Borderline Personality Week: Making sure you’re not getting too much out of medical care

I’ve already talked about how Van Gelder’s mental hospital wanted to make sure she didn’t enjoy them caring about her too much.  They also wanted to make sure she didn’t get too much out of their long term assistance.  Van Gelder participated in the hospital’s MAP program (outpatient, but you attend therapy for a full workweek), two different Dialectic Behavioral Therapy groups, and a graduate BPD skills class (none of which were directly associated with the hospital).    Participants in these programs are not allowed to make friends with each other, not allowed to provide emotional support in group, not allowed to exchange contact information and keep in touch after the class.

On one hand, I understand why the therapists think this is a good idea.  BPDers friendships with neurotypicals are chaotic, two BPDers is chaos squared.  They don’t want to be constantly interrupting their skills class to deal with interpersonal drama.  On the other hand, people have emotions about people they’re spending a lot of around.  People have more emotions around people they’re doing difficult, vulnerable, things around.  Trying to cut that out seems a lot like the military’s Don’t Ask Don’t Tell policy- it pushes the problem deeper underground and denies people tools for coping with it.  It seems especially cruel to form a group of out of people with abandonment issues and then demand they cut ties at a point you determine.

It’s not just the skills class that is temporary. The Dialectic Behavioral Therapy and then Internal Family Systems therapy Van Gelder gets (which is the gold standard for borderline personality disorder) is very clearly meant to be temporary.  They teach you the skills and then you’re on your own.  It is, like physical therapy after a traumatic injury, meant to be a cure.

Except the same professionals will tell you there is no cure for BPD.  A lot of the benefit of the therapy is that it treats the symptoms by giving people a safe place, with unconditional positive regard and no risk of abandonment.  In that way it is like massage therapy for office workers, or insulin for diabetics:  minimiizng suffering and collateral damage by treating the symptoms, but with the expectation that problem will reoccur if treatment stops.

The mental health field seems very determined to make their services a cure rather than a treatment.  You can be on psychoactive drugs for the rest of your life, but not therapy.  The thing is, unconditional positive regard is not that difficult or expensive to provide.  That’s why they let us volunteers do it after 20 hours of training (and providing active listening to BPD sufferers is at times a large part of my work at crisis chat).   There’s also some evidence that’s the benefit of most counseling modalities, regardless of what the therapist says they’re doing.  It would not surprise me at all if there are issues I haven’t thought of that mean giving BPDers low-level therapy for their entire lives is not viable.  But I haven’t heard anyone give one, or even really ask the question.  It’s just assumed that lifelong therapy represents failure.  And I don’t think that’s fair.

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