describing what the parents are doing with their children can make those parents feel even more guilty than they already were, when guilt is what has been driving their problematic behavior in the first place. Therefore, they can get even worse rather than taking any new knowledge they may have gained as a way to reduce their problem behavior.

A similar issue takes place when adult children who have BPD read my discussions of family dynamics. For the role of spoiler that they are playing, part of what drives it is often their parents’ insatiable and unceasing efforts to “fix” what’s wrong with them. Because to all outward appearances their parents seem to want or need to continue to do so, their adult children must remain “broken.” That is, in need of fixing. The people with BPD also think this about their narcissistic romantic partners, who are also constantly trying to fix them - while seeming to feel that they are God’s gift to them. The more the partners try to do the fixing, the more they reinforce their mate’s spoiling behavior.

So guess what happens when an individual with BPD comes to see a therapist? The therapist’s whole purpose for existing is to “fix” what’s wrong with their patients! How can therapists not end up inadvertently enabling their patient’s spoiler role? It’s sort of like coming to see someone whose goal is to “make you independent.” How can someone really be independent if another person is making them do something?

In therapy, the way around this is for the therapist to validate the ample evidence their patients offer (even while sometimes pretending that this is far from the case) that they are smart and capable, and that “their” problem is not a personal defect, but trying to figure out an enigma. They are trying to come up with a way to solve an almost-impossible-to-solve problem: the conflicted, ambivalent dynamics of their family members.

Doing something equivalent to this therapy countermove when writing for the public is a rather devilishly complicated proposition. Even spelling out what I am saying here with disclaimers doesn’t always work because it’s easy for someone coming from a borderline-ogenic family to see that as a ruse to lull them into a false sense of security. 

I had one reader write to me to tell me that something I wrote, rather than being empowering, made her feel so helpless she made a suicide attempt. She didn’t say that what I wrote was wrong, it should be noted, and I would wonder if she already had a history of making suicide attempts. But still, I understand her request that I be more careful about what I write.

Another reason I might make persons with BPD feel helpless is that, if family members were to read my stuff and figure out what they are up to, then the people with BPD might no longer be able to successfully pull off the spoiler role. They would become less powerful because I gave away their "secrets."

Nonetheless, facing the truth is the only thing that can set free everyone involved in family dysfunction. Dysfunctional roles only stabilize families (homeostatsis) over the short run. In the long run, they prevent resolution of ongoing issues.

So there is hope, especially if there are more therapists who understand family dynamics. I continue to hope for potential patients to create a high demand for therapists to start helping them identify interpersonal triggers and find ways to avoid the typical negative consequences of change - rather than just focusing on what is going on inside their patient’s head.