“What is BPD?” I remember asking this question when walking into my first presentation as a Marriage and Family Therapy trainee. As the presenter went on to describe Borderline Personality Disorder as a diagnosis, I began wonder, "What does diagnosing someone with BPD mean for the individuals, and moreover what does that mean for me as a clinician?"
On the Borderline
I come from a professional background of working with children who suffered severe trauma and were living in a group home setting as foster children. That is where I had my first hands-on experiences with BPD. It appeared that the intense trauma that many of the girls had suffered throughout their life triggered, often times, undiagnosed BPD symptoms. In my early experience, I saw many of these behaviors as attention seeking or “being dramatic.” It was not until a friend of mine was diagnosed with BPD that I became thoroughly interested in how I viewed BPD as not only her friend, but as a clinician.
The more I sought BPD treatment for my friend, the more I became intrigued by the topic in general. I came to the realization that, like with most labeled disorders, we all have a little of the BPD criteria within each of us.
How many times have your emotions changed for a loved one? How many times have you felt abandoned when there were no signs of abandonment? The only thing that would make anyone different from individuals diagnosed with BPD is what others do to cope with stressful or triggering situations.
As a clinician, we are taught that coping skills are key to lifelong success. If clinicians can employ coping skills with clients who are going through divorce, moving, or job transitions, why would employing these ideals with someone who is impacted by BPD be any different?
When gauging appropriate care for individuals who are impacted by BPD, clinicians should remain aware of their perceptions and beliefs. In the therapy world, we call this countertransference. While working emotions are difficult, therapist report 2x more burnout when working with individuals with BPD.
It is important for clinicians to first and foremost see the individual as an individual, then work their way through the diagnosis. Many clinicians opt to intertwine DBT therapies, cognitive therapies, and humanistic ideals to work on the whole person. I believe the key phrase to be: The Person. I find it necessary to develop an individualistic approach to treatment in order to render positive outcomes.
What about you?
As a therapist who has now become specialized the BPD treatment of adolescents, I can say that my clients that have been impacted by BPD have changed my outlook on diagnosing for the better.
When a client walks into my session, I first and foremost want to know their story. When presented with an individual with any diagnosis, the person becomes a “client.” As clinicians, we have to shift our views from simply treating the symptoms to promoting lifelong wellbeing.
While it appears major, BPD is only a small part of what makes these individuals human. Many people diagnosed with BPD have families, careers, hobbies, and passions. By separating clients from their diagnosis, they can be empowered to develop extended resources to build upon as coping mechanisms, thus, promoting furthered tolerance, love, and acceptance within both the BPD community, as well as the therapeutic community.
by Tia Brisco, MFT-Trainee Independent Living Specialist