Posted by: Marie | July 17, 2009

(107) Borderline cluelessness

Post #107
[Journal entry written to my therapist on Sunday, March 15, 2009]

Hi, Dr. Barb –

So, there is something I need to ask you. Given what I am dealing with, do you feel qualified to handle my case? If so, are you willing to handle my case? I can imagine that working with a client who is consistently negative, angry and combative wouldn’t be very much fun for a therapist.

I need to learn how to convert my negative thoughts to positive thoughts – that may require great patience on the part of my teacher. Are you willing to be that kind of teacher to me? If not, how do I find someone who is able and willing?

Inline Teasers_Page_1My motivation for asking comes from research I conducted over the last year. First, I have learned that people with a history of childhood sexual abuse are very difficult to treat because of the complexity of the resulting trauma. Relatively few therapists are qualified or willing to handle such a case. Now, I’m not even 100% sure that I was molested, but I think so. Assuming I was, that makes my case more difficult to handle.

Second, I have done enough clinical research to know that my symptoms significantly align with the symptoms associated with borderline personality disorder. I did this research before I started working with you, when I was trying to move forward on my own. I know laypeople are not supposed to try to diagnose themselves, but I didn’t get the information I needed from my previous attempt at counseling, so I found it myself. It may or may not be helpful to you.

The following is a comparison of my symptoms to those listed in the DSM-IV:

Present in a variety of contexts as indicated by five or more of the following criterion:

1) Frantic efforts to avoid real or imagined abandonment

This is more about rejection for me – in my 20’s, I dedicated most of my free time to figuring out how to gain and keep the attention and approval of men. In my 30’s, I came to realize the repeated rejections were so painful that the emotional attachments were no longer worthwhile. Since then, I have become more and more reclusive and now feel mostly hopeless about emotionally or physically intimate relationships, especially with men.

2) A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation

Building on my response to #1: When someone (especially a man) pays me a little positive attention, I instantly become infatuated with him or her. I work very hard to gain more attention. I tell him or her my entire life story early in the relationship, especially the gory details.

I find ways to “bump into” the person in public. I pay a bit more attention to my appearance when I know I’m going to see that person. Everything I say, do or write is done with an awareness of how that person would respond to it.

Flower by Martin Chen

Flower by Martin Chen

In my 20’s and early 30’s, I would offer my body (sexually) to men very early in the relationship because I figured out that sex equaled even more attention. But, that always left me feeling used and somewhat of a prostitute (getting attention instead of money).

I really hate being in that infatuated state because I know the “high” is tenuous and short-lived. I know for certain that the attention and apparent approval is going to end, it’s just a matter of time. I dread the impending disappointment. The dread is bigger than the high. I don’t know how to move through that phase any faster (or how to avoid it, altogether) – I get stuck there.

Then, when the person doesn’t continue giving me attention, or when the attention falls short of what I desire, I find ways to lower the person’s value to me – to prove to myself that I don’t care. I take an inventory of the person’s faults to prove to myself that the person’s opinion was never valuable in the first place. Then, to deal with the pain of rejection, I engage in behaviors that allow me to go numb.

I’m in one of these two states about 80% of the time and in a neutral state about 20% of the time.

3) Identity disturbance: markedly and persistently unstable self-image or sense of self

While my professional intentions are (relatively stable?), I am often unsure about how I want to participate in the world on a personal front. Sometimes I want to be reclusive and hide in a cabin in the mountains; sometimes I want to be a social butterfly and participate in a multitude of social groups. I’ll whole-heartedly commit to social organizations and then back out a few weeks or months later when the intensity overwhelms me.

Sometimes I even think it would be cool to date – if I could just figure which gender I prefer – if I ever felt stable enough to handle the pressure of intimacy – if I could ever stomach the thought of being touched sexually. Some days my sexuality is warm and alive and other days it is ice cold. Some days I want to express my femininity and other days I want to be an androgynous blob.

In some ways, I think I’m a fine specimen of a human being – I’m really smart, for example, and love to study and learn. Yet, I feel socially inept – unless I’m at a party where I only have to spend a few minutes with any one person. At a party, I tend to walk away from a conversation while the person still thinks I’m cool. I wonder how I can be so smart and yet so clueless about how the world operates and how I am supposed to show up in it. I wish someone would explain the rules to me.

4) Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating)

My fascination with high-risk activities (racing motorcycles, fire fighting, bungee jumping, etc.) is lessening as I get older, but it still shows up once in a while. I struggled with alcohol abuse, compulsive spending and promiscuity in my 20’s, but those behaviors have lessened significantly as I’ve gotten older. The only compulsive behaviors I really struggle with currently is binge eating and picking my skin.

5a) Recurrent suicidal behavior, gestures or threats

No – just periodically wishing God would allow me to die so I wouldn’t have to get up the morning – but I don’t think I could ever take my own life because the hell I would put my family and friends through is a million times worse than what I’m experiencing in the moment.

5b) Recurrent self-mutilating behavior

Hours and hours of picking my skin – not sure if this fits better into #4 or #5b.

6) Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability or anxiety usually lasting a few hours and only rarely more than a few days)

The onsets of my negative moods are usually sudden and unpredictable. Then, my moods always begin to improve within a matter of hours but require several days to completely shift back to a positive position. Part of the delay in the dispelling is that I am nervous about believing in my “good mood” too quickly because I know it can disappear very quickly. It is tempting to make a commitment or start a project before my mood has fully stabilized, which can trigger another “crash and burn” in the middle of it – that’s when I break promises and commitments and disappoint people. I need to feel good for 2-3 days, in an isolated setting, before I really believe I’m over the worst of it and can resume my public participation in the world.

Inline Teasers_Page_2

I measure the positive-ness of my mood by how well I’m able to function in the world – if my mood is not preventing me from functioning, then my mood is “good”. I never experience sustained feelings of happiness and well-being.

7) Chronic feelings of emptiness

Yup. All the time.

8) Inappropriate, intense anger or difficulty controlling anger (frequent displays of temper, constant anger, recurrent physical fights)

I’m really good at covering this up – most people never see it. However, when I’m given a situation where it is acceptable to allow my anger to show (like therapy), it appears quickly and explosively.

9) Transient, stress-related paranoid ideation or severe dissociative symptoms

I don’t know enough about this to comment . . . .

I believe, on the continuum of severity, my case is less severe – I’m guessing I could be described as a “highly-functioning, borderline” borderline – maybe not even severe enough to be classified as having the disorder. When I read the stories of people who have this disorder, I can relate a lot to them, but my story seems much milder.

I don’t really care what labels do or don’t fit – but having the “label” does give me a textual tag with which to search for more information on the Internet. Using that label has allowed me to find valuable information.

One thing I have learned is that this disorder is also very difficult to treat – many therapists aren’t qualified or willing to work with such cases. As you can see, I have cause for asking the aforesaid questions of you.

– Marie

Quotes 018


Responses

  1. Dear Marie,
    Wow! What an amazingly honest confession. Wouldn’t it be something is a doctor actually read something like this and responded?

    I often thought that I’d prefer a psychiatrist who’s a writer and rather than visiting her at all, I’d just send something I’d written, and ask her to respond.

    That would have been so much more valuable than my sessions, which weren’t valuable at all.

    My current therapist, however, is truly great and very insightful, and he’s the only person (besides the healer I recently saw) who’s truly helped me.

    Alas…

    Susan

    • Hi, Susan –

      Thanks for acknowledging my honesty!

      In response to your musing (“Wouldn’t it be something . . . “), my psychologist (Dr. Barb) did read this . . . and even responded (somewhat) in our next session.

      She is very methodical – so, at the start of our session, we reviewed my journaling, top to bottom – as usual. When we arrived at this section, she did what I expected she would do – she neatly bypassed the entire discussion about BPD.

      Her attitude about labels and diagnoses is usually something like, “Does it really matter?” So, her skipping it was no surprise to me. I didn’t bring it up, either, because I knew (from past experience) she would then sidestep the discussion – a waste of my breath, even though it did matter to me (it would help me know what direction to aim my research).

      She did, however, touch on the matter of her being qualified to handle my case . . .

      She said what she thought was not important . . . I disagree because, if she does not feel she is qualified, she should remove herself from my case and assist me in transitioning to another therapist – the sooner, the better.

      She said what really mattered is what I thought – more specifically, if I trusted her to handle my case effectively – or not. Of course, given the rough start we were experiencing in our relationship, my immediate thought was, “Well, I’m starting to think ‘no’, and I was hoping you would give me a reason to think ‘yes’ . . .”

      That was the end of the discussion. I didn’t press her to say more because, again, it would have been a waste of my breath – and I knew time would tell if she was going to be helpful in my healing . . .

      Anyway, back to you – when you wrote the part about wishing therapists would work with you via writing . . . did you know some do that now? They are called “online therapists” – I have been reading up on them lately – several therapists have blogged about them and it seems to be a pretty good deal, if you like to write (if you don’t like to write, some work via phone).

      It provides you with a wide selection of therapists (anywhere in the world) and you can work via chats or emails . . . just a thought . . . I have been considering that type of therapy for myself for the same reason you give.

      Thanks for writing!
      – Marie

  2. Hi, Marisol –

    I accidently deleted your comment, so I’m re-creating it (below) the best I can. For some reason, I can’t get it to not use my photo . . . sorry!

    – Marie

    —————————–

    I like surprises!

    Take care,
    M

  3. Marie,
    Actually, if there’s something you truly feel is important to discuss, it shouldn’t matter what the “label” is, but it sure matters what the issues are. And, if you can’t discuss the issues you consider the most important with this therapist, then she needs to acknowledge that and help you find someone else.

    At least, that’s how I would feel.

    Thanks for the info about therapy. Actually, I’m almost done with it, and it was truly healing. But, that’s something to think about if I return to it in the future.

    Susan

    • I so agree with you, Susan! I did really need to talk through the issues and she was not allowing that to happen . . not good.

      – Marie

  4. Hi Marie,

    People who are angry and negative can be much more interesting and engaging. These people really mean it, relating to people who are pretending is draining and dissatisfying.

    Maybe the problem for the doc was the word “qualified”. This is different too “willing” which you asked about or “wanting to”.

    I would think that someone who has the very high degree of self-awareness that you show in your journal would be a wonderful client to have.

    • LOL . . . thank you, Evan . . .

      I’ll hang onto that little nugget . . . that, while I would be a challenging client, I would also be a wonderful, interesting and engaging client/person . . .

      I can sure think of a lot worse ways to be described! It works for me . . . thanks for the boost to my self-esteem! (Or would that be self-worth? LOL)

      – Marie

  5. Hi Marie,

    Now that I’ve figured out the ‘quirky’ chronological dating system you have here (it’s nice to be quirky), I’m going through your posts.

    I’m struck by the intense honesty with which you write. Especially with respect to sex. But also to other areas.

    I think while you have many questions, like were you molested?, you have a wisdom about you that is helping soften the blow of what you have to deal with. So, I see where you say you may have a “mild” case of this or that. But what’s really important, I think, is that what makes it more mild than perhaps someone else, is what you are doing about it and how you are committed to learning about and understanding yourself.

    I look forward to reading more…

    Paul

    • Hey, Paul –

      Thanks for taking the time and effort to figure out my system . . . LOL.

      I greatly appreciate your recognizing my honesty — sometimes after I publish stuff, I’ll go back and read it — and immediately wish I could take it back — sometimes I feel like I just got caught wandering around the house with no clothes on — too naked, too vulnerable. But then, I take a breath and it is okay — especially when I receive feedback like yours.

      I like your point about why my case might be milder . . . I had never thought of it that way before . . . I’m betting you have a very valid point! Thank you for sharing it!

      – Marie

    • Hey, Paul –

      Did ya’ see??? I finally found the text widget . . .

      So now I can explain my quirky date system in the sidebar! Cool! LOL

      – Marie

  6. Marie,
    This post is amazing.
    I am very behind because of all that has been going on in my life. Still I am so very interested in your process.
    I think your honesty is remarkable and I am benefiting from it, Thanks.
    I still think your therapist must find you to be fascinating and wonderful to treat.
    I had to laugh when you said that she responded “does the diagnosis really matter?” I know and understand how frustrating it is to feel like they won’t discuss what I want to talk about! I do find that if it is important to me, it WILL come up again. Have you found this for yourself?
    My therapist has always been a “does the diagnosis really matter?” guy, after 13 years I have come to understand the value of this way of thinking. We treat, we work Harder than I could ever have imagined and I begin to understand that I am so much more than a Diagnosis!
    Best to you dear.
    You are amazing.
    Vicki

    • Hey, Vicki –

      I keep up with your blog, so I am aware that you have been VERY busy lately . . all the more reason I’m tickled to see a comment from you!

      Thank you for the kind words . . and, yes, if it is important to me, it WILL come back up again in therapy . . mainly because I tend to be single-focused . . . I usually won’t let it go until it gets handled, or until I know it is not going to be handled.

      Thank you, again, for such kind words and for stopping by!

      – Marie

  7. Hi Marie,

    Yes, I believe it does matter. If your therapy is being paid through insurance, it matters to them. They don’t approve sessions without diagnoses.

    I disagree with what your therapist is saying and what others may believe. It does matter. A diagnosis can mean one type of therapy is better than another, one type of therapist is better than another. That is about healing and progess and as the client you have a right to that. There is also a code of conduct that therapists are trained in and must adhere to and one of the conduct rules is that a therapist must not treat a client that they are not competent to treat. And knowing a diagnosis is a part of assessing that competency.

    I’ve never had a therapist say they weren’t competent and I was told in college that therapists don’t want to admit they are over their heads, metaphorically speaking. That does a disservice to clients as well as interfering with their lives, their healings, and their rights to being treated in an ethical and moral manner by someone who is after all an employee of the client.

    Having read a lot of your blog, though not all of it I wlll give you some personal opinions of mine. No you do not seem to have borderline personality disorder. I have known BPD survivors of abuse and they are routinely nice people. My mother who abused me was also, I believe, BPD. I’m not sure if I can tell you how different you seem from them, but I would say that you seem hugely different from my mother. The best way that I would say the difference would be hysterical and hysteria. Borderlines do not usually manage their lives better as they get older, like you have, to heal and grow. Not unless they get the kind of therapy that focuses and targets the issues they deal with, like Dialectical Behavior Therapy (DBT).

    This is not meant to be a slam on those with BPD. Rather it is an acknoledgment that therapy as it has been forumlated has not been very effective until recently for dealing with skills and life changes that targets the issues those with BPD deal with.

    I would say that your symptoms sound more like Post Traumatic Stress Disorder or Complex Post Traumatic Stress Disorder or the aftereffects of child abuse or a combination of the above.

    There is a great book on Complex PTSD by Judith Herman called “Trauma and Recovery.” Have you ever heard of it? It explained my whole life and blew me away. But in a good way.

    Good and healing thoughts to you.

    Kate

  8. Hi, Kate –

    It doesn’t surprise me at all that you think I may have self-diagnosed myself inaccurately . . . I really don’t know much about the clinical aspects of all this, so I could easily be “off base”.

    I appreciate you telling me what you think could be going on with me — I’m not familiar with the term “complex PTSD” nor the book you mentioned. I will look into those avenues of information!

    Thank you!

    – Marie


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