The Therapeutic Underbelly of Borderline Personality Disorder

By Sonia Neale

The Rose

The most difficult aspect of Being Borderline is intimate relationships and that includes the special relationship we have with our therapists.  After nearly twenty years of (on and off and when needed) therapy, a certain familiarity happens and feelings, not always positive, can occur.  I will be honest here and I find that envy of my therapist and her happiness can threaten my internal security.  Because I know less about her than she does about me, I tend to fill in the blanks with “stories” of how perfect her life is.

This is one of the many reasons there are no shortage of therapists unwilling to engage with people diagnosed with borderline personality disorder.  There is no doubt we can unwittingly (and wittingly) press therapeutic buttons.  It is their job to gently needle us out of our ego centred comfort zones so we gain insight into our less than desirable personal qualities which I might add are universal, it just depends on the extent.  In a conversation with my therapist where we are working on why I see her as a threat to my happiness, she referred to this as the “therapeutic underbelly” of our work together.  What lies beneath our valuable work together and what is known in the trade as “transference.”

For everything there is its opposite.  It was Sigmund Freud who coined the term “transference” as well as “counter-transference” which is therapist feelings towards their clients.  Even Freud was not immune to his own feelings for his clients as he used to regularly transgress boundaries and even take his favourite clients on holidays with him.

So why would I pay someone good money if I see them as a threat to my security and happiness?  Because due to my BPD thought processes, I am aware enough to know never to compare my insides with anyone else’s outsides.  My perception of her as a “threat” to me is not based in reality.  She is at peace with herself and is happy with her life.  I sometimes forget that peace and happiness is not a finite resource, that when you give peace and happiness away, it expands exponentially and creates ongoing karma.  This is something I have to practice every day.

For a few days there instead of stewing in my own juices and emotionally dysregulating up to DefCon One, I sent her a morning email hoping she had a wonderful day and a photo of a flower I had taken.  I kept a record of how I felt and found that the mornings I send her positive vibes I felt she was less of a threat to me.  I had to stay very mindful and after a while I was feeling quite good about myself and less threatened by my perceived perfection of her.

Mindfulness and meditation without judgement on thoughts both good and bad have a way of helping me through the drama of my life and connect me with others in a real way.



Being Borderline Abroad

By Sonia Neale

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I recently was awarded the Inaugural Barbara Hocking SANE Australia Fellowship to study mental illness overseas. The sole focus of my application was Borderline Personality Disorder and what services and programmes I could bring back to Australia.  I was so excited because I could now set out to change the world.

For the past nine weeks I have been travelling the world with three weeks to go. Ordinarily this is a recipe for disaster for someone with boundary issues, self-harm tendencies, routine and daily structure issues, food, alcohol and drug dependencies, entitlement and anger problems, inter-personal skills deficiencies, mindlessness, mood swings, black and white thinking and everything else BPD.  Even though I have eighteen years of therapy behind me, sometimes the unexpected can happen and I need to be able to deal with it on my own because my family are back in Australia, and I am the only person I can rely on to sort things out.  As well, I am representing an Australian mental health organisation who have placed their trust in me to do a good job.

So when I lost the connection to my mouse going through Los Angeles customs, got financially ripped off by a British hire car company, had no wifi access in the Ireland because my sim card did not work as promised and somehow connected to international roaming (very expensive and expecting huge bill) or found myself at night at Waco airport with taxi issues, I had to get myself free from not only the situation but the toxic headspace that these happenings engendered.

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Being Borderline overseas can be frightening. I have circumvented several panic attacks over many different scenarios. I have woken up in different countries, with different seasons and different time zones and for several minutes I have to work out am I safe, do I have enough money, am I physically well and who am I and what am I doing here?  I have to breathe, pause, feel the anxiety, breathe and pause again, remember that I am OK, I am functioning.  My pre-frontal cortex has learned to kick in quickly.  If I get overwhelmed I can also email and skype with my husband.  I got sad and irritable one day and I emailed him and he said he gets sad and irritable as well with me being away and I resonated with that and felt validated as well.

Living out of a suitcase for three months, collecting experiences, business cards, conversations, books, papers and souvenirs along the way is tiring, exciting, fascinating, mind-blowing, scary, frightening and terrifying but never lonely and boring. I am comfortable with my headspace because I have very few demons inside my head anymore.  However on this trip I have had many “aha” moments and shifts in cognition about historical events.

I spend a lot of time at airports, eating airport food, paying airport prices and sitting in planes watching “The Big Bang Theory.” So far I have watched the same eight episodes of Season 7 twice, whilst sandwiched between two fat people (Hark at the kettle because I’m not terribly slim myself at the moment).  I also have to negotiate international menus and try and find local but healthy choices.  Early into my trip I decided to choose what looks like fun food I want to eat, I can always lose the weight when I get back home.

So being Borderline overseas means being flexible, seeing shades of grey (not the movie) staying in the same mood, being consistent and reliable, eating regularly with real food (not just cookies and chocolate), not giving in when people drink alcohol or smoke (I’m an ex drinker/smoker) being patient, very patient, courteous, polite, deferential, socially amenable to all situations, being empathic and taking on others perspectives, tipping wait staff realistic tips and most of all, exercising extreme mindfulness.

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I have met some amazing people, if you are reading this, you know who you are. People who have opened up my mind and expanded it with different perspectives on the same theme, from the register clerk at a Texas gas station to a psychiatrist at a NAMI conference.  I have met people who have taken me into their homes for the night, driven me far and wide so I can get to my next destination, bought me a meal, shared their most precious stories, given me books, files and invaluable information and generally all people have made this “gone walkabout” Aussie feel welcome and at home, no matter what US state or country I am in.  I am humbled by the kindness of strangers who are no longer people unknown to me but are now friends.

One of the major advantages of being Borderline is the ability to merge and take on characteristics of others. This expands to countries and cultures as well.  When in England I drank tea and my accent took on a British quality.  When in America I drink coffee and was staying at a B&B where the host, who had lived through two world wars, said Grace before breakfast and expounded his views on this new-fangled idea called Science.  He called me Miss Sonia.  I will miss him when I leave Texas.  I even went to church in Waco because I felt so attuned to this place.  Everyone said to me, Waco?  And I said there was a pot of gold in every place I visited, I just had to look hard enough.  One does not always recognise a pot of gold even when one stumbles into one.

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I found gold nuggets all over Ireland. From the beach called Greystones (aptly named) to the Spanish man who was part of the Mindfulness course I did.  Ninety two people from 27 countries shared five days together in a function hall in Wicklow County, each of us on our lonely little yoga mat islands.  I got thoroughly pissed off when one morning I came in to discover his yoga mat had the audacity to touch mine and I felt personally violated.  When we had a group sharing session I mentioned this and then he turned around and gave his version of this angry woman who tapped him on his shoulder while he was meditating and asked him to please move his yoga mat.  That gave others permission to share their territorial rights stories as well.  Part of the learning process of being Borderline is finding out your impact on how you come across to other people.  I said to him that was the gold nugget I was told we would find in this course.

Next week I get to go to Canada. I am truly blessed having received this Fellowship.  I set out hoping to change the world, and the person who has changed the most is me.

 

All photos by:  Sonia Neale



Borderlines Working with Borderlines

By Sonia Neale
Stormy Oceans

Stormy Oceans

If non-Borderline mental health workers are triggered by working with people with BPD then how do peer support workers with a diagnosis of BPD cope with working with Borderlines?

Triggers, both conscious and unconscious can catapult people in to the past where old issues surface and can affect how workers interact with their clients.

One of the symptoms of BPD is becoming emotionally overwrought with an inability to decrease that arousal and staying at that high level for several days. Obsessions, ruminations, delusions and even micro-psychosis around the event, always relationship driven, don’t diminish easily. When working as a peer, trigger upon trigger can occur where personal stuff gets activated, and it is not unusual for peer workers to have to leave the job they love because it can affect their own mental health.

Having worked with a therapist myself for many years, I am getting a sense of what it feels like to work with someone with low insight and sense of responsibility. It sucks, I feel devalued and the work we did together dismissed as irrelevant. Everything I have ever read about BPD countertransference and how workers feel came true.

The other part of me, understands the illness better than most, the lack of social skills, inability to find words to convey feelings, feelings of perpetual victimhood and had the utmost empathy for their inability to navigate through the dark, murky waters of BPD.

I have to differentiate my professional and my personal feelings and days after the event I am still slightly stinging from this. I went above and beyond the scope of my job description for this person. This is not unusual when working with people with BPD. They can easily evoke the “rescue gene” in me as I elicited the “rescue gene” in my therapist.

I know I did my best for this person. I know my heart was concerned only with recovery. All I can do is let go and move on and wish them all the best. Hopefully one day she will see that, like my therapist, I am not perfect, I just did my best.



The Many Faces of Being Borderline

By Sonia Neale
Interpret this!

Interpret this!

 

Misreading neutral facial expressions as hostile is reported to be what distinguishes BPD from other mental illness disorders according to this article from US News Health

Rolling the eyes, the extended blink, the nose wrinkle, the eyebrow rise, the lip twitch; all these can be erroneously interpreted as provocative, insulting and combative and cause huge ruptures in relationships. However, sometimes these interpretations are spot on. We can display our deepest prejudices in our facial expressions and not even know it.

The eyebrow rise can display surprise, the nose wrinkle can portray disgust and the extended blink, an indication that the person is either bored to death or that you have tapped into some shameful secret or synchronous event or both. I’ve been eerily accurate on several occasions with my therapist through the extended blink and the nose wrinkle; all confirmed by subsequent personal interrogation, just short of thumb screws, to extract a confession. But the hotter my mood, the less accurate I am. Depending on my internal state, misinterpretation is also possible.

People with BPD are highly tuned into their environment. Hypervigilance is another hallmark of BPD. This is a learned survival skill, where accurately interpreting the finer nuances of another’s intentions can save one’s life. Getting it right albeit half the time means you can go on to live another day. It means you will survive long enough to pass your genes onto the next generation. This makes perfectly logical evolutionary sense.

Checking faces and reacting to expressions is highly advantageous when your main care-giver or your so-called friends at school convey mixed messages, verbally annihilating on one hand and smiling sweetly while doing it. Or punching you in the face all the while grinning and telling you this is for your own good. It is hardly surprising when you become unconsciously and bodily tuned into your environment as a self-protection measure and have a meltdown when someone looks sideways at you.

Context is important. Press the pause button and check out what else is happening in the room.
What is the general mood of the conversation?
Are these people “safe?”
What else do I sense is happening between us?
Did they just look up, but because I was feeling enraged did I interpret it with hostile intent?

Relationship history is also very important.
What is your past relationship with this person?
Is their expression about you or them?
Have you triggered a personal memory for them?
I had an aggressive boss who gave me the lip curl once. Later on she told me she had been trying to get rid of me for six months.

Upskilling old behaviour patterns and mindfulness can settle nerves and give comfort that not everyone who blinks or grimaces is the enemy to be beaten and annihilated at all costs.

Photo:  Benson by Sonia Neale



Damning Diagnosis or Blueprint for Healing

By Sonia Neale

Fox Glacier, New Zealand

In 2005 I was given two diagnoses. One was for cancer and one was for Borderline Personality Disorder. Both diagnoses were delivered with a complete lack of caring and empathy, but the cancer diagnosis was not imparted with disgust and revulsion, either real or perceived. After the cancer diagnosis, I cried, came to terms with, made friends with and learned to live with it until surgery removed the tumour.

I was given support, love, kindness, empathy, flowers, fridge magnets that said “Don’t worry, be happy” and family and friends wanted to take me out on picnics. I found the BPD diagnosis far more difficult to take in; in fact it gave me chronic indigestion for many years. I was ashamed and embarrassed, told no-one and called it “depression and anxiety.” Going through the grief process, I cried, denied, got angry, bargained, got depressed and then accepted it and with that acceptance I grieved no more and started a new life. I then embraced it with loving/kindness.

Within that acceptance came peace and gratitude. Then came knowledge, education, advocacy and activism. I started to tell people, came out on my previous blog Therapy Unplugged and was surprised when people didn’t take out a restraining order on me. Then, turning it upside down, I made it my life’s mission to educate and inform the world that with the right treatment, the right support, people with BPD can recover and live a well life. I now work in mental health supporting people and educating organisations on what BPD is and what it isn’t.

BPD is no longer seen by some as a life sentence, an incurable, untreatable condition, just like cancer was a few decades ago. I still get upset, I still get angry, I still react with emotion to life, I still act on impulse occasionally and I still feel abandonment and rejection when people don’t reply immediately to my emails, but I no longer act on these feelings. I process them, decide how important they are and let them flow in and out of my mind, let go and move on.

The DSM is not perfect and I used it as a descriptive guideline, it does not define who I am, it describes my behaviours only. I am much more than the sum total of my diagnosis.

However, not everyone feels the way I do.

South Island, New Zealand

 

Photos by Sonia Neale:  South Island, New Zealand 2013



Welcome to Being Borderline

By John M. Grohol, Psy.D.

Borderline personality disorder (BPD) is probably one of the most misunderstood and most stigmatized of mental disorders. Even mental health professionals sometimes have a hard time hiding their disdain for people who have this disorder. Discrimination against people with BPD is rampant.

That’s why I’m pleased to introduce, Being Borderline with Sonia Neale, a long-time Psych Central blogger who approached me about starting this blog.

As Sonia says in her introduction to the blog,

If there is stigma within the general community about mental illness, then there is a special type of stigma within mental health services for people with Borderline Personality Disorder (BPD). Often there is a misconception that all people who suffer from BPD are low functioning. In fact, there are some high functioning people in the professional services whom you would not suspect have a BPD diagnosis.

Outward appearances can be very deceiving because with enough stress and pressure their internal thought processes and sense of self and the world can fragment and disintegrate without any external actions or behavior. […]

No two BPD presentations look alike yet we mostly hear described the ‘acting out’ type of BPD presentations. BPD can be perceived as an untreatable, incurable and unrecoverable disorder.

I’m here to tell you that it is not.

Please continue reading her introduction and learn more about Sonia now… and please give her a warm welcome to her new blog!



 
 

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Recent Comments
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