This article is published in the book:

"Psych 101 -
What you didn't learn in nursing school."


by Kathi Stringer
Paperback: 320 pages
ISBN-13: 978-0615193137
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Questions About Therapy and
Borderline Personality Disorder

by Kathi Stringer

Question

I wonder how to tell which type of treatment would be best for me, e.g.. Dialectical behavioral therapy, or schema therapy? Do you have an opinion on who benefits from which outpatient therapy? Is one clearly better than another?

Answer

I think the main thrust for fragmented individuals in outpatient therapy gives them structure. A sense of being contained while they can work on their problems.

Cognitive Behavior Therapy (CBT) is a good choice for most all dx's except BPD. CBT was tried on borderlines but it had somewhat of a negative effect at times. CBT has an invalidating component to the sensitive borderline. Dialectical Behavior Treatment (DBT) was created to include validation. "I accept you the way you are (validation) as long as you will commit to change." I know some treaters in group will square-off and confront an individual on their views, and those having BPD will stand their ground, may even be triggered into self-harm or some other impulsive act after group. Yet, CBT is better then nothing for those with BPD if they can understand the nature of CBT before going in and letting it get to them.

As you know, some treaters have an assortment of tricks to bring into group therapy. Medication, breathing, role-playing.... Some use David Burns material to identify feelings from reality. Thoughts are not actions..etc.

Question

Thanks for your reply, especially the explanation about validation and CBT vs DBT. I wonder if you'd be willing to answer another question:

My biggest relationship problem is with myself, because of an introject that sees me as bad and causes misery whenever I start to feel good about myself. What type of therapeutic approach is most likely to help me reduce this part of myself? Will it always be a part of me?

Answer

This question is much more difficult. Before one can ameliorate a problem, one must understand it. There could be a Drama Triangle in process, (the victim, rescuer, persecutor rotation) or an unconscious wish for quasi-parental intervention, or resistance to relinquish that which is familiar known, or the damming ego-ideal as the relentless inner critic sabotaging your self-esteem.

You could research, learn, and study. However, this said, it is also going to take some extensive talk therapy. Knowing and understanding is usually not enough. You could have extensive knowledge of psych, yet the knowledge is only ‘instructions’ on how to get there, and getting there involves a process – teamwork. For example, I could build a fantastic ride at Disneyland, but that doesn’t mean I could ever understand the feeling or thrill of the ride unless I got on it myself. See what I mean? Building, planning and designing is one facet of treatment/therapy, but experiencing it is all together another.

Lets say I’m in therapy. My treater is hitting on a nerve. I began to escalate. My emotions are coming up, and out. I am now in touch with that which was closed off, like molten lava in the center of the earth. Now, a CBT treater would typically confront me and may say something like, “This is your anger, I don’t want it crammed down my throat.” This comes off as invalidation, because my anger was amplified from unresolved material buried so down deep, that I have a hard time understanding it. I hear it as I don’t have a right to that anger. Now Mr. CBT is confronting and intimidating me into stuffing it back down again where it will continue to stew. And, as Glen Gabbard M.D. stated, “This will usually backfire.” However, a skillful treater will ‘go with it’ and see where the anger in the transference takes us as joint partnership looking for answers, that is to feel, and process, that which is buried, and cut-off. If done correctly, I may experience a wonderful cathartic release. It is in my opinion, tapping into that which is distant, and confusing, can give the most healing and transforming results.

Treatment can open many doors of the unknown, and like a broken puzzle, will hold a picture after all the pieces are looked at one-by-one and placed into canvas. As Vaknin Ph.D. explained, “It is an intricate and subtle dance of aggression ("bad object") and counter-aggression, neediness and rejection, attraction and repulsion, assignment of roles and their assumption, assimilation and denial, insight and cognitive distortions. It is a hall of mirrors.”

The point is, to answer your question; it is going to take a skillful treater in a joint trusting partnership, with you, to process the fragmented feelings that you have.