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- May 9, 2000
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I find there is a disturbing "conspiracy of silence" among mental health professionals about the diagnosis of borderline PD. I work in a Partial Hospitalization program, and will often see pts who are in outside therapy (sometimes for years) and while their borderline characteristics are clearly evident, their therapists never talk about it with them. I get why we all do this, on one level: there's a huge prejudice in mental health against borderlines, and having that label come up when you pull up a person's record could facilitate dismissive treatment of the pt. But really, I think that argument rings hollow--it's not like, without that diagnosis in the chart, their character pathologies are magically hidden from other providers...
In my experience, having the conversation about borderline PD is an important part of treatment. Mind you, I do get motivated borderlines (my fav patients, actually, so my countertransference is positive and hopefully helps to shape how they hear this) in my program. Certainly there are borderlines of the more impaired variety (who help create some of the negative countertransference against borderlines in our field). People are coming in b/c they are recognizing, hey, something in the way I conduct my life ain't working, and I find them to be receptive to the diagnosis. Of course I preface it by telling them not to Google borderline PD, b/c it'll make you feel bad about yourself, and also often give them the Marsha Linehan article from the NYT last summer where she outed herself as someone who suffered from borderline PD.
I get frustrated with the long term outpt therapists who seem to collude in the silence around the borderline diagnosis. I mean, I've had patients who have gone through DBT in the past who have never heard of borderline PD --WTH? Honestly, some patients who have made the biggest leaps seem to do it in the context of understanding so much more about themselves because of the context the diagnosis (and discussions about etilogy and antecedents) gives their own hx.
In my experience, having the conversation about borderline PD is an important part of treatment. Mind you, I do get motivated borderlines (my fav patients, actually, so my countertransference is positive and hopefully helps to shape how they hear this) in my program. Certainly there are borderlines of the more impaired variety (who help create some of the negative countertransference against borderlines in our field). People are coming in b/c they are recognizing, hey, something in the way I conduct my life ain't working, and I find them to be receptive to the diagnosis. Of course I preface it by telling them not to Google borderline PD, b/c it'll make you feel bad about yourself, and also often give them the Marsha Linehan article from the NYT last summer where she outed herself as someone who suffered from borderline PD.
I get frustrated with the long term outpt therapists who seem to collude in the silence around the borderline diagnosis. I mean, I've had patients who have gone through DBT in the past who have never heard of borderline PD --WTH? Honestly, some patients who have made the biggest leaps seem to do it in the context of understanding so much more about themselves because of the context the diagnosis (and discussions about etilogy and antecedents) gives their own hx.