Borderline Personality Disorder: Naked Therapy

By Sonia Neale

vampire-seductress-costumeWhen you go to your therapy session what do you wear and why do you wear it and what does it mean to you?

Many years ago I would spend a week deciding what to wear. Should I wear this skirt because it was bold and flowing or these jeans because they were tight and hugging – leather or lace, denim or Doc Martens? What stylish, stunning threads would be the right ones in order to illicit the response I wanted? It all depended on my intention – was it to entertain and seduce, defend and demand or gain hope and heal?

Years ago I used to dress according to the role I wanted her to play with me, whether it be best friend, favourite aunt, smart sister, emotionally devoid mother, or secret lover and I would spend an inordinate amount of time getting my clothes and hair just right to illicit as many compliments as possible. When I was more regressed and should have been wearing a onesie to therapy, she would always comment on my hair and I’d forgotten about that until she mentioned how nice my new hairstyle looked recently and the memories came flooding back. In the past she always appeared to have a special weakness for my long blonde hair, one that I used to exploit mercilessly for her attention and approval. I always gave her compliments the more sinister interpretation of a seduction scenario.

Whether a cigar is just a cigar depends if you have a psychoanalytic bent or a cognitive-behavioural one. I finally realised that I had a therapist who prefers to stay in the present moment and lets you know that your hair looks nice today and that her compliments should be met with a simple “thank you.” Ever since that time ten years ago I have met similar compliments from other people with a similar response. Much of her firm, common sense therapy has sunk in over the years.

Since I stopped worrying about impressing her and more time asking her to challenge my belief systems, we spend a greater proportion of the time in authentic therapeutic connection. Our conversation has become real and genuine, warm and vulnerable – on both sides. It is what happens on the inside with therapy not what you wear on the outside. The intimate connection happens when you let that hard shell soften because the therapist wants to connect with your inner beauty and not your fashion sense. Clothes can be the barrier you unconsciously choose to protect yourself from hurt and harm when sharing your dark and dangerous past.

Even Freud in his quest for answers to turning neurotic misery into everyday unhappiness failed to realise that what we wear matters and can be an implicit coping/defence mechanism, along with splitting, projection and regression. Do we wear low cut lacy tops to seduce our therapists because we are afraid to let them see the raw viscera of our broken hearts, the naked, vulnerable self that was once so badly damaged? What lies beneath the surface of what Victoria’s Secret covers up is far more important to the curious inquiring therapist.

I do however, notice everything my therapist wears, which is usually baggy, shapeless, black and flowing garments with long strands of pearls, mismatching rings and bracelets. It has always puzzled me because from the back she appears to have a dynamite figure, pretty much the same one she would have had at 18, so she is not covering up issues and secrets between rolls of fat. She eats well and exercises regularly, yet chooses not to show her svelte figure (stunning for her sixth decade) off during business hours. Does she do this so her clients do not know who she is really is, so that they have more of a chance to express who they are? This dramatic attire appears to be de rigueur for the elderly, aging middle-class, wise-witch old-crone therapists who are finally comfortable with who they are. Black is her favourite colour. I sit on a long black couch surrounded by a seething tsunami of black scatter cushions, but her therapy is many shades of cool, calm and collected grey.

In summer off comes the shoes and she sits cross legged in the chair, and so do I. Our mirroring body language connects us at a more intimate level which occurs when I am not fixated on how attractive and pretty I need to appear in front of her. It’s easier to cry when you are not worrying about whether your mascara will run. Cortisol and adrenaline levels rise during therapy so scratching my forehead and cheeks is easier without fear of spoiling my foundation. I constantly play with my hair scrunching my fingers through it, pulling the strands from side to side in order to emphasise a point or to elicit the same hair-pulling and lock-playing transference from her – which ALWAYS happens.

No matter how we wear our hair or dress to impress there is always that ultimate defining moment in the therapy hour where we unwittingly, accidentally expose our deeply protected secrets and realise we are not wearing Gucci or Prada but The Emperor’s New Clothes rendering us raw, naked and vulnerable – and that is where the real therapy begins.

Picture:  http://www.halloweenplayground.com/images/legavenue/vampire-seductress-costume.jpg



Borderline Personality Disorder: Healing in Bali

By Sonia Neale

The difference between my young Borderline self and my older, somewhat wiser Borderline self is that I may still have the same intense feelings of rage, paranoia and injustice, but I now sit in those feelings and try to discover what they mean to me and channel them into a different, more positive direction. Instead of hating civilisation and its discontents I embrace the suffering, look inward and transform it into a learning opportunity for personal and spiritual growth. Part of that was learning to love what I already had instead of seeking out what didn’t belong to me and never would. The Buddha said, “Suffering is inevitable.” And it is – sometimes. It is what we do with that suffering that counts. I had to learn to lie down beside the Borderline bull, embracing her lacerating horns at a level we were both comfortable with.

After fifty years of eating disorders, lap bands, a small bowel obstruction, kidney cancer, malnutrition, metabolic syndrome and diabetes type 2, I was further diagnosed with a lump on my ovaries in August 2012. So I went to see my disease-free, de-toxed, slim, fit, healthy, yoga-inspired, meditative, free-range, organic, body-centred clinical psychologist who advised to me to do what she had been advising me to do for the past 17 years. Look after myself, be kind to myself, be gentle with myself and start to eat and exercise accordingly. What would you know about life? I thought, as I threw my last sugar binge in her outdoor bin before taking off on holiday with my husband.

Bali for me is usually one long, eating/drinking self-indulgent binge punctuated with cheap shopping sprees in and around Kuta – buying clothes I never wear and items I would sneer at back in Australia. This time we stayed at Lovina Beach and Ubud and I made the epiphanous decision to eat organic vegetarian, drink detox blends and spend as much time as possible being mindful at the Yoga Barn. I also relished the idea of torturing myself by hiking 500m almost vertically down (and back up again) to see the spectacular Munduk falls, as well as trekking through the Balinese National Park before embarking on a canoe trip across a mountain lake. Apparently I had not punished myself enough because later on we walked 5km through stunningly green rice paddies under the blazing Balinese sun to digitally capture some fluorescent-blue Papillon butterflies, blood-red mayflies, friendly but boringly beige frogs and the many indigenous birds whose fleetingly quick movements made me feel as though they were suffering from some form of avian ADHD.

I bought no commercial goods in Bali but came home with a replenished body, a renewed spirituality, a rediscovered soul and a magnificent collection of nature photos David Attenborough would be proud to own. Our Ubud accommodation overlooked 180 degrees of rice paddy fields where I captured this image of a Java Pond Heron who had just caught a huge, hapless frog in its mouth. There was much spiritual meaning in this photo for me. Some days we are the heron and other days we are the frog.

Heron and frog

I had come back from Bali with much less internal baggage than I had taken because, still detoxing and exercising a month later, it was discovered my ovarian lump had disappeared. As well, much mindfulness, meditation and mung-beans had smoothed and refined the sharp horns of the Borderline bull and were now gently but firmly nudging me along the right path rather than endlessly stabbing with furious intent along the wrong one. That was a clear defining sign from the Universe that I had been given a second chance at life.

I fully believe in the mind/brain/body connection. I believe that what we put into our bodies affects our feelings, and this affects how we process our thoughts and all are intimately linked and entwined to our particular behaviour and make us who we are. Clean living equals clean thoughts or at least the ability to process them in a different more thoughtful, reflective and uncluttered manner. I learned to separate me from the rest of the world. I learned that I still have the same old problems after I have eaten, drunk, drugged or smoked in my futile attempts to smother the enduring shame of unspeakable, unbearable pain of existing in a world that constantly misunderstood me. Those days I was definitely the frog.

I started to use the words self-responsibility and empowerment and learned to apply them to my life. When I pried into her personal life, my therapist gently pointed out that she was very angry with me without raising her voice. This was an entirely new experience for me; I was far more used to a violent vocal reaction which effectively suppressed all forms of further communication on the matter. So I punished her with fifteen minutes of the best silent treatment I could dish out all the while fantasising about Revenge by Suicide. To me what I had done was not that bad (I thought she was being far too touchy and sensitive) but because my normal behaviour is another person’s abnormal, I needed to learn what sort of behaviour was socially acceptable to others so I could “fit in” – whatever that meant.

So as well as eating properly and exercising regularly, I was now learning how to regulate my emotions and tolerate distress without self-destructing and threatening suicide. I was to learn that lesson over and over and over again before it sunk in. I pushed my trusted therapist to the razor-edged abyss of her genteel anger where she saw perhaps abandoning me was the only way to reduce her own considerable stress tolerance levels. However, years ago she had made a promise never to abandon me, even though I made every attempt I could to make her throw me out of her professional life. I wanted to turn her life-long promise into my self-fulfilling prophesy. Her compassionate loving/kindness was driving me insane.

There must be easier ways to earn a living than being a DBT therapist. Not that she is one. I was assigned to her 17 years previously in a public mental health facility and I followed her into private practice. I used to think she was an Ice Queen, a Frigid Wicked Witch of the World of Therapy and paradoxically (because we Borderlines LOVE contradiction) fell deeply in transference with her. There is also an authentic bond between us that is part nostalgia, part business transaction, part mentorship, part symbiosis and mostly mother/daughter role-playing. Slowly I am starting to see her point of view. This can only happen with all-encompassing trust, respect and honour.

Being Borderline means that my logical, rational cortex goes off-line under severe stress and my immature, unplugged, raw and naked amygdala takes over like a black, seething, swirling vortex where the perfect storm of rage, paranoia and suicide-ideation collide. When my therapist went on holiday or away for the weekend, I learned to send her a polite email telling her to have a wonderful relaxing time instead of decompensating, booking into the nearest psychiatric facility and threatening to self-destruct. Those were the days I firmly embraced the heron.

I once had an adverse life event, picked up my 17 year old son from school, went to the local shops and had a road rage incident of such epic proportions I was prepared to die in a blaze of glory rather than move my car and let the other person pass. It was survival of the fittest and surrender was not an option. Charles Darwin might have applauded my efforts at self-preservation but everyone else involved was appalled.

That was the way I had lived my life – eat or be eaten. I’d lost my husband’s family, many employment opportunities and plenty of friends along the way. But I consoled myself thinking it was everyone else’s fault and nothing whatsoever to do with my repeated behavioural patterns.

My psychologist and I worked on many issues and it was her tough loving/kindness on a harsh family experience that finally permeated and infused my essential being. It was this feeling that shifted and cracked the Teutonic plate of self-hatred inside of me, something that was toxic, concrete, rigid, inflexible and unmoving and from the shattered remains arose an expanding, ethereal and cloud-like softness that had the feeling of self-love, self-forgiveness and self-acceptance. I had never felt more vulnerable, exhausted, uplifted and transformed all at the same time. It was a harrowing experience not unlike passing through the fires of hell and experiencing rebirth on the other side.

Peeling off the placental shawl and cutting through my own umbilical cord that had attached my whiny-self to my long-suffering therapist, I noticed that my old destructive addictions had given way to new, rich oxygenated life-giving ones. I am now addicted to good wholesome food, great health and much well-being. My husband and I like getting up at 5am and going for long walks in the bush, jogging at the gym, walking on the beach, and hiking up mountains. We dusted off our bikes and permanently traumatised our two teenage boys by purchasing matching bike-lycra and think nothing of riding 40km before breakfast. I now have stable employment and good relationships. I have lost 30kgs in six months and gained new vitality of body, mind and spirit.

I embrace Buddhism and being rather than destructive thinking and doing. I have learned to relax and live and let live. Suffering is not as inevitable as the Buddha made out. One can choose to suffer or one can embrace an imperfect world, let go of what is not necessary, and in the wise words of my sometimes devalued/mostly idealised therapist, “Take the bull by the horns and rejoin the rest of the world.”

Picture: Sonia Neale Bali 2012



Support Groups for People Diagnosed with BPD

By Sonia Neale

logo[1]
It’s been a long time since my last blog because I felt I had run out of things to say about BPD. However, since working in peer support work for the past year with a caseload that comprises of 75% women with BPD, I thought it prudent to resurrect my blog because I now have lots more to say both now and in subsequent blogs and I also need your valuable input for something I feel is incredibly exciting.

In Western Australia, we have no non-clinical psychologist run Dialectical Behaviour Therapy (DBT) services for BPD sufferers. We do have three teams in the metropolitan area of Perth run by fantastic, dedicated clinical psychologists who are the only MH professionals able to deliver this service. This is not nearly enough though. Only a small percentage of people can get help in this public sector which means they don’t have to pay. Medicare-refunded therapy (mostly with a considerable gap payment) is six sessions per year, an extra four if there are exceptional circumstances. Seeing as many people with BPD are on disability pensions, unemployed or under-employed, self-payment is not an option.

The new Clinical Practice Guidelines for the Management of People with BPD by the National Health and Medical Research Council states that “Health professionals at all levels of the healthcare system and within each type of health service, including general practices and emergency departments, should recognise that BPD treatment is a legitimate use of healthcare services. Having BPD should never be used as a reason to refuse health care to a person.”

It is great that this is finally recognised but the reality is that long term clinical and non-clinical treatment options are simply not widely available in Western Australia. Through my role as a peer support worker I am hoping to start up a non-clinical self-help support and friendship group under the existing umbrella of government and non-government services. My long-term vision is to be trained and train others in DBT skills to set up other groups all over the Perth metropolitan and even rural areas. I have the backing of my team leader and manager of the organisation I work for.

My recovery from BPD has been a profound experience. I want to pass on that recovery process to the participants of the programme I work in and others who would otherwise be not able to access services. The group I am proposing to develop will be based on Dialectical Behaviour Therapy skills and strategies as well as individual strengths and goals.

In the two hour, once weekly group (consisting of six attendees and two facilitators consisting of one peer support worker and one professional) there will be an educational informational half and a caring and sharing half. It will be probably be obligatory for all attendees to have some previous DBT exposure mainly for risk management reasons. There will also be house rules and group norms and sharing guidelines and this will serve as an adjunct to clinical BPD services.

I am very excited about this and have the enthusiasm, support and help of like-minded others. So here is what I am asking you.

What would you like and not like to see in a self-help friendship group for people with BPD?
What BPD services are available or not available in your area, no matter what part of the world?
Were these services enough or not enough for you?

picture: http://www.freshwinds.org.uk/programmes/supporting-people/



Borderline Personality Disorder: Google-Stalking Your Therapist

By Sonia Neale

Is Google-stalking your therapist morally wrong, a self defeating masochistic exercise in futility, considered Borderline Personality Disordered behaviour or worse, or downright creepy, dangerous and illegal; or is it healthy curiosity and something everyone does but would not admit to – or perhaps all of the above?

I have received emails from my blog readers and heard personal anecdotes from people who have Facebook and Google-stalked their therapists and I have heard of therapists who have terminated clients once they found out the client had typed their name into the internet.

The golden rule is that you never put anything up on the internet you would not want your grandmother to read or the world to see on the front page of the daily newspaper. Google your own name every few weeks to see what other people have said about you and if it is derogatory either ask them to take it down or if they won’t then there are legal avenues you can take. I had to caution a friend’s daughter who had written some slanderous content about my motherhood skills on a parenting forum where someone had reviewed one of my books.

This is the internet age, the age of information sharing so expect to be Googled especially if you are a mental health professional. But while I might want to find out your professional history, qualifications, cost, location and perhaps some testimonials, there are self-imposing strict personal boundaries around this. If I start to type your children’s name into Facebook to find out personal information or to see family snaps of you then perhaps my curiosity belongs in a different dimension and I need to address the reasons why I want to seek this information out.

This sort of behaviour, like drugs, alcohol, smoking and food, can become very addictive very quickly. When you find out new information there can be a dopamine rush to the brain which acts as a reward and creates a deep neural pathway which leads to more of the same behaviour. Or it can work the other way and the information can be so distressing it can lead to self-harming behaviour. This is serious and non-judgemental, empathic and compassionate help is much needed.

I also believe, for the mental health professional, terminating the Google-stalking client is also about safety, security and risk management. I believe most therapists would want to find out the reasons why their client finds someone else’s life more fascinating than their own, but management can see things differently. Questions to ask is what is it that is lacking in their life that they want to spend inordinate amounts of time in a dark room in front of a pixellated screen in order find proof of life of someone else’s happy existence? Perhaps it could be a golden opportunity to address the lack of substance in the client’s life and boost and enhance their daily activity to a level where Google stalking no longer seems an attractive proposition.

However, as a therapist this can be very disconcerting at least and downright scary at worst. But if you do find out about this, would you be curious and ask the client what this meant for her/him or would you automatically terminate the client out of a sense of compromised personal safety? Also are you sure your personal safety is actually compromised? Does it depend on the functioning and insight level of the particular client? Would you allow this behaviour in some clients and not in others?

I am a Google-stalker and I have been Google-stalked. As an author who has appeared regularly on radio and in print and once on TV I have had people I work with tell me I have written two books, or been on radio or even that I write a blog for Psych Central. That is not creepy for me; I enjoy hearing that and feel as though what I do is appreciated and loved.

So at what point for some does this change from acceptable to downright creepy? Pre the internet age no-one would come up to you at a party and say they did a Dun and Bradstreet on you? Yet people tell me they Googled my name. I have Googled my therapist over the years. She knows about this and we have discussed it. Anyone with transference issues is highly curious of how someone else lives, especially if you have that someone else up on a pedestal. I was always open with her and let her know what I had found. We discussed my need to do this until I got to the point where my own life was more interesting than hers. Had she not addressed my behaviour in that manner and terminated me I would not be in the good place I am now. I also learned in the process that she also was curious about other people’s lives.

It is very much context dependent. It is all about culture, existing zeitgeist and what is considered socially acceptable behaviour for the changing times. If you are a therapist and you have an open Facebook with 1097 “friends” and you post controversial opinions and update your status three times a day (yes there are therapists who do that) then you should accept that your clientele are going to be curious about the rest of your life. Or perhaps you are so private that your Facebook is on total lockdown and even your own mother could not find you. In other words you need to manage your Googleness and check on it regularly.

I have been in the public eye in the past and I now work in mental health and I have met many people who do not meet social norms in terms of acceptable behaviour (not all of them are clients or patients some belong to other organisations) but rarely do I feel scared or threatened or feel my security and privacy compromised.

It has been said also, in jest, that you have not made it in Hollywood unless you have a stalker (see Kevin Bacon episode of Will and Grace). Some therapists might be terrified that they are not being Google-stalked. Others might be upset that they are not even considered Googleworthy.

Curiosity did not kill the cat, curiosity made it most inquisitive about its own nine lives. Unlike felines, you only have one life so make the most of it.

Photos: Sonia Neale – Ubud, Bali 2012



Borderline Personality Disorder: Good Will Hugging

By Sonia Neale

huggingI was surprised to find “Good Will Hunting” on our DVD recorded movies list. Apparently my oldest son, Matt recorded it thinking it was about guns. A great movie, and it was the bit at the end that settled an eternal question for me. Matt Damon hugs Robin Williams and says: “Doesn’t this violate the doctor/patient relationship?” and Robin Williams replies, “Only if you grab my arse.”

So, let’s get to the bottom of this once and for all. If it is OK for therapeutic couples to hug, then here are some types of therapy room hugs that might be considered appropriate:

The Stealth Hug: This happened for me about eight years ago. I saw her in the corridor wearing a green jumper and a black pleated skirt and I made a snap decision, so when I got into the room, I launched myself at her. She was quite startled, but put her arms around me and hugged. That, by the way, is the only correct response when a client stealth hugs a therapist. Had she refused, my mortification factor would have been stratospheric and I would have had to leave immediately – never to come back again. When a therapist refuses a client’s stealth hug it can make the client feel contaminated at best and the embodiment of evil at worst.

Continue reading… »



Borderline Personality Disorder: Mental Cramps and Diarrhea

By Sonia Neale

Sometimes, I catch myself having fierce arguments in my head with people I have never met, about situations that have not happened, followed by resolutions that are never satisfying. My headspace is cranky and irritable and there is no logical preceding incident; it is just where my head automatically ends up when let off the leash and wanders free range. I call this IBS – Irritable Borderline Syndrome.

Now, when I catch myself doing this, I redirect my thoughts into something else. I discovered I was doing this on the 45-minute journey to and from work. Without external noise distraction (my radio/CD broke) and only my thoughts to keep me company on the stop/start traffic jam journey to and from work, I was mentally irritable from plotting evil thoughts, arguing with my inner self and ruminating long before I reached my destination. My armpits and skin would itch with stress induced hormones and my bowels and intestines would cramp into knots.

Continue reading… »



Borderline Personality Disorder: Social Survival Skills

By Sonia Neale

Borderline Personality Disorder is not just about mental illness and emotional distress, it is also about social skills (or lack of them), empathy, manners, conflict resolution and self-care. Most children learn these vital social skills early on at pre and primary school where they observe other children’s behaviour, learn a “theory of mind” or how other children think and feel (mentalising) and experience compassion and empathy for others. These things come naturally to them.

But some children, through no fault of their own, are unable to learn and remain totally clueless about how to survive socially in the playground. These are the kids who suffer social neglect, rejection and abandonment. These are the children who need a step by step guide or a “recipe” on how to learn empathy, how to be a team player, how to get on with other children, negotiation skills, conflict resolution, the rough and tumble of give and take and sharing toys with grace and dignity.

These kids need to learn that when this happens, this is the correct response. I was not one of those naturally cluey children; I lived in social Siberia most of my school life and became a library refugee.

Here are five survival techniques desperately needed when suffering from BPD:

Continue reading… »



Borderline Personality Disorder: Self-esteem vs Self Destruction

By Sonia Neale

BPD and self esteemThere is a saying in a self-help group I used to be in back in the eighties. When a “normal” person gets a flat tire, they call the Automobile Association. When someone with (what’s now known as BPD) gets a flat tire, they call the suicide hotline. There’s an awful lot of truth in that.

My goal recently has been to respond rather than react to what I perceive are excruciatingly provocative circumstances and situations. I want to think and act with grace and dignity, to deep breathe, turn around, walk away, move on, learn the lesson and get a life. This attitude has, in the past, kept me in relationships, out of the law courts, out of jail, out of psychiatric hospitals, in employment and in therapy (or life coaching as we are now doing).

No longer is my therapist my nurturing supporter, smothering me endlessly with loving/kindness, reassurances of never abandoning me and justifying my bad behaviour and lack of social skills as a result of my environment. We have a more pragmatic egalitarian relationship where I feel mentored, rather than mental.

Continue reading… »



BPD: Narcissistic Injuries, Madness and Mindfulness

By Sonia Neale

When you suffer from Borderline Personality Disorder (or complex trauma) one person’s constructive criticism or negative response is another person’s life-threatening narcissistic injury. I received a narcissistic brain hemorrhage this week when my challenging and authoritative therapist decided it was not relevant to our therapy to watch a video link I had emailed her.

My borderline reaction went to DefCon One in less than a nanosecond and I thought my brain would implode.

To be fair to myself, my thoughts remained relatively mindful (she’s said no before for the same reasons and yet I continue to email her things; it could be said that an idiot does the same thing all the time and expects a different response. If that is the case, then I am that idiot) but my body was transported instantly back to the mid-seventies where school bullying and parental fighting had finely tuned my fight, flight or freeze response.

Continue reading… »



Borderline Personality Disorder: Is Your Therapist Dogged by a Dark Side?

By Sonia Neale

At my last therapy session my therapist turned into a savage rottweiler; baring her sharp teeth at me, picking me up by the scruff of my neck and shaking the living daylights out of me. The doggone woman deliberately picked a fight about nothing, provoked me into a snarling row, called me a liar and then threatened to sue me for slander.

Interpretation of unfolding events is always a personal perception. I have been seeing her again for some workplace issues that need resolving. I was having problems accepting constructive criticism from the top dog in my organization. I found I was getting deeply triggered when told I was not achieving what I was supposed to achieve in the way she wanted it achieved and I was getting my feathers ruffled in a big way, getting upset, huffy and resolving the issue by fleeing or freezing.

So when within five minutes of arriving, my barking mad therapist activated every button on my panel and almost blew us both up, I almost called her a bitch, walked out the door and planned on brooding, ruminating and plotting impotent revenge against her for the rest of my natural life. Talk about an idealizing transference killer.

Continue reading… »



 
 

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