Written in 2013

Dear Therapist,

I am writing this as someone who has had BPD for many years and who has spent 6 of those years in contact with various Mental Health Services.

I feel there are two categories of therapists those who can and want to work with those with BPD and those who detest having us on your caseload. If you are one of the latter, we will not get on at all, a patient/therapist relationship will not work, I will hate you as much as you hate having to see me. Please treat people with BPD with respect and don’t be judgemental towards us. You may not understand me and you may find me difficult at times but I do have feelings, I have just been damaged by life. If you cannot help me, hold up your hands and be honest, but don’t leave me hanging and don’t pass me from one person to another trying to find someone who can help me.

If you can/want to work with me then the following may be helpful for you. I have grown up in a world full of lies and fear, nothing was what it seemed and life was very up and down. I lived in a home full of hatred towards me. Goalposts were constantly moved, I never knew where i stood. I find it almost impossible to trust anyone and am very suspicious of everyone. My world is black and white, there are no shades of grey.

What would I like from you? Well in reality I want a lot from you so please only take me on if you’re up to the challenge. If you test the waters only to quickly retreat you will confirm my view that I am worthless, useless and will amount to nothing, that I am better off dead.

I will try to push you away, and fight all the efforts you are making, and at times I might seem the stereotypical person with BPD, I dont mean to be, Im just trying to find out if you really do want to help me or if I am just part of the job. Now of course Im not asking you to devote your whole work existence to me but I’m wanting you to prove to me that you are different, that the past isn’t repeating itself. I need you to show me that you understand me, my insecurities, actions and behaviours.

I do the love/hate thinking that is classic of a person with BPD and I may think you are the best therapist ever one day but then something can happen, just a few words can be said and I will be left reeling, but I won’t say it to your face instead I will cut off contact for a short while, cancel appointments and ignore phone calls or letters. Usually it takes for either yourself or my husband to talk to me to see why I have felt it necessary to behave how I have for contact to restart. I will put you so high on that pedestal and hold high expectations of you and if those do not materialise then I’m left feeling rejected and my fear of rejection is once again a reality. I need you to get across to me that you are there for me but you are human and like everyone you make mistakes, but I can still trust you.

I have the emotional skills of a child and it causes me a lot of problems now I am an adult and supposed to conform to society and the behaviours of a well meaning and decent adult that society approves of. Only very recently I have realised that my emotional skills are that of a child and have failed to mature properly, before I saw my behaviour as normal and was left upset and surprised when I was “pulled up” about my behaviour.

As a child I never had anything I did validated. My opinions didn’t count, I was told to shut up and be quiet, the saying “children should be seen but not heard” was much observed in my mother’s home, well at least with myself. I was bullied through secondary school and intimidated if I spoke out. I never felt safe to speak my mind or to stand up for myself. This was deemed to be shyness growing up only it wasn’t and the shyness label was just a cover up.

As an adult I have failed to express myself safely and in a socially acceptable manner, this has been frightening, embarrassing and very tough. Rejection as usual plays very strongly here and when I have been left invalidated, my thoughts feel confirmed that I am worthless, that no one wants me around, that I should be alone. I need guidance and nurturing, someone to tell me where I have gone wrong but to do it without destroying my very fragile self esteem and confidence. Please dont put the word manipulative and me together, that is one thing I seek never to be, however I understand that if I ever behave in such a way I would like you to tell me but not so I am left feeling soul destroyed and pathetic.

I need you to do what you say you are going to do, if you say to me that you are going to get someone in the team to call me then please do that and let me know you have done it or if you are asked to call me on that day then please do, but I do understand that your workload is busy and that sometimes there are not enough working hours, if you are unable to call me could you please get a secretary to contact me so I’m not left hanging. Because when that call doesn’t come and the end of the working day arrives I am left feeling abandoned, like I don’t mean anything to you, that you don’t care and that I’m not worth the effort.

I need you to be honest with me, I would rather you told me something than keep it from me, if I detect a lie or think you are diverting from a subject I will be on to it. I am hyper-vigilant. I’d rather you be honest with me. I want to learn from my mistakes/actions/behaviours but in a safe way. I am a perfectionist and I want to please everyone and to know that I haven’t been able to complete that kills me. I am desperate to be liked by everyone and take it very badly when I discover someone doesn’t like me.

There are times when I do become so distressed that I begin along the suicidal path. The fact that in the past I have only attempted suicide 3 times despite being suicidal numerous occasions doesn’t mean that the next time I become suicidal I won’t act on it. I do try to ride out the feelings, the waves and yes quite a lot of the time that works but sometimes it doesn’t and when it doesn’t I need extra support. I often won’t pick up the phone and call you, especially if you are someone who isn’t in the office a lot as experience has shown the messages either don’t get passed on or by the time they do it’s the next day. If however I do call you, you need to understand that I am really distressed and want help. That help however I am ambivalent about , yes sometimes I want the responsibility of life taken away from me, I feel I should be locked up but I know too that hospital isn’t the best place for me. I want help but I don’t want to be referred to the crisis team only for them to just tell me to distract or take extra meds and made to feel a nuisance on the phone. Sometimes just letting you know I am struggling a bit can help me.

I need to know that although yes I have BPD that I am normal too and that whilst the BPD can show itself at anytime some of my thinking is actually normal. Distinguishing between what is BPD thinking and normal thinking is very helpful for me, makes me feel a little less insane. I need to know that you do some of the things I do and that it’s normal. Being able to keep a grasp on to normality is vital for me. Working with you I will be sharing my most inner pains and hurts and I need to know that you get it. I don’t need responses that are condescending that will not help me at all instead will infuriate me.

I’ve witnessed in the last 6 years that people with BPD are not the favourites in the psychiatric world; they are deemed demanding, manipulative, attention seeking. That some will throw back at you every effort you try to help them. I understand that it is potentially frustrating.

I want to recover. I have taken a lot of time to research mental health, it has become something I am passionate about and would like to eventually one day have a career in. This means I have knowledge of medications, treatments, diagnoses, and the mental health act. I have even researched into the trust and the way that the trust works for mental health clients. This includes the Mental Health Cluster Tool currently being used by the trust. I fear after reading the MHCT that I will be discharged before I’m ready and that 3 years is enough time to recover. I really hope it is but that fear still lies strongly with me.

My fears are that whilst there are people very unwell with the classic typical BPD case that I am going to be tarred off with the same brush just because I have the disorder. I want more than anything to recover. I want to be able to nurture my son and to give him the emotional care he deserves. I do not want him to think that the emotional skills I have now is the norm. I do not want him to learn the behaviours I have. I do not want him to become Borderline.

I am very lucky that I am in a stable relationship and whilst we have our ups and downs, my husband is the only person not to have run away from me and has shown me nothing but love and care no matter how much I push him away, try to get him to leave me to prove myself that everyone leaves me.

I need you to understand that I do not always know myself and that my husband knows me better than anyone else and I want him to be a part of my care and to work alongside the mental health service. I want you to validate him and to believe what he says about me. He is with me a lot more than you are (obviously) he sees my behaviours, mood shifts; he knows when I’m unwell or heading for a crisis sometimes before I do myself. He is the best source and should be consulted a lot more often than he has been.

I can see that this letter is long and it may seem demanding but actually this is me trying to work with you. I am often told that no one is a mind reader and that no one can tell what I am thinking well that’s why I wrote this letter. If you can have some insight into my damaged mind then it may help you to help me better.

Living with Borderline Personality Disorder is a very difficult and hellish time for me, whilst medication can help me somewhat I know that therapy is my best chance at recovery. I know it is hard work and I have to work hard, but I also know I cannot do it alone and I need support from you.

2 Responses to “Dear Therapist”

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