Do Mental Health Professionals Care About their Patients? I have Seen Mine for 5 Years and She Can’t Help me with my Borderline Personality Disorder – Vol. 592, August 11, 2022

Unfortunately, there are many therapists out there who care yet haven’t the skills to do therapy because they have never taken care of their own issues. There is little supervision both as they go through their training and less on the job, so many haven’t a clue in how to do their job. Many are burned out with the needs of too many patients if they work in agencies, deal with insurance reimbursements if self-employed, and take managed care.

However, BPD is a special area of practice all its own and few therapists want to deal with those with it because of the behaviors associated with it. Those of you who are dealing with it or love someone who has it recognize the very quick mood swings, the inner rage, the manipulative behaviors, the splitting behaviors, etc that go along with the diagnosis. People who have it are very hard to treat because of the incapacity to implement the suggestions given.

So, it is indeed harder to find a therapist who understands that the best way to work with one with BPD is to have very clear boundaries and to let them know that they will never be abandoned as that is the biggest fear that anyone with BPD has as anyone who has it knows. The other thing that needs to be understood by the therapist is that though the person looks to be an adult the emotions are those of a person of a very young age because of the emotional damage that was done when they were a very young age which was why the personality disorder occurred in the first place – but that these folks can be very insightful and intelligent so to treat them with that in mind. It is never about treating them like a child, it is about being present and understanding their ability to see through a lot of crap that many never give them credit for being intelligent enough to understand – and yet they do.

Most of all to be able to allow these patients the ability to show their positive aspects and grow those through the therapeutic process to whatever degree they can as each one is going to have their own level of ability to do so.

I once had a BPD in my practice who had been thrown out of 3 conventional therapists’ practices because they would piss her off and she would find interesting ways to entertain herself by doing things like moving the magnets on the charts in one office that showed who was in the office and who was out of the office. She put smiley stickers in the headlights of another therapist’s car, and she hung just outside the windows of another for hours at a time. She did these behaviors on purpose to ‘get back at each of them for treating her poorly, not taking her seriously, reporting to her husband as if she were a child instead of the 52-year-old she was when she employed me with 3 healthy grown children (according to her husband). I let her know from the beginning that there were 2 rules of engagement 1) If she tried to manipulate me in any way, she would be held accountable for it and 2) She would NEVER be fired by me, she would make her own decision when she was ready to end her work with me. I can tell you years later that we only had a couple of minor situations during the 2 years we worked together and that it was a positive experience for both of us.

I didn’t know that this particular client was a BPD till a bit later in the work with her because she was never told she had it, but it was evident to me after a few weeks of working with her that this was what her issue was – though she came to me for alcoholism. I had her get her records from her first therapist who she saw for 5 years before being tossed out of her practice for her behaviors and the diagnosis was written in the files. Why a therapist would see a person for 5 years and never give that patient a diagnosis is beyond my understanding. However, neither of her two other therapists told her, her diagnosis either. I had to do it which was fine, but best to do it with the records from the licensed folks to back it up.

So, there you go – a real case history of one woman who was treated terribly by 3 different licensed mental health professionals or she would never have done the destructive behaviors she did and sadly none of them really understood why – not really.