Calling it what it is?

[Sector]

Curious how others have handled this.   My husband's symptoms have for years seemed well-aligned with BPD (the quiet type.) He has been very open to therapy and has been religious about it and working hard.  However, the initial psychiatry office was incredibly dismissive of the borderline traits existing even though she really knew nothing about hubby's behaviors outside of her 20 minute virtual questionnaire sessions.  And his therapist who I was seeing in conjunction with his therapy (I know...bad idea) did not really acknowledge it either.  She still tells him it's not that.  Fast forward a few years and he has just switched psychiatry offices. I am always invited to these appointments because he knows I see a different side than he tends to present.  I shared a couple recent episodes that were elevated but characteristic of what happens at home and she asked if he'd been diagnosed as borderline.  Like within two minutes of talking to me, she was already there.  Hubby is not pleased how I presented him and thinks psych is now biased against him. He says I painted him as a tantruming teenager who can't control his emotions...and yes that's what this episodes looked like. But he also acknowledged everything I said was true.

So...it seems likely what's happening is that his therapist either reeeeeeeally doesn't see what's happening or she reeeeeeally doesn't want him to have that label.  She has dabbled in giving him DBT exercises but I'm not sure that the therapy is true DBT.  He loves her and she is very dedicated to helping him.  But if he needs true DBT then by dancing around the diagnosis, aren't we just avoiding him having a chance to get better? And at the same time kindof gaslighting me?

I feel like many here must have had a similar experience so just hoping someone can help me get my head around this and the best way to move forward.

[square]

Hey there,

Of course you want him to ne diagnosed and to get help and to finally get better.

Borderlines seem to be the only personality disordered people who have much of a chance of accepting a diagnosis. But even they more often than not reject it. And even when they accept it, they see the condition not as being about their maladaptive treatment of others but about how bad they feel and how others need to understand and help and give them a break.

A therapist develops a rapport and trust with the patient. Telling the patient they have a personality disorder usually breaks that rapport and trust, usually the patient quits therapy, and often will never seek it again.

And of course, they are the patient, not you. The therapist serves them, not you.

It's a hard pill to swallow.

The best thing to do is to let go of the idea that they can be changed, and look at ways that you can change in order to protect yoursef. Sometimes those changes can actually improve things - could lead to fewer and less severe explosions. Sometimes your changes could make no difference in their behavior, or even ramp it up. But either way, those changes could help YOU manage and pull away from the constant turmoil.

[bloomie]

Sector - What a disappointment when you thought there may be light shed on what may be the root cause of many of your H's behaviors. I am really sorry!

I handled this kind of thing by removing myself from any part of the therapeutic process with my own H. My participation ended in frustration and being backed into a no win corner of H asking for me to go with him and offer my input and then not liking my input. From there, the therapist's primary focus shifted to preserving the opportunity to continue with my H.

In my experience with the therapists we have seen (and there have been several), when faced with a couple, they lean heavily toward the least healthy person at the expense of the healthier person. They are healers and brokenness is very compelling. As well we all know.

For what it is worth, in my experience joining H in therapy is time, money, energy invested that gained me very little and cost me a whole lot.

Agree wholeheartedly with Square's wise thoughts:

The best thing to do is to let go of the idea that they can be changed, and look at ways that you can change in order to protect yoursef. Sometimes those changes can actually improve things - could lead to fewer and less severe explosions. Sometimes your changes could make no difference in their behavior, or even ramp it up. But either way, those changes could help YOU manage and pull away from the constant turmoil.

[Sector]

Square and Bloomie thanks for the responses.  I know you're both right.  I think the most damaging thing for me in this journey so far has been watching for three years as his therapist and psychiatrist told me to just keep trying the same thing over and over which wasn't working and was SO bad for me!  And I can't believe I didn't extract myself sooner. Within a few sessions of having my own therapist I was already learning how to protect myself.   I am glad I went to the first session with the new psychiatrist and have said I will go tomorrow so I will honor that commitment (also because I'm really curious to see what she is going to say after last time!) But then I may bow out and just let it be.  I think Bloomie's comment about the care team tending to the less healthy party and sacrificing the more healthy party is exactly what happened here.  That really resonates. 

Fingers crossed the appointment tomorrow goes smoothly.  And Square yes I have definitely been working on myself to be less in the line of fire and also to better protect myself during the episodes.  That part is definitely a work in progress!

[bloomie]

Sector - sending you strength and wisdom as you go once again. Hoping the interaction it will bring help and clarity to both of you! Let us know how you are as you are able.

[Sector]

The appointment actually went fine which is a relief.  She asked him the nine questions and I believe they were  all yes except for one. Interestingly he didn't think some of the things counted like beating on himself as self harm or getting in the car and driving while spiraling out of control emotionally as reckless driving.  He thinks most people hit things when they are angry.   And going for a drive in that state is a safe way to blow off steam. She said again very high chance it's BPD but going to speak to the therapist to hear more about him since she is new with him so will see if anything changes after that happens.  And he seemed outwardly ok with all that.  The one question she asked him which I am wondering about was if he has ever considered divorce.  Like if things don't get better. I can't figure out what that question gets at? It does seem like the new medication is also a better fit than anything else has been so far so I'm cautiously optimistic.  And hoping they figure out a way to get some DBT going sooooooooon!

[square]

Glad to hear it went well and I hope DBT will be helpful.

The divorce question might have just been gauging interpersonal turmoil, and possibly may have revealed fear of abandonment. I don't know.

One thing to keep in mind is that imho therapists see BPD differently than the spouse and close family. We see it as something destructive to the relationships and to us. Often the therapist is a trusted confidante to the BPD, and sees a vulnerable person. The therapist doesn't feel ripped to shreds.

Therapists seem to approach treatment primarily to reduce self harm. They may consider a BPD cured if they stop needing inpatient services for suicide threats and self harm, or just overall have fewer freakouts involving the mental health system.

Meanwhile, at home, the spouse, kids, and other close family members are still experiencing being put into no win situations, being blamed and devalued. In fact the BPD often removes responsibility BECAUSE of the diagnosis - "you have to treat me better, I have BPD, you're the one driving me to this, my therapist says you should/n't ___."

Personality disorders are really tough because personalities are inherently entrenched. You mentioned a belief that "everybody" bangs and slams things when upset; such a belief will continue the behavior because it is seen as perfectly normal, no change needed. Likewise the belief that driving recklessly is a safe and healthy way to manage feelings will perpetuate that behavior.

All that being said, I have read some spouses say DBT did help things enough they could manage. I could imagine that if my husband had received some form of help early on enough I could have continued with him. But after so many years of destruction, the relationship was shattered, trust was gone, the well dry, etc.

[Sector]

Square yes on ALL of this.  I remember about a year into this process when I kept being told to just keep trying and he would learn how to interact with me again.  And I said that we are getting to the point of serious damage to this relationship that I don't think we want to label as acceptable collateral damage. And I felt like I got the blow off.  Because yes the damage to the relationship can get to be too much even if therapy is effective and he changes, there is only so much one can handle over time and still be able to reconnect.

 I'm still not totally sure what his therapist thinks.  She is definitely his trusted person! In my one on one interactions with her it seemed like she didn't understand how damaging the situation was to me given that she did not advise me at all on how to protect myself.  And I do know for sure that she told him he was not to drive in these situations but perhaps didn't convince him it wasn't safe.

Interestingly, my new therapist has checked in with her and is confident she understands what is happening.  So...🤷�♀️ I dunno.  It was just a relief for the new psychiatrist to immediately see what was happening off the bat and I'll take that as finally something moving the needle in the right direction.

Here's to hoping his therapist is on the same page and is supportive of adding DBT.  Because I am still trying to be optimistic.

[notrightinthehead]

Sector, you seem so much focussed on HIM and HIS therapist and HIS diagnosis. Where are YOU in all of this? You will be able to handle whatever is thrown at you - and with a BPD there will be a lot - if you leave him to handle himself and concentrate on yourself. What you do, how you can be compassionate to yourself. How you can boost your self esteem. How you feel. What you want. What you think. What you expect for yourself. How you can improve your life. Also look at your behaviour - does it align with your values? Look at your life - is that what you want for yourself?
The sooner you realize that you have NO control over what he does, feels, thinks or how he behaves, you will move towards a better path for yourself and him. He is not your child. He is not a disabled person who cannot take responsibility for his life. Let him take responsibility for himself. You deal with your side of the street.

[Sector]

Notright...I so appreciate your standing up for me.  I need more of that in my life!!! But rest assured I am definitely working on me.  I've gone through all of those questions.  I have never doubted myself or my worth, just baffled by how others didn't believe me about what was happening. It took a few years before my parents even seemed to get that this wasn't a standard marriage counseling issue. Once I understood (quiet) BPD at least everything made sense. It's tough for sure but getting out of the meetings with his therapist and starting with my own was a huge deal (ugh that it took me so long to figure that one out) and has helped me tremendously. And stopping couples therapy where yet another person was not understanding what was happening and was not holding him accountable. Yes I completely understand I have no control of his anything—and I have learned that modifying my way of interacting with him also doesn't matter.  He will find criticism and attacks in my softness.  He is threatened by my vulnerability and openness. I know this and am not still in that fog of thinking I can help him with my own behavior.  That said, we have two amazing kids one still at home and when we are together as a family things are ok.  He is great with the kids.  And I would like to take a chance on preserving us with this new psychiatrist seeming to be a chance at getting him on the right path if that makes sense. He has made a lot of progress in some areas so we aren't talking about someone that is untreated and not putting in the work.

Should I completely extricate myself? Maybe. And will likely do that very soon. I have extricated myself from nearly all of it.  I just am seeing here one last chance to hopefully get him help from the first person to meet him and see what is going on.  And she was only able to see that because I spoke up. My instinct is to encourage getting him into DBT and then step back.  I may be wrong but I do think I have some degree of input that is being heard right now and want to take advantage as it's probably the last chance.  I will not stay in this situation forever. 

[Poison Ivy]

Here are a few thoughts, in no particular order.

My ex-husband has had depression, anxiety, and ADHD since he was a child. (He's now 70 years old.) During our 31-year marriage, he was in therapy, taking medications, or both for much of the time. Although I was frustrated by what seemed to me to be the lack of success of the therapy, my frustration was less than it might have been because I always kept in mind that the therapists were my husband's health-care providers, not mine. Their duty was to him, not to me and not to our marriage (the third "participant" in many situations). I was invited to a few therapy sessions by the person whom I thought was the best therapist, and I declined to attend. I did share some information with this therapist by phone and maybe written communications. I have no regrets about not attending therapy sessions with my husband. He deserved to have his own health-care providers, with the attendant confidentiality and duty of care, and he had the obligation to deal with his own mental health and not make it be my responsibility to make him better. (Look up dependent personality disorder.)

[Sector]

Yes mine may be of a similar profile—ADHD suspected but untreated through childhood (treated now tho) and accompanying depression and anxiety.  With a scoop of childhood emotional neglect and bullying on top.  It all makes sense but having had zero previous understanding of mental health conditions, I was baffled and confused and hurt until I finally understood.   Living through this has been tough.  And it took me waaaay too long to realize seeing his therapist with him or without him was incredibly damaging for me.  I had this naive notion that we were a team working together. Then the lightbulb moment like you said where I realized they are his team working for him and not me and yeah I am acceptable collateral damage.  I get that now but didn't for a long time.  Probably 3 years.  I will not attend any therapy sessions with him and haven't in quite some time. 

The other thing I hadn't mentioned which maybe makes the picture more clear is we have been together for almost 30 years.  He fell apart during Covid and that's when he was no longer able to mask anymore.  Was it perfect before then? Of course not.  I look back now and see the warning signs and the hidden resentment.  But we are talking about a very long relationship with wonderful almost adult children who adore both of us and each other.

I think (relatively speaking) my eyes are open.  And I truly still am in the "working on it" camp.  I'm not ready to give up yet and am taking care of myself.  And as I believe square mentioned above in their case, the distancing really upsets him, so the biggest challenge right now is finding the sweet spot of detaching enough to protect myself without detaching so much that he gets set off. And yes I will err on the side of protecting myself if there is no happy medium

I don't think it's DPD with him.  He wants the privacy of his therapy sessions, and I have no interest in participating.  He knows I see a different side of him than anyone else and wants that presented to the psychiatrist so we can actually get somewhere—he just really didn't like what he heard when I presented him without sugarcoating in that first session.  I have advised him I will continue to be honest and not sugarcoat in the future if I come again.  I don't regret going.  He also won't protest if I don't go back but he and the doc both still want me there for a little longer if I am willing.  I will talk to my therapist about this today. I don't want to abandon ship on what may be the last chance to get him into DBT.

Thanks for all the comments.  I need to keep being reminded of a lot.  Hopefully I will have positive updates over the next few weeks, but for right now I am hopeful.

[square]

I think it's a great plan, and rational hope is a good thing. Anything I wrote was not meant to discourage you but just to prepare you for some possibilities.

My husband also sounds similar in some ways. ADHD, anxiety, traumatic childhood with abandonment and emotional neglect. A pervading feeling of resentment. In my husband's case there is a history of psychosis starting in childhood when he had a bad fever. I will say I BELIEVE ADHD meds MAY have worsened the psychosis.

I also relate to the bafflement, I think that is the best way to describe my reaction to his meltdowns. They made no logical sense to me. And earlier on the meltdowns would pass and he'd be sorry and I'd assume we figured something out and we could move past that but then another one would happen. I felt like he was two entirely different people.

There was always something wrong but it used to be more good than bad. But over time he fell apart, started needing alcohol, raged more often, and then started having full on psychotic episodes. To be clear, I don't believe my husband's issues are primarily PD and it seems he just has some traits. I guess maybe bipolar or schizoaffective, idk. But our relationship issues felt like PPD with some BPD features.

Best of luck, keep posting.

[Sector]

Thanks square.  That sounds incredibly difficult.  And yes, baffling!  I do think the ADHD meds help mine but there have been MANY other meds that have made him so much worse.  And the professionals didn't want to believe it.  (This was when I still thought I was able to be part of the team that wasn't 🤪) Luckily the medication he just started actually seems to be stabilizing for him so that plus the psych seeming to see what is happening in real time is hopefully the best recipe for progress.  Whether the relational stuff can also stabilize will be a process for another day...