In Feb 2013 I was delivered a massive blow, self created to some extent. Considering the death and loss I have experienced that is really saying a lot. I walked out of a job in anger, as I had several times before. The difference was this was a career ender from a job paying me more than I had ever made and came with the responsibility I had craved. While I know it wasn't the right way to handle it I also realize that without the eventual diagnosis of Borderline it was to some extent an inevitable occurrence. Perhaps still is.
Initially when I was diagnosed I knew enough to know that Borderline was a nasty personality disorder to have. Limited success in treating it. Shortly after the original diagnosis people began to talk about DBT (Dialectical Behavior therapy) being the new "go to" treatment with borderlines. The success for SOME was lauded in a way that it has (MY experience) become the Prozac of Borderline and that is sad. Really sad. I have again blogged at length about why that statement is what I believe. The main reason is that its presented as Pass/Fail and there is no room to do anything but "stay in the present." Of course when your present is so painful that being in it causes more pain...well no one has the answer to that. It also, I have come to realize, carries a sense of shame. Yes, it does...like it or not when DBT is presented as something that Cures BPD I say bull shit and will till I die.
I could extol (and to some extent I have) argument after argument supporting my belief. If you are a "DBT or bust" person I doubt you made it this far and if you did perhaps you have more of an open mind that I credit you.
The underlying cause has somewhat mystified me though. I have heard that NPD with BPD is a bad mix for DBT. But why? Then one day a few weeks back I was sitting around trying to process once again what had happened in early 2013 to make me bail. To some extent I had corrected that behavior as I grew older but something snapped and now I know why and what caused that for me.
That last professional job in 2013 had me take a personality test, more detailed than any I had seen. Way deeper that Myers-Briggs. Custom made even. So I spent my first 3 months with no boss and then when she came back it was water and vinegar. At one point HR asked me to re-take the test...and shockingly the results were so drastically different they were almost 180 degrees apart. They had hired me based on my 1st test...then they "paired" us up with the retake and lo and behold my boss and I were paired. The eventual crossover was a disaster in the making. The test results used very strong language describing the difficulty this person and I would have- and it nailed it...off my 2nd test.
Why they results were so drastically different 4 months apart? No clue...but it is interesting and is probably more related to the environment combined with my quick belief that I had no desire to be "like my boss" was also a factor. She was 15 years younger and it was a mess. She really manipulated me with fear, shame and "private' conversations with my staff.
My point in the story above is to illustrate the weight and validity major companies give to personality tests, including hiring decisions. Whether they are perfect or not isn't relevant as they work well enough to continue to be used.
So...let me try to bring this together. While we are all individuals and unique...we share enough genes that personality types and groups do exist. I am going to plug for me dad here lol...he lives by a book by Richard Rohr called "The Enneagram" which breaks us up into 9 personality types. Each with their traits, both positive and negative...never promoting one type over another
So one day a few weeks back my father and I were having coffee and talking about mindfulness and its value for everyone, etc.... and it hit me. Like a ton of bricks.
IF, and only IF, you prescribe to a one stop shopping experience where you think you know better, you may cause more harm than good and for heavens sake evaluate why you got into the field.
Therapy shouldn't be the same as common core education.
And sometimes it is
My father, a retired CFO and very much like one, were he to need therapy the only thing that may work for him is DBT...he is not a talker, emotional or anything like that so CBT wouldn't work great. I, on the other hand, need to talk. It's how I process things. It's what works for me. I have 47 years of crap to process and ignoring that part would be disasterous for me.
I'm perched on 50 years old and its far more likely to work if I am met where I am versus trying to pigeonhole me into some pre-created box in your mind.
The goal is to have the therapy work. Period. There is a very result oriented goal in therapy and harkening back to my common core statement above I challenge the belief that the therapist "knows whats best".
I've come a long way in 2 1/2 years and I know I have a ways to go...but I believe that is because both therapists I have seen have allowed me to progress in a way that works for me. I am given much credit for such self-awareness and I assure you that didn't come from DBT....it came from talking and processing the pain and loss...and that is the point I want to drive home here.
The treatment needs to fit the patient not the patient trying to fit into treatment that doesn't account for who we are as individuals.
Before the MH professionals say the above statement isn't true I would say to you...then why do you tell us treatment will only work if we buy into it...then you try to sell us something we don't buy into. If its truly a joint effort then the treatment needs to be as well. Lumping us into a category and saying things like "Your lazy" "You won't do homework" "You only have BPD because you won't do DBT"
What does that actually accomplish? Well it creates more stigma which is ironic as stigma is already inherent in Mental Health.
So when someone comes in hurting and broken...try to think of this.
If you haven't seen the move Bettlejuice this may not make sense...but basically after the couple has died they go to meet with their "case manager" and in the waiting room there are a variety of people that have obviously come to their end. One person has cigarette smoke coming out of her throat...etc...but they see one person where their cause of death isn't as evident and they whisper "What did they die from?"
The response is priceless
[in the waiting room of the afterlife]
Barbara: Adam, is this what happens when you die?
Receptionist: This is what happens when *you* die.
[points at a gaunt man smoking]
Receptionist: That is what happens when *he* dies.
[points at a woman cut in half on the sofa reading]
Receptionist: And that is what happens when *they* die. It's all very personal.