I hate introductions almost as much as I hate goodbyes. For someone living with borderline personality disorder, though, both of these occur commonly with personal relationships and with mental health professionals.
Effectively treating my BPD requires both medication management from a psychiatrist and psychotherapy from a licensed counselor. I couldn’t tell you how many professionals I’ve seen in the past 15 years, nor can I remember most of their names. However, I remember both how they greeted me and how they told me to go away.
Working with borderline individuals can be difficult, but it’s not impossible.
I am not an easy client, I will fully admit. Sometimes, I’ll remain skillful and stable for months. Then, without warning, I’ll crash and burn. My reactions don’t always fit the facts, and sometimes my emotions don’t fit the box of typical responses. Despite all that, I’m hardworking and loyal. Once I trust you, I’ll share completely and honestly without hesitation or fear. Most importantly, I want my providers to like me, and I want to recover.
So, why is it so difficult for people with borderline personality disorder to maintain lasting relationships with mental health professionals?
For starters, some psychiatrists and therapists carry stigmatizing views of BPD. Some professionals limit the number of borderline clients they accept, while others refuse to work with them altogether. Personally, I’ve experienced moments when therapists stumble upon my borderline tendencies and suddenly decide they’re “not equipped to help” me. Even my current psychiatrist (whom I adore) often avoids using the word borderline with me. Instead, he says that my “personality structure” or my “condition” cause certain behaviors.
Furthermore, some professionals truthfully are not trained with the proper skill set to effectively work with borderline clients. Although dialectical behavior therapy is by no means the only effective treatment for BPD, a background in some type of behavior therapy or other scaffold-type treatment statistically does wonders for both the client and the provider. That potentially means more training that a newly licensed clinical social worker may not yet have obtained.
Even when professionals willingly accept clients with BPD, they sometimes dismiss them at the first subtle signs of resistance. Therapists especially use the fact that their services are elective treatment to dismiss clients they feel are unwilling to do the work. Unfortunately, this only increases fear of abandonment and hopelessness for someone like me. This, in turn, creates more work for the next professional who tries to work with this client. Their anxiety and emotions will be even more intense.
What can people with borderline personality disorder do to maintain their providers?
Clients with BPD have several options to maintain relationships with the professionals who provide their care. The first choice (and sadly does happen), is that the client chooses to not disclose their BPD. They can especially do this with therapists who don’t require extensive information from previous providers. Although this may help someone with BPD gain a new therapist initially, it may be difficult to maintain this and receive the full treatment he/she needs.
Another option is for the borderline client to seek out professionals who choose to work with people with BPD. Thanks to the internet, websites like Psychology Today provide web searches for professionals in your area. You can narrow the search by adding filters for things like borderline personality disorder, specific types of psychotherapy, or even specific credentials.
Finally, the best course of action may be to seek a treatment team that is not completely connected. For example, separate your medication management from your individual therapy, and consider finding a way to see a different individual therapist than the one who leads any group therapies you attend. For me, this has allowed me to maintain at least one or two professionals even when one part of my treatment team makes the choice to terminate my care.
While people with BPD should not feel like professionals discriminate against them, it’s also important that borderline patients always consider their behaviors when a provider terminates their care. While psychiatric professionals hold an important job, it’s up to the patient to do the real work.