Choosing a therapist (without losing hope entirely)

Someone recently asked me to write a post on the relationship between a borderline and his/her therapist, and I realized it was kind of weird and silly that I hadn’t already written one because the topic dominates a LOT of my BPD-related thoughts of late.

Boundaries – or the lack of them – are a crucial aspect of what makes BPD so distinctive, so difficult, so complicated. When I look back on the last twenty years or so of my existence, I realize that my total lack of understanding re. personal boundaries has been a HUGE part of the problem. My personal boundaries only have two settings: 20-foot titanium walls or smothering closeness and co-dependence. That’s not okay.

So who can help me learn boundaries? Who can teach me about them while putting them into practical use at the same time? The holy grail of relationships to the borderline: the perfect therapist.

The perfect therapist bears the brunt of your fears, vulnerabilities and frustrations so you can live a normal life outside their office. The perfect therapist takes on the role that your family/best friend/partner was always forced into in the past: save me, fix me, tell me how to be okay. The perfect therapist recognizes that BPD comes with its own particularly volatile set of triggers and treads on tiptoe but does not shy away from dealing with them. They shrug off all the off-topic outbursts and insults, they push boundaries at the perfect times, respect boundaries at the perfect times, and intuit the borderline’s every feeling so that they feel understood and validated 100% of the time. 

The perfect therapist, in short, is not a human being.

Human beings get sick or busy and have to cancel appointments. Human beings can be hurt or confused by what someone says to them. Human beings have their own vulnerabilities and frustrations simmering below the surface, even when they’re focused on dealing with someone else’s.

I feel for BPD therapists, I really do. God knows what made them go into that specialization in the first place. That being said, it seems to me that a lot of the people who chose to enter the mental health profession did so because they have serious issues of their own, and I’m not entirely convinced that helps them be better therapists. I don’t want to go into all the awful experiences I’ve had with therapy, because I’d imagine almost everyone of us has had them: they range from hurtful to incompetent to invasive and traumatic.

By way of background, I started one-on-one therapy with a specifically BPD-trained psychiatrist for the first time a couple months ago. It was the first hopeful or helpful person I had seen in almost three years of “therapy” (wtf). I wrote about being tentatively hopeful in a post around the time I started therapy with this lady, who we’ll call Karen.

Karen made big claims the first day I walked into her office. I’m not entirely sure she should have, but we’ll see. She said, and I quote, “You will walk out of here a different person.” Now on the one hand, it was nice to hear someone saying something positive or optimistic about my situation, because everything before that had been negative or vague. On the other hand… I’m not always sure I want to be a different person. I know how she meant it. But still. You know those times when BPD seems like your “real” identity and you don’t want to get rid of it because who knows what you’ll be without it? Yeah, I still have those. A lot. I cling to the pain and the anger and the suffering because it’s so bloody familiar. I often think of that horrible parable about the tiger who was confined to a tiny, filthy cage in a rundown illegal petting zoo for years. By the time she was rescued and released into a large, beautiful habitat, it was too late: she could only pace an area the size of her old cage.

Even a positive change can be too much, too scary if misery is all you’ve ever known.

The therapist’s job is to get you taking baby steps around your new, bigger habitat – your new world of possibility and hope. But for a borderline (potentially more than for any other disorder) it is essential that this relationship be a really, really, REALLY good fit. It’s going to be characterized by all of the things that are nitroglycerin triggers for a BPDer: trust, vulnerability, honesty, emotional intimacy, and addressing past traumas.

So how do you pick the right one for you? I’m sure there’s a lot of info on how to do so out there, but just for the record, I thought I’d contribute my two cents based on my own experiences and research: 

  1. Make sure the focus is on you helping yourself – not the therapist’s help. This goes without saying. I know it sucks to hear it. Borderlines spend most of their lives waiting and wishing for someone else to save them – even though most of us are smart enough to realize that fixing yourself is not the kind of work you can outsource. Any therapist worth their salt will make that crystal clear. They are going to guide you, help you, support you – not fix you. You have concrete tasks/homework to do between sessions, and skills you can practice instead of just stuff to talk about once a week. You are accountable to them as much as they are accountable to you. There’s no facade of victimhood to hide behind and they don’t treat you like a victim: they treat you like someone who has been hurt but is going to get through it with some guidance.

     

  2. They have a specific plan of attack that you’re going to implement together. Too much of my “therapy” had consisted of sitting there, wondering what the hell we were actually accomplishing (nothing, as it turned out). There wasn’t any plan, there wasn’t any concrete agenda or schedule for our sessions, there wasn’t any real reason to feel hopeful about progress, even when I repeatedly asked for those things. It was mostly just back and forth blabbing about extremely upsetting things, and as a result, I always left feeling worse than when I went in because we were bringing up all this horrible crap but never touching on even the remote possibility of a solution. It made me feel powerless, aimless, and even more full of despair. For this reason, it went a long way in making me feel hopeful and validated when Karen assured me it was okay to feel guarded with a therapist because what I’d actually experienced was medical trauma. I’d never thought of it that way but it was true: a botched job, a half-hearted sloppy attempt at repair that had actually made things worse – that was what I’d been through. She was able to outline exactly what she hoped we’d accomplish over the next weeks and months, and how we could change that plan as we went if it wasn’t working. Now that’s what I call progress.

     

  3. Their motto should be “safety first.” They ask about a million times if you’re ready for the things that could prove painful or upsetting to discuss. They never push or force information from you. They set a tone that means you feel comfortable telling them what you don’t want to do or talk about. They don’t let you leave a session until they’re sure it’s safe for you to be on your own. This goes two ways. It’s your responsibility to be safety-obsessed too, and to be honest about it when you don’t feel safe. No creeping out of the room with a fake smile on your face insisting everything is fine, when you know you’re about to go out and do something self-destructive.

     

  4. Don’t hand everything over at once. The temptation to do this can be overwhelming, especially if you haven’t been broken/hurt/rejected quite as many times as some borderlines have. You’re caught up in the classic cliché of “let it all out and you’ll feel better.” I can not tell you how many horrible, pointless, traumatic years I spent believing in this cliché and not understanding why it just wasn’t working. It’s what happens in t.v. shows and movies, right? Have a good cry, spill the secrets, hug it out and move on.

    NOOOOPE.

    Not with BPD. That cliché just does not apply to us. Until you can honestly consider yourself a master of emotion regulation, self-soothing and various DBT skills, I wouldn’t recommend handing over any of the deep dark moments that have made you what you are. Some abstract examples, sure. Some mini/less intense examples of what the real problem is can be extremely helpful, and a good BPD therapist will know that and stick to those until you’re ready. As opposed to delving into the core traumatic event, for example, discuss instead how your family ignoring that core trauma made it so much worse. That kind of thing is painful to address, but not devastating.

    One rule of thumb I now live by is, “If this person invalidates what I’m about to say, how badly will it hurt me?” If the answer is anything more than “badly but not that badly,” I don’t say it. That may mean it takes me 10 times longer to heal than someone who lays it all out there on the table in their first session, but if that’s the case, so be it. I know I have to protect myself because my BPD means I can be absolutely crushed by things that other people may not even notice or understand. I know that spilling certain secrets and having anything other than the absolutely perfect reaction to them means I go home and slice at my arms and legs. I’m really fucking sick of doing that. So I reduce the chance of it happening by keeping certain things extremely guarded until I can handle the hurt a bit better.

     

  5. Look for a vibe of genuine friendship, caring and understanding. Could you see yourself being friends with this person in real life? Do you feel like they really do care and are making an effort to understand and help you? Or is there something about their personality, their manner, that you just don’t click with? Of all the therapists I’d had (five, in two and a half years), I didn’t feel like I could be friends with any of them, until Karen. Within one session, I felt that connection, like we really could address this together. This is obviously extremely personal so don’t feel bad for rejecting someone on the basis of, “this just isn’t a good fit.” If they’re a good therapist, they’ll understand completely. It’s painful to have to keep seeking out help but it’s so worth it when you find what works for you.

    And on a related note…

     

  6. BACK AWAY IF THEY RAISE ANY UNPROFESSIONAL FEELINGS. Positive or negative. Doesn’t matter. This one is so crucial.You’re opening a door into your very soul, the essence of who you are. Don’t open it for just anyone. If you ever get a vibe of romance/physical attraction, or dislike, or personality clash, or whatever – get the hell out of there asap. Even if it’s a positive but unprofessional feeling. One woman I saw reminded me so much of my grandmother, who had passed away just about the time my BPD took a turn for the worse. At the time, I thought it was great: it was a sign that I could rely on her as much as I had relied on my grandmother for understanding and nurturing, and it made me feel safe. Predictably, however, it went horribly. The second I felt remotely invalidated by this woman, it hurt about a BILLION times more than it should have because I had poured all these memories and associations into our relationship that she had no way of knowing about. Ouch. As noted, your sessions have to be a safe environment. There is no safety if external emotional dangers are there from the get-go.

 

What tips do you have on finding a therapist? Are you lucky enough to be enjoying a good fit or still looking? I’d love to hear other borderlines’ thoughts on this complicated and crucial relationship…

 

Cat Earnshaw xxxx

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