What qualities are important in a therapist treating BPD

For me, as I wrote on here several times, I terminated care with my therapist dramatically.

Looking back I realize I should have done it earlier because that therapist lacked certain qualities I find essential to my care.

Among those qualities, trust, empathy, flexibility, cooperation.

In January it became apparent that my therapist was not flexible in my treatment and no longer trusted me, not only that but at times it was obvious she was annoyed and frustrated with me.

What do you find the most important qualities in a good therapist to be? When has therapy gone wrong? Has it hurt you? When has therapy gone right? How has it helped you.

isnt that like letting the crazies running the asylum

look at it like looking for a personal trainer
you come to you trainer and he tells you you can do a bouble marathon in one years training
he's not the one
if he let's you goof off dunring training
he's not the one
if he doesn't try to impove your weakness
he's not the one
etc

Choosing the right therapist is crucial. While many wonderful therapists are knowledgeable about BPD, many aren't.

A therapist on the Net warns, "Therapists who work with BPD patients must be absolutely committed to the process of working with the patient and the family. This is not short term therapy, and anyone looking for short term solution focused therapy quick fixes is not going to accomplish it with this type of client. (Speaking of the therapist here.) The therapist must be absolutely committed to long-term therapy with both the client and the family if any help or change is to be obtained."

When trying to find a therapist, ask many questions. Determine the person's attitude toward BPD and their knowledge of the subject:

What percentage of their patient load is people with BPD?

What treatment approach do they use?

What is their philosophy about calls between visits?

Read up on BPD and visit the therapist.

Ask insurance questions as well.

Why It's So Hard to Find a Therapist

If you want to hear a lively and revealing conversation, listen in to a group of mental health professionals talk about patients with BPD. June Peeples, a producer of the Infinite Mind radio show, did just that. It happened at a cocktail party attended by social workers, psychologists, and psychiatrists—"smart people and concerned, caring therapists," Peeples says.

Over hummus and veggies, the group started to talk about patients who, it seemed, were a therapist's worse nightmare. One therapist said that she was careful to make sure she wasn't treating more than one of them at any given time. "I won't treat them at all," said another, and a heated discussion ensued about the importance of a rapid and correct diagnosis of these patients—not for therapeutic reasons, but to make sure you don't get stuck with them.

Therapists develop this negative mind-set for two general reasons. First, BPs are one of the most challenging types of patients to treat—if not the most challenging. Second, treating borderline patients can be emotionally draining for the therapist. Each of these factors feeds into the other.

BPD is more tightly woven into the fabric of a person's being than other types of brain disorders. The disorder alters the process by which a person thinks, feels, and acts. You can't get any more fundamental than that.

Lower-functioning conventional BPs often come to therapy with a defeatist attitude—understandably, after all the time they've spent in the mental health system without feeling better. Psychiatrist Richard Moskovitz says, "Even during the first therapy sessions, patients make remarks like, 'You can't help me,' 'Why should you be any different from the people in my past who betrayed me,' and 'I am too defective to ever be repaired.'

What all this comes down to is that borderline patients are probably the toughest clients a clinician will ever treat. They test the skills of even the most experienced and well-trained therapists. One common dilemma is finding time to explore deeper issues when the BP is always in crisis. Another is that some therapists (especially those inexperienced in treating borderline clients) have difficulty observing their own limits, such as keeping after-hours phone calls to a reasonable number. Once problems begin, it's tough for the therapist to reverse course without seeming critical or abandoning. In situations like these, an untrained therapist can be worse than none at all.

Borderline Patients Are Emotionally Challenging

Mental health professionals are human beings. As such, they have many of the same gut reactions that you do when they're faced with rage and blame—even though they know intellectually it's not personal. "Borderline patients can be hostile or attack," says Marsha Linehan. "Therapists can feel so scared, angry, frustrated, or helpless that they pull back. And that is harmful to the patient."

Kathleen, a woman with BPD, agrees. "A lot of the therapists I saw were frightened by my rage and my inability to engage or form an alliance with them. I didn't want really to get better. I just wanted to express rage. I always felt that the people who were treating me were disgusted by me." On the other side of the spectrum, it can be scary if borderline patients go overboard in the other direction: idealizing their therapists, fantasizing about having a relationship with them, and making them the focus of their lives.

Mental health professionals go into the field because they want to help people. When a client doesn't get better despite the therapist's best efforts, it's tempting to blame the client for the lack of progress and to view their attempts at trying to get what they need as manipulation, rather than to question whether the treatment they're providing is effective.

Of course, all of this is only a problem if your family member is willing to walk through a clinician's door.

Life-Changing Therapy Requires a Major Commitment

Therapy is hard work. Transforming the way you think, feel, and act while taking responsibility for things you've always blamed on someone else is a tall order. People with BPD who are serious about treatment will pursue it, perhaps with your help, and make a commitment to it. They will make their own appointments, be honest with their therapist, and complete any "homework" the therapists give them. Life coach A. J. Mahari says, "The truth is relative, and each person with BPD must come to their own truth in their own time and way."

With BPD I think it needs to be emphasized a persons primary not only serves as an instructor but as a healthy place to role model behaviors.

A therapist who works with BPD who only wishes to correct negative behaviors and not develop a healthy, trusting relationship with their client isn't helping their client.

This isn't pilates, its not yoga, its not a course in calculus.

If anything, a healthy relationship with a persons therapist should be a clients first concern, in addition to expertise.

If I want to run a marathon I'll adhere to a curriculum I find online.

If I want to find out how to better interact with my world, I need a safe place where I can screw up, make mistakes,and not be punished or felt condescended.

I haven't had much luck with help for BPD specifically but there are two qualities that stand out for me throughout all of the therapists I've had. One is being sensitive to my needs because I am very sensitive and hypervigilant so if I feel like something is off, I can get affected by it for a long time. Another thing is listening to me and letting me speak. I've had horrible therapists who would spend most of the hour speaking instead of listening. I have no idea how that could help anybody but maybe it does.

Speaking from my experience - the most important thing in the therapist is an ability to look competent and strong in my eyes.

I really, really hate when I see some lack in knowledge/lack of understanding/confusion in the therapist. At all sudden they turn into being stupid in my opinion. And I am not able to continue therapy since I loose all respect for them.

I have some "I know the best" tendencies, so if some specialist don't agree with me (unless they are able to defend their opinion and stand their own ground) - I start to think that I know better, so I must be smarter than them. And they don't seem like professionals to me anymore. They get totally devaluated and there is no going back.

Some of the therapists I've worked with had some irritating tendency to search for deep meaning in everything I did/said. That was totally awful. It felt like they read some book "how to perform psychoanalysis - a quick guide for beginners. become a therapist in 3 days!". I felt like I was on literature lessons and they were analyzing some poem, looking for "what the author meant". It always gave me the feeling that they had no idea how to work with me and what to do. I devaluated them everytime due to being unprofessional and utterly stupid. Then I decided to leave the therapy, and they were always like "oh, i see, you have some deep relationship issues and are too afraid of building a connection with me as a therapist, because you're too scared that I would reject you".
And there was I - standing in front of them with colossal urge to facepalm myself and shout "hell no, you f****g moron, I'm quitting because of the idiot you are, stop looking for something that is definitely not here".
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I also hate when the therapist seem to be bored and emotionless (I've met two such ones) - it feels like I cannnot have any connection with them.

Several things discussed are vital to the happiest outcomes.

All of Medicine strives for optimal outcomes. Mental Health is no different.

The first things to look for in a therapist were mentioned, so I'll just emphasize them: you must appreciate and accept that BPD is a brain disorder. It is not a trauma-induced condition, it just comes over people who are predisposed to it. I mention this discernment because so many BP and BPD individuals blame loved ones for traumas, label them as toxic parents, and deny they have a brain disorder at all. They run away from home and abandon parents, but cannot connect the dots that they did not leave their problem behind, but took their condition with them. This is the first thing to realize. Brain condition, not mom and dad condition.

The second thing is to appreciate that just as there are trolls in the BPD culture, such as the arts, there are also trolls in the credentialed sectors of practice. They write articles that BPD is not a real disease and give pretty flimsy evidence for that view. In short, they are wrong in their very standard of practice, and tell kids parents are toxic, there is no such thing as bipolar and don't go home. They convince their readers mom and dad are abusers and not to listen to them. You can Google many of these 'toxic' professionals by search terms Bipolar and Borderline Personality Disorder. My guess is that one out of ten recent articles is such a writer.

This is important because you don't want to choose someone who makes therapy look agreeable and easy. It's not easy, but it is worthwhile. How do know who is right for you? Answer: if he or she insists on involving family as posted above. Family means historians who can define things and bring the patient back to reality the way the doctor needs. This isn't easy, but it is best for the patient. It has the power to reunite the family and develop the ability to cope, which is so absent in most BPD persons.

Pretty soon, you see a light at the end of the tunnel, and that kind of quality of Hope can make things look like one big misunderstanding. And - after all - isn't that what it is?

How would you like to discover that your pain is not from some original wound of blame and trauma, but a misunderstanding? Just finished reading a piece this morning about a bipolar who confesses what it's like, and blaming parents was a confession she regrets as pure anger without a foundation.

Understand that BPD is a brain disorder and that no one is to blame. Understand that the best doctor is one who believes in family reunification, communication, and the ability to cope with life's realities. Stay away from trolls who say your parents abused you and who keep you away from your parents.

Being wrong about mom and dad was the best step a BPD can take in where to get help and support. You won't get much of it from people who just agree with you. Go with the doctor who wants to involve your family and and you will have begun to turn things around.

I'll be transparent, I started this thread because I was mad at my old therapist.

My biggest trigger is feeling like I'm being bullied. I'm a proud strong man, who because of his BPD struggled in my earlier years. When I think someone is trying to force me to do something, to bully me I lash out. That tends to be my biggest trigger. As you guys know in my last few posts of work thats how I felt. Its not a surprise things ended as they did. When I feel bullied I tend to become fully defensive, and go on the offense, that means burning bridges, cutting and running.

Its not the best thing to do

I know for me, I need a nurturing therapist who understands the difference between trying to make pressure, and when I start to feel insecure. As soon as I start to feel insecure, any therapeutic goals can't be progressed until that insecurity is addressed

Thanks for clearing that up. It makes more sense now.

I've seen MANY MANY therapists throughout the years, but this last one has truly been a gem; a life changer for me.

I will share her qualities with you. Hope that helps.

She:

-has been there (meaning, she comes from a dysfunctional family and has done her own work)
-has an innate understanding of dysfunctional family dynamics
-is trustworthy
-gives me homework (EFT exercises)
-is an active listener
-is an optimist
-will tell me if I am out of line
-is empathetic
-is well versed on BPD and alcoholism (I'm also an ACOA)
-holds me accountable (I've only missed one meeting in 1.5 years)
-is my cheerleader
-is compassionate
-is strong
-is a leader

Basically, (some may say this is unhealthy,I'm not too sure myself) I view her as a mother figure. She is gently guiding me through life stages and never ever makes me feel stupid for asking her questions that I feel like I should know at age 40.