From Both Sides of the Couch

A therapist reflects on her time with patients, and her time as a patient.

Borderline Personality Disorder: Crossing Over

Having not been given up on, I don't give up on others.

     Five years into our treatment my psychiatrist and therapist, Dr. Adena* asked me for permission to write about my case in a chapter she was preparing for inclusion in a textbook. I said that was fine on the condition that I could read it when she was done. Dr. Adena said she was going to write about the process of our work together.

     When she was finished, the book had not yet been published, but she gave me part of the chapter to preview. The first paragraph read:

      Ms. S. is a middle-aged woman whose strong schizoid tendencies would probably place her into low borderline personality organization. Ms. S. came to see me after nearly two decades of behaviorally oriented therapy during which she gradually relinquished suicide attempts, highly ritualized cutting, and substance abuse. In spite of significant behavioral improvements, Ms. S. remained socially isolated but derived some pleasure in her work. She continued to worry about her weight and was asexual. Soon after an apparently successful termination (with a previous therapist), Ms. S. fell into a deep depression with psychotic features, hearing voices with derogatory as well as grandiose content. She became resistant to biological treatments, including ECT, at which point, addressing the characterological underpinnings of depression was inevitable, and she embarked on twice-a-week transference focused psychotherapy (TFP).

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     Aghast when I read this excerpt, I thought, no that couldn’t have been me. But it was and although TFP has successfully allowed me to work through many of these issues, various schizoid tendencies remain. Socializing, although easier than it used to be, remains a challenge and I sometimes tend to prefer solitary activities. With family and friends, I have an active inner process of reflection and contemplation, but verbalizing my thoughts, if I choose to do so at all, is a relatively slow process compared to someone who is not schizoid. Occasionally, they become frustrated with my long pauses in the conversation.

     Borderline patients have acquired a reputation as a difficult population to work with and the diagnosis as a whole has taken on a negative connotation. All patients with borderline personality disorder are not alike; the individuals with BPD who have been on or are currently on my caseload each have their own set of qualities, unique characteristics, behaviors that frustrate and endear, and experiences that belong to them alone.

      There were many times that Dr. Adena could have walked away from me, several times where she gave me ultimatums regarding a specific behavior, instances where she told me she was frustrated with me or angry with me; all of which I needed to hear at that time. I am extremely fortunate that she chose to continue to work with me for I believe that if she hadn’t I would be dead at worst or would be existing in a regressed state at best. She believed in me and I am grateful.

      That’s why I am determined to find potential in all my patients, regardless of their current situation, not just the ones who are diagnosed with BPD, although I do have a soft spot for them. I know what it’s like to feel chaotic and/or empty, to long for someone to be with you when he or she is away, to place someone high up on an unreachable pedestal, and, to hurt so badly inside that you want to hurt yourself in some way or worse, you want to die.

     I am beyond thankful for what’s been given to me and that’s why I want to give back what I can. I don’t have Dr. Adena’s training as a psychiatrist, a psychoanalyst or in TFP, but I am who I am and I am doing what I can through my practice as a social worker and my writing. Every little bit helps, I hope.

* Names have been changed

Gerri Luce is a licensed clinical social worker who publishes under a pseudonym.

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