Mental illness as a therapist, student, etc.

[psm1776]

- maybe it's my countertransference with BPD's (probably) but it's typical that people will begin bickering about borderline symptoms, diagnosis and behavior.

Just look at this thread.

Also, a word to the wise, about supposed internet anonymity- nothing is really so anonymous as you think it is. Pinksoil, while I truly commend you for seeking treatment - I do think it's slightly inappropriate and provocative as a future clinician to post so prodigiously and in such detail on psychcentral.com about your struggle, while also wearing the dual hat of "future dr.".

Anyone could easily go over to that site and see exactly what you go through on a daily basis. Was that your point or intent?

I am also concerned that you are pursuing a psy.d and will someday practice while exhibiting some of the very extreme and chronic symptoms such as self-injury on a daily basis, all the while thinking that your judgement and boundaries are not affected in the least. I think that is what disturbs me the most.

---

Members don't see this ad.

 

[ClinicCase55]

-

I do think it's slightly inappropriate and provocative as a future clinician to post so prodigiously and in such detail on psychcentral.com about your struggle, while also wearing the dual hat of "future dr.".

Anyone could easily go over to that site and see exactly what you go through on a daily basis. Was that your point or intent?

I am also concerned that you are pursuing a psy.d and will someday practice while exhibiting some of the very extreme and chronic symptoms such as self-injury on a daily basis, all the while thinking that your judgement and boundaries are not affected in the least. I think that is what disturbs me the most.

I think you summed it up very eloquently. Much better than I did. Thank you.

 

[Therapist4Chnge]

*MOD NOTE: I don't want this to be a personal thing of people passing judgment. Please stick to talking about the topic at hand (mental illness as a therapist), and not about particular posters/members. -t*

 

[PinkSoil]

- maybe it's my countertransference with BPD's (probably) but it's typical that people will begin bickering about borderline symptoms, diagnosis and behavior.

Just look at this thread.

Also, a word to the wise, about supposed internet anonymity- nothing is really so anonymous as you think it is. Pinksoil, while I truly commend you for seeking treatment - I do think it's slightly inappropriate and provocative as a future clinician to post so prodigiously and in such detail on psychcentral.com about your struggle, while also wearing the dual hat of "future dr.".

Anyone could easily go over to that site and see exactly what you go through on a daily basis. Was that your point or intent?

I am also concerned that you are pursuing a psy.d and will someday practice while exhibiting some of the very extreme and chronic symptoms such as self-injury on a daily basis, all the while thinking that your judgement and boundaries are not affected in the least. I think that is what disturbs me the most.

To be slightly provocative is to think outside of the box. My, my how stuffy and "by the books" doctoral students can be! I thought I thought I was the one who was supposed to be extreme. I go on PsychCentral, for reasons that anyone else on PsychCentral, goes there. I don't place myself in any special place. I am both a patient and a therapist. I'm also candid, provacative, creative, aware of myself and my boundaries, driven, and graduated at the top of my department in both undergrad and grad school. I was offered a job as as therapist at the very first interview I went on. So... I can't be doing that badly. Maybe you should look into you countertransference towards borderlines because I notice everyone on this board attacking the fact that I said "borderline." Barely anyone has mentioned bipolar, and certainly no one has mentioned my anxiety disorder, which, ironically, happens to be the very thing that has impaired me more than anything! That is because it is more accepted. I think it's cute, though, how people jump on the fact that a patient with borderline disorder said to me, "Someone understands" and we shared a connection. Again, aren't I supposed to be the extreme one? Get real, guys. "Borderlines" can be genuine, too. PSM1776 is right in regards to everyone beginning to bicker about BPD behavior-- I make a comment about a moment I shared in a session, and of course to everyone else, it is considered idealistic, borderline behavior. Godforbid those with BPD could have real feelings without a motive! Sad, sad, sad.

 

[deleted75966]

Barely anyone has mentioned bipolar, and certainly no one has mentioned my anxiety disorder, which, ironically, happens to be the very thing that has impaired me more than anything!

While, of course, someone in the midst of a depressive or manic cycle with bipolar disorder would be an obvious problem, bipolar disorder can often be controlled fairly well with medication (though not always); anxiety disorders tend to also be fairly treatable. BPD strikes a chord because 1) treatment success is limited 2) the nature of the disorder may be particularly dangerous in a clinical setting (that is not to say that you, personally, are a poor or dangerous clinician) and, in your case 3) you have mentioned symptoms severe enough to warrant inpatient treatment recently, which, potentially, suggests an uncontrolled situation.

People here responded to your example of a connection with a borderline patient because borderlines tend to have "special" and "intense" relationships in which they idealize people as the only ones who get them and they tend to go on about how said person can do no wrong until that image is shaken and then they can do no right. It's not about a motive; the feelings are usually genuine from what I understand. It's about the derivation of the feelings. We cannot speak to a particular case and are treading dangerous waters in discussing one of your patient's at all, no matter how vague. But, speaking in steretypes, such a statement in therapy from a borderline patient wouldn't surprise me at all. It was an unfortunate example; that's all.

 

[psm1776]

Please make no mistake, I am not passing judgements - but I think Pinksoil's initial post was provoking, no?

I do know my limitations in terms of my own countertransference, but Pinksoil is not my patient, but I did make note of my initial reaction to her own description of somewhat chronic and extreme daily symptoms.

I just find it interesting that Pinksoil considered herself impaired enough on a personal level to go into inpatient treatment and now 2 weeks later is practicing. That is a real cause for my concern.

The APA has set rigorous guidelines as to the impairment of clinicians.

http://www.apa.org/ethics/code2002.html


http://72.14.205.104/search?q=cache...mpaired+psychologist&hl=en&ct=clnk&cd=2&gl=us



While I respect Pinksoil's opinion that she is

also candid, provacative, creative, aware of myself and my boundaries, driven, and graduated at the top of my department in both undergrad and grad school. I was offered a job as as therapist at the very first interview I went on. So... I can't be doing that badly.

I find a large disconnect between needing inpatient care and then being perfectly OK to practice soon after.

I also find it disingenious that someone could write a post this provactive and then accuse everyone of not being fair and objective.

I don't care if you have BPD, GAD, or purple polka dots - if it impairs in your ability to function - you should not be practicing.

Our patients have a right to good care and the sound judgement of clinicians who also practice good mental health hygiene and within a range of functioning.

I think many practioners I know of are in therapy, or have been in therapy as a method of self care, self exploration or dealing with a "mental illness" on a spectrum. This is not the issue.

I guess the issue is the severity of the mental illness in regards to impairment. Any illness, including mental illness is on a spectrum. Someone who needs inpatient care needs a "higher level of care" not available on an outpatient basis and is case for impairment, pretty much by defintion.

Personally, I would not want a neurosurgeon who was battling an opiate or alcohol addiction doing brain surgery on me. The same holds true for severe pathologies in the clinical therapy room.

EDIT -
I agree with Jon Snow about discussing patients. I think discussing a vignette about a patient, although an anonymous one, is telling in terms of boundaries.

 

[Ollie123]

2) the nature of the disorder may be particularly dangerous in a clinical setting (that is not to say that you, personally, are a poor or dangerous clinician)

I think this is really the key. We need to take this on a case by case basis.

I think part of the original point was that level of functioning does not necessarily overlap 100% with severity of disorder. I agree entirely with this.

The remaining issue is where to draw the line. Alot of the discussion has been about stigma surrounding borderline PD. I don't necessarily agree with those folks, but I DO think labeling what folks have been saying as "stigma" towards borderlines is misguided at best.

One of the hallmark characteristics of borderline PD is poor ability to regulate interpersonal boundaries and relationships. It isn't present in all borderlines, but to say it "stigmatizes" borderlines to think a borderline therapist might have problems with a client-therapist relationship is like saying its "stigmatizing" depressed people to think that they might be sad. Everyone deserves a chance to prove that they are the exception to the rule, and I think it would be foolish to make a sweeping statement such as "Any current DSM diagnosis means you are incompetent to practice" (not that I think anyone is saying that).

However, just like anything else, I think a degree of caution is needed. I ABSOLUTELY think someone with borderline PD needs to be extra extra careful about their client-therapist relationships. I think that if a disorder is poorly controlled to the point that it is affecting one professionally, its best to address that first. If repeated hospitalization is expected, for example, I think that definitely means one shouldn't be practicing. If nothing else, because its unfair to take on clients who can end up without a therapist for months at a time because their therapist is in the hospital. That isn't stigma against mental illness, I'd feel the same way if a therapist had an unstable heart condition and would likely need several surgeries over the year.

So really, it boils down to "Does it affect your professional life". In certain cases (borderline PD), I think its quite fair to say it is more likely to affect your professional life than, say, a specific phobia unrelated to the profession. So I don't believe a diagnosis should preclude anyone from practicing outright. However, I also don't think its unreasonable to expect an extra degree of caution from those practitioners, nor should they be given even the SLIGHTEST bit of leeway with unethical behaviors.

 

[erg923]

To be slightly provocative is to think outside of the box. My, my how stuffy and "by the books" doctoral students can be! I thought I thought I was the one who was supposed to be extreme. I go on PsychCentral, for reasons that anyone else on PsychCentral, goes there. I don't place myself in any special place. I am both a patient and a therapist. I'm also candid, provacative, creative, aware of myself and my boundaries, driven, and graduated at the top of my department in both undergrad and grad school. I was offered a job as as therapist at the very first interview I went on. So... I can't be doing that badly. Maybe you should look into you countertransference towards borderlines because I notice everyone on this board attacking the fact that I said "borderline." Barely anyone has mentioned bipolar, and certainly no one has mentioned my anxiety disorder, which, ironically, happens to be the very thing that has impaired me more than anything! That is because it is more accepted. I think it's cute, though, how people jump on the fact that a patient with borderline disorder said to me, "Someone understands" and we shared a connection. Again, aren't I supposed to be the extreme one? Get real, guys. "Borderlines" can be genuine, too. PSM1776 is right in regards to everyone beginning to bicker about BPD behavior-- I make a comment about a moment I shared in a session, and of course to everyone else, it is considered idealistic, borderline behavior. Godforbid those with BPD could have real feelings without a motive! Sad, sad, sad.

Yes well I'm sure you are correct that borderlines certainly do have genuine emotions. Your comment just struck me as extemely clinically naive. A truly good clinician does not not always take idealist comments such as these at face value. With one clinical ear you believe everything, with the other, you believe nothing. This keeps our critical thinking skills in check and identifies us as true scientist-practitioners. If I believed everything a patient told me with out questioning it, I would be a shoddy therapist and a poor scientist.

You have yet to answer my question about what you refer to as "generalizations." When the statistical model is strong, they become the best predictor of behavior/outcome. If we do not use the literature as the guiding light, what do we use instead?

As an aside, I too agree with citing the APA ethics code for this matter. The AMA has a strict policy mandating reporting of compromised physicians as well.

PS: If "by the book" you mean guided by empirical evidence and innately skeptical, then yes! This forms the foundation of a good clinical scientist. Yes, I am "stuffy" about protecting our patients and the integrity of this profession. We should all strive to be "by the book" to some extent in a profession that deals with the well being of others. I would hope all clinicians are guided by a skeptical and scientific mindset. I would not have it any other way!

 

[timecoloured]

Can I suggest this "vignette" be edited? It freaks me out to imagine I could go online to a forum and see something I had said to my shrink in a session, especially since it's not that hard to figure out where geographically this event took place and probably more if you tried.

I take undergrad classes at a university and also have done intakes on patients at the affiliated hospital. One of my professors put up an "anecdote" to give insight into mental illness that was from the chart of one of my patients! For a second I thought I had written it, though I figured out I hadn't but I certainly recognized the person. It was surreal, I kept thinking, what if that guy's kid is in this class? So I may be overly protective, but you never know, especially when something gets preserved on the internet.

 

[psm1776]

Can I suggest this "vignette" be edited? It freaks me out to imagine I could go online to a forum and see something I had said to my shrink in a session, especially since it's not that hard to figure out where geographically this event took place and probably more if you tried.

I think it should be edited out as well - I think that was my inital point about the anonymity on the internet - we can figure where the original poster is - it wouldn't be hard for someone to put 2 and 2 together.

So much for being aware of boundaries!

EDIT - T

The APA guidelines include many ethical concerns, including patient confidentiality. It's what those "stuffy, by the books doctoral students go by", as well as physicians, lawyers and many other professionals.

 

[sunlioness]

So are you saying it's inappropriate to discuss cases anonymously online at all in any form? If that's the case, the MD boards of SDN have some major housecleaning to do . . .

 

[deleted75966]

So are you saying it's inappropriate to discuss cases anonymously online at all in any form? If that's the case, the MD boards of SDN have some major housecleaning to do . . .

psychiatric issues are different and, as such, should be afforded a greater level of security. . . e.g., at the hospital I work at, psychiatric records are protected above and beyond general medical records. I think this is as it should be.

 

[psm1776]

I don't want to turn this discussion into something rhetorical about internet posting - but, given the very prolific nature of Pinksoil's posting's on other forum's - the internet really becomes a very small place. I think there is a very line about posting any given clinical info.

There are numerous cases on other forums where the "anonymous internet poster" has been found out IRL.

Given someone has the inclination to do so - the information trail is not as obscure as one would like it to be.

How many therapy patients have googled their therapist or tried to find out whatever info they could. Look over on psychcentral and you can see how many even look up utility records. It can happen in any medical specialty, but given the intimate nature of a therapeutic relationship, it would seem even more important to try and keep that confidential.

I would think there would also be a difference discussing a hard clinical case versus a vignette that was said in session.

Huge difference discussing a bowel re-section versus talking someone down from a ledge, no?

 

[Therapist4Chnge]

*words*

I agree with everything Jon wrote.

 

[sunlioness]

psychiatric issues are different and, as such, should be afforded a greater level of security. . . e.g., at the hospital I work at, psychiatric records are protected above and beyond general medical records. I think this is as it should be.

I was including the psychiatry forum itself in that comment. But it's true that cases discussed there are almost exclusively related to med management and not to discussing what happened in a therapy session.

I don't want to turn this discussion into something rhetorical about internet posting - but, given the very prolific nature of Pinksoil's posting's on other forum's - the internet really becomes a very small place. I think there is a very line about posting any given clinical info.

Yeah, I don't belong to psych central so I don't know what's going on over there.

How many therapy patients have googled their therapist or tried to find out whatever info they could.

Yeah, this happens all the time.

 

[Therapist4Chnge]

psychiatric issues are different and, as such, should be afforded a greater level of security. . . e.g., at the hospital I work at, psychiatric records are protected above and beyond general medical records. I think this is as it should be.

Psych is a fine line. I know at SDN we've had a lot of discussions about case discussions. The challenge with psych is that it seems to have much more identifying information. I always err on the side of caution, but that is just how I do it.

 

[Therapist4Chnge]

How many therapy patients have googled their therapist or tried to find out whatever info they could.

This has happened to me on a number of occasions, since my population age tends to be tech savvy and I am very blank slate with my individual work. At least it offered some nice intros into the importance of boundaries and our roles in therapy, etc.

 

[sparkleflower]

Can I suggest this "vignette" be edited?

If you're referring to the "finally someone understands!" comment (and even the context), that seems about as generic as it gets.

 

[psm1776]

Yeah, I don't belong to psych central so I don't know what's going on over there.

Just as an FYI, I don't belong to Psychcentral either - I was only alerted to the site after Pinksoil's first post. Pinksoils' post was like "wow, OK", so I went over there to take a look.

I'm not exactly why she included that info in her post anyway - if only to send people over there to look and see what she wrote. Why else would she include that? As I said, it was a pretty provoking post, for me at least. And judging by the responses of other posters here, I don't think I'm alone in that reaction.

But the bickering is typical of any inpatient unit with any given number of PD's, especially a BPD.

Splitting galore.

 

[timecoloured]

If you're referring to the "finally someone understands!" comment (and even the context), that seems about as generic as it gets.

Okay, so let's say it's so generic that every formally diagnosed borderline woman in PinkSoil's location who reads it thinks, wow, I said that to my shrink and had a totally meaningful moment, and here it is on the internet. I think I'm going to Google this PinkSoil person and see where she lives, etc. I realize it's not the most identifying of anecdotes, but why take that chance? If I had ever said that to a shrink I certainly wouldn't want to come across it on some message board, even if in your experience such statements happen every day.

 

[WannaBeDrMe]

wow. I had not considered utility records.

I did google my own name and found it on TWO clients' myspace pages.

that was uncool in every way...

I worked two counties away from where I lived for 3 years... I am very comfortable with that at this stage of my life...

 

[ClinicCase55]

Believe it or not, I work with "lower income clients" and some of them have PAID on-line search services to find information about me. I was shocked. Now, it is rare, but it has happened. And then I am stuck knowing that a client (usually someone with poor boundaries) knows my address and phone number and relatives and .....

 

[PinkSoil]

I am not sorry that I opened up this discussion, but I must say that I was quite naive to not realize how personally attacked I would get. It is interesting, though, because it is the complete antithesis from the reactions I received from professionals that I decided to disclose to IRL.

 

[erg923]

Please articulate why you feel that people who are pointing out the concerns with this situation are personally attacking you. If I remember correctly, you are the one who laid out your private life on a public forum. When people point out how these personals issues have the potential to confound clinic work, what about this is a "personal attack" exactly? Perhaps you are perceiving it this way because you laid out your personal issues as the topic of this post?

 

[CitizenPanda]

I'm glad this issue was brought up, as it doesn't seem as uncommon as you may expect for individuals in clinical doctoral programs to be diagnosed with mental illnesses. I know someone with BPD in another program, and in my program it's come up that a couple of people are on antidepressants, have/had eating disorders, OCD, GAD (so far it seems the issues haven't impacted their work). However, whatever one's issues are, I think when you begin seeing clients you should realize that if you spend a large amount of time on a forum that has members who are more likely to see a therapist (i.e. could see you one day), it's perhaps not wise to post a load of identifying info/photos. While the forum may be a great source of support, it may be wiser to seek it in a more anonymous manner.

 

[Therapist4Chnge]

There are definitely people in programs with at least symptom clusters (sub-clinical) and some with Dx'd stuff (MDD, SAD, ED). We often joke that the OCD tendencies are a necessity in grad school, but obviously taken to the extreme they can be very problematic.

PinkSoil: I think some of the strong responses were in reaction to some of the disclosure, because that is something that frequently comes up in supervision as areas of concern. Personally, I am very conservative with what I share with colleagues and even more so with patients....it is both orientation influenced and personal preference.

I'm sorry it felt like attacks, because I don't believe most/all meant it that way...it is just a hot button issue out there. I'm glad you brought this up because it makes us take a more careful look about how we perceive and deal with potentially blind spot issues. I hope you stick around and continue to contribute to SDN.

 

[ClinicCase55]

PinkSoil: I think some of the strong responses were in reaction to some of the disclosure, because that is something that frequently comes up in supervision as areas of concern.

Um, I can only speak for myself, but the issue of disclosure seemed less of a concern to me than the fact that she is/or will "be practicing while exhibiting some of the very extreme and chronic symptoms such as self-injury on a daily basis, all the while thinking that your judgement and boundaries are not affected in the least. " (As stated so equolently by another member)

Disclosure is a problem yes, but so are the symptoms that are going to affect your client interaction. Posting about needing inpatient treatment and calling one's own therapist in hysteria before going to work shows decreased levels of functioning that could be potentially harmful to clients.

Not to beat a dead horse, but if any clinician is in constant states of crisis or going inpatient, or experiencing mood swings, it is simply not good for the client.

 

[erg923]

"Not to beat a dead horse, but if any clinician is in constant states of crisis or going inpatient, or experiencing mood swings, it is simply not good for the client."

I think this last point is the core issue that the poster is not addressing. Unfortunately, this is common attitude in many psych students and the greater society at large. Many times people get so caught up in doing something, they often don't stop and think if this is the most appropriate thing to do in terms of other those they will be serving. Just because someone wants to do something doesn't mean they should, ethically and practically. Unfortunately, our society fosters this sense of entitlement. The "Who are you to deny my dream" phenomenon.

I'm not sure why this gets labeled as discrimination or stigma however. This in no way sends the message that those struggling with mental illness are somehow deemed as sub-par or inferior. But this mistaken notion that mental illness will not or should not limit some of your career options is just not true. Unfortunately, this is an inconvenient truth, and serves to protect the welfare of those utilizing services. This is in no way different from Epileptics who have their driving privileges revoked until they are seizure free for a set period of time. This is done to protect the public from an unnecessary potential danger. Is this stigma of Epileptics? I think not. Just the same, I would not recommend that someone who has attentional problems due to stroke/TIA expect to be an appropriate candidate for an assembly line job, or a schizophrenic to be my neurosurgeon. I think any reasonable person can see this point and agree on this issue, no? Similarly, I think we can all agree we would not want to have a therapist who is occasionally absent for inpatient hospitalizations or calling their therapist in hysterics before the session with us. I would implore the original poster to ask themselves if they would like to be seeing a therapist like this? I sure wouldn't.

 

[pingouin]

Disclosure is a problem yes, but so are the symptoms that are going to affect your client interaction. Posting about needing inpatient treatment and calling one's own therapist in hysteria before going to work shows decreased levels of functioning that could be potentially harmful to clients.

Similarly, I think we can all agree we would not want to have a therapist who is occasionally absent for inpatient hospitalizations or calling their therapist in hysteric before the session with us. I would implore the original poster to ask themselves if they would like a therapist like this? I sure wouldn't.

I've been just observing this thread from the beginning, and I do agree with much of what's being said regarding impairment of the clinician impacting the patient(s). However, I'm having an issue with the bolded parts above, as I've not seen the OP mention this at all. If I've missed it, I'd welcome someone to redirect me to the relevant post.

 

[sunlioness]

Not to beat a dead horse, but if any clinician is in constant states of crisis or going inpatient, or experiencing mood swings, it is simply not good for the client.

I have to say that I agree with this. I initially thought that the "fuss" was about the OP's disclosure here and to be honest, I don't have much of a problem with that. I wasn't aware of the stuff over on psych central.

So the bottom line is that no, a diagnosis or a h/o diagnosis does not automatically preclude someone from doing this work. But I think we need to be healthy ourselves (or as healthy as your average neurotic human being) before we can really hope to facilitate healing in others. But that doesn't mean giving up or abandoning one's goals entirely. It just means proceeding cautiously with good self-insight and guidance from trusted mentors and not taking on too much too soon.

 

[erg923]

The first post by the OP contained a reference to recently being denied admission for an inpatient hospitalization she was seeking. The phone call came from a post on psychcentral. If I misstated the nature of the event, I apologize to the OP and retract it. However, I think we can all agree that any one event was not the point of my last post. The point was the very plausible reality of this or similar events occurring as the result of the poster being symptomatic and see clients concurrently.

 

[sparkleflower]

I've been just observing this thread from the beginning, and I do agree with much of what's being said regarding impairment of the clinician impacting the patient(s). However, I'm having an issue with the bolded parts above, as I've not seen the OP mention this at all. If I've missed it, I'd welcome someone to redirect me to the relevant post.

"Posting about needing inpatient treatment and calling one's own therapist in hysteria before going to work"

The references to hysterical calls come from her posts on psychcentral.

 

[ClinicCase55]

Yes. With much of this issue being related to the OP's disclosure on PsychCentral and here, one should probably look at what is posted there as well, to get a picture of what we are discussing. I was actually amazed that the OP would disclose so much ~ one hat T, one hat severely distressed.
Also, another member here mentioned pictures of the OP. While drinking is not a problem, a client snooping around as they do, might come across these pictures and posts.

Besides the professional issues related to disclosure, we are back to the effect it has on a client (in this case, both the behaviors and the disclosure).

 

[pingouin]

The first post by the OP contained are reference for recently being )denied admission for an inpatient hospitalization she was seeking. I did not personally see a reference to the phone call (this was taken from ClinicCase55). If it is not accurate, I apologize to the OP and retract it. However, I think we can all agree that any one event was not the point of my last post. The point was the very plausible reality of this or similar events occurring as the result of the poster still being currently symptomatic and see clients concurrently.

Absolutely, and I edited as I did solely to shorten the length of my post. I agree that symptoms severe enough to warrant recent hospitalization (or wish for hospitalization) would be of concern to me for an actively-practicing therapist. I also don't think it would be fair of us to put words in the OP's mouth, which is why I asked for clarification.

Otherwise, as I said I agree with much of what has already been said and don't know that I have much new or novel to add. I know the OP said she's getting a different type of response here than what she gets from her program and others in her life. For one, we're seeing only a piece of your life, only what you choose to present here. Your therapist and advisors have a much more developed picture of who you are and what you're capable of. On the other hand, I think there are some pretty darn objective posts on here which are worthy of your consideration as you move forward with your education. After all, as a therapist your clients are only seeing a piece of you, too. It's essential to know which one.

 

[pingouin]

Thanks to sparkleflower and cliniccase for the clarification- I will have to check in over there sometime..

 

[shock-me-sane]

I think this has been an interesting transaction, especially coupled with the recent post about eating disorders.

Maybe I am naive as an incoming PhD student, but I think awareness and self-care as the most important issue. Granted no one should be seeing patients when considering or fighting for hospitalization, but I think clients should be able to trust the therapist to be with them on their own journey. The actually journey of the therapist is less relevant if prior or current issues are being addressed or cared for.

I am glad that my goal is to be a researcher and will likely only have client contact throughout school. I would like to say that I believe therapists that are aware of their issues rather than living on the downlow seem less likely to adversely affect a client. Of course this is just my .02

 

[toby jones]

> I must say that I was quite naive to not realize how personally attacked I would get.

How about this: 'I was quite naive to not realize how personally attacked I would feel'.

There are a number of things that have contributed to that.

Firstly, you chose to discuss this issue by way of self disclosure thereby making the issue personal.

Secondly, you seem more interested in making a point to others (e.g., chastising them for being stigmatizing or narrow minded or whatever) rather than being genuinely interested in hearing what others have to say about the issue.

Thirdly, you posts raised a number of dilemmas. People feel dissonant when faced with a dilemma. It might be that posting dilemmas is one way to think outside the box, but it is perfectly possible to think outside the box without posting dilemmas. It is perfectly possible to think outside the box while simultaneously appreciating that other people can think outside the box too, and have interesting things to contribute to the discussion.

> It is interesting, though, because it is the complete antithesis from the reactions I received from professionals that I decided to disclose to IRL.

They have to work with you. We don't. Have you ever read the book 'Stop Walking on Eggshells' with respect to things that you can do to make your time run a little more smoothly when you need to work with a borderline colleague?

You keep saying that you have significant insight and awareness, but I'm afraid I don't see it. Worse than that, I don't see you trying to come to a state of better insight or awareness. Raising an issue in a way that makes it more likely that you will perceive insult isn't terribly aware. Striving to make a point instead of posting in an attempt to gain a better awareness and understanding on the basis of other peoples contributions isn't terribly aware or insightful. Failing to appreciate that the majority of borderline clients do go through periods of 'my therapist is just god' and that that doesn't signify terribly much with respect to your abilities as a therapist isn't terribly self aware. Posting about how in tune you are with alterations in your therapists moods, posting about how out of control your moods are, posting about how your moods have no negative impact on your clients whatsoever really isn't terribly aware or insightful either.

I pointed out some of the dilemmas that were raised by your posts here. I don't think that you acknowledged those at all. I don't think that you were terribly interested in a way of synthesising them. Instead... This whole thread seems to have been about your making a point. When other people disagree you fall back on other people personally attacking you.

I'm not quite sure what to say... Ego's are fragile. And there is a dilemma indeed because part of your ego strength comes from your identification with being very severely mentally disordered (with very severe symptoms and need of much support). But another part of your ego strength comes from your identification with being a highly functioning clinician who is superior to other clinicians out there (such that you are in the position to teach them something without reciprocating in the sense of being open to them teaching you something). I'm not sure what to say...

Progress involves synthesis. But the first step to synthesis involves insight and awareness into the nature of the dilemmas that one has posed...

 

[WannaBeDrMe]

> .....
Progress involves synthesis. But the first step to synthesis involves insight and awareness into the nature of the dilemmas that one has posed...

I must say that I have gained some insight and awareness through this thread.

I gained insight into the fact that even 4 years of experience haven't made a dent in my naive approach to this field. I guess I realized that the potential existed for various issues... but I had never really accepted them as real until I read some things on these here internets.

Also, I have a greater awareness about the internet as an extension of self... regardless of how much someone might say they wish to remain anonymous. This is with no regard to anyone, in particular, but rather more directed at myself... I guess...

I watched Frontline tonight and it was titled Growing Up Online and talked about an entire culture of socialization via these tubes. I remember hearing some research about it all over the last few years and this show sort of synthesized it for me. It is a whole new world and I wonder, as a mental health professional, how it is impacting the treatment and progress of those with mental illness.

In the real world, you can assume that humans interacting with other humans will find reinforcement and consequences for each of their actions. Sure, they can seek out different environments to find a fake sense of homeostasis if the reaction isn't what they want... but I'd guess that is much more difficult than finding a new messageboard or chat room once the internet well has run dry.

How is this shaping these folks' behaviors? If they are spending the majority of their free social time in online environments where reactions of others are terminated with as much as a click of an "x"... or, conversely, where all of the negative consequences are immortalized in html... how is that affecting their overall mental health and how can we, as those dedicated to helping the cause, create a treatment plan that addresses the new contingencies for social development?

I'm sure there are a ton of people doing this research now... and if I wasn't so anti-work in this moment, I might psychinfo it and learn myself some knowledge. Though this thread was triggering for me, I appreciate that it existed to help me process these concerns... Yay learning.

 

[RayneeDeigh]

This all reminds me of the time one of my profs suggested I shouldn't be seeing clients because I bite my nails too much and that might give people the impression that I'm mentally unstable. I wonder what he'd say about this whole thread, haha.

I've read bits and pieces of An Unquiet Mind and to me it didn't sound at all like she was seeing clients while she was experiencing either her extreme highs or extreme lows. Maybe I'm mistaken, but I don't think she meant her book to be used as justification in quite the way that it's been used thus far in the thread by the OP.

That said, I absolutely do believe (maybe because I'm naive) that someone experiencing acute distress can compartmentalize their life enough to be an effective clinician for short periods of time. I doubt that this could last long-term but I honestly don't know. I think problems would arise if that therapist seemed unaware of how his/her issues MIGHT affect clients. To the OP, I don't think anyone here is saying (maybe I'm wrong) that you're a bad clinician or that you can't practice because of your diagnosis. I think it just raises a good point about the need to be EXTRA aware of the potential for boundary violations.

Now it's a bit of a tangent, but while I was writing a paper last semester I came across this website about BPD that has an interesting spin on it all. http://www.emophane.org/emophany.html

 

[toby jones]

Hey,

I've found this thread hard too. I find it hard because my natural inclination is to react rather than to respond. Something that I've learned is that my reactions tend to escalate the situations whereas my responses sometimes go some ways towards diffusing it.

One thing that I like about the message board forum is that the nature of the time delay means that I get the opportunity to respond rather than to react. But it is hard, and sometimes I find myself feeling like the other person is attempting to provoke me into reacting. That I'm 'possessed' somehow and I have this strong urge to react... And it would be so easy to react. But to take a couple of deep breaths and walk away from my computer... Do some reading... Make some progress on my work... And come back to it with a response later.

I have a history that is much the same as Pinksoils. Something that I struggle with is how much to identify with a diagnosis of borderline personalty vs how much to identify with being a fairly competent professional. I worry about how much I'm running away from my issues when I'm in the role of a fairly competent professional. I worry about how much identifying with having had borderline personality disorder is something that is more likely to facilitate the return of my symptoms and the return of behavioral dysfunction.

I pose the dilemmas because they are particularly salient to me. I'm pretty good at spotting them, I think. I'm not so good at synthesizing them, however. I know that (for me) the way forward has been a combination of identifying the dilemmas and synthesizing them and taking the time to respond rather than to react. I no longer meet criteria but I still struggle with how much to identify with being mentally disordered (in a way I am not, though I still struggle with various things) and with how much to identify with being a competent professional (with limitations to be sure, but ones that are 'normal' rather than inherently 'dysfunctional').

There is some research that has been done on the message board forum. I have a concern about the message board forum, particularly when it comes to consumer sites. There is concern about there being anorexia boards where individuals encourage each other to embrace their wanting to be super-skinny and where they consider that such a choice is perfectly rational and that they should be allowed to exercise their autonomy to do that if they choose. There is a concern about there being amputation boards where individuals with perfectly healthy limbs encourage each other to have amputations if they so desire (and pass on the names of surgeons who will perform that operation for a fee). There is a concern about there being self injury boards that are devoted to embracing self injury as a normal way of being. There is a concern about there being suicide boards that are devoted to helping 'ease the way' by way of suicide pacts.

I have a concern about how much consumer boards base in-group identity on severity of symptoms. The thought is that the person who self harms the most and who exhibits the most severe emotional dysregulation is the most important member. The thought that the person who self harms the most and who exhibits the most severe emotional dysregulation is the most authorative when it comes to generalizing their experiences to the experiences of all people who have had mental health issues.

I have a concern about a person who was sexually abused reading sexual abuse (as the only way) to make sense of anothers symptoms. So that person starts asking the question: 'was I sexually abused? was I sexually abused?' Then has a dream... And since sexual abuse is (it is thought) the only rational response for their symptoms then the dream must be veridical and so lets haul uncle xxx off to court for having sexually abused me. There are dangers of a person needing to identify with being a sexual abuse victim in order to gain acceptance by a forum. There are dangers of a person saying to another 'either you have been sexually abused and you are in denial or you don't really have dissociative identity disorder. And if you don't have dissociative identity disorder then your experiences do not matter and there is nothing that you can say to me unless you have been precisely where I have been. And so piss off out of our forum now thank you very much - unless you are prepared to admit that you have been sexually abused'.

There are dangers of consumer forums to be sure.

And how much is posting to those places something that allows you to face up to your issues in a helpful way... And how much is posting to those places something that keeps you focused in on your pain and exhibiting your dysfunction?

And now I'm doing the posing dilemmas thing, and I apologise for the dissonance I cause.

I'm realizing that I'm moving on. I no longer consider borderline personality disorder to be a part of my identity. Don't get me wrong, I struggle with certain issues at times, and I have a vulnerability that I know I need to be careful to nurture and respect. But I've learned that my experience with this in the past really doesn't intrinsically make a damn with respect to my ability to empathize (or react) to others with similar issues. All I can do is the best I can do with what I've got.

I'm not quite sure what I'm saying... But this board was a board in which I was to have a 'professional identity' and not self-disclose about my history at all. And yet... Pinksoil's post has led me to do so. Maybe I'll regret it... But the synethesis... If people can give me some insight into different ways of doing that... I'd be grateful.

 

[moonflwr]

I must say that I have gained some insight and awareness through this thread.

I whole-heartedly agree with the above comment. I don't feel knowledgeable enough on the topic to weigh in my own opinion (having yet to start my program) but I will say that I have gained a tremendous amount of insight by the responses I've read.

I've often wondered myself if my personal struggles will affect my ability to be an affective therapist and this discussion has really put some things into perspective for me.

So thanks for allowing the discussion thus far T4C and thanks to everyone for voicing such eloquent and well-reasoned opinions. This is why I love SDN.

(Thought I would toss some warm fuzzies out there )

 

[toby jones]

And of course, people already have. Thank you.

 

[Ollie123]

Now it's a bit of a tangent, but while I was writing a paper last semester I came across this website about BPD that has an interesting spin on it all. http://www.emophane.org/emophany.html

I just flipped through that website and the "quack" alarms started ringing like crazy. Maybe I'm just not into the new-agey stuff, but he has a basically untestable theory that basically boils down to all borderline folks being good people on the inside, but it doesn't get expressed. Of course the qualities he lists probably exist in most folks and can be brought out through therapy so I'm not entirely sure how this is different then "Everyone is a good person if you dig deep down".

Sorry, people like this just drive me up a wall. My initial thought is that he's trying to land a book deal and figures a website might help with that.

 

[psm1776]

toby jones said -

I'm realizing that I'm moving on. I no longer consider borderline personality disorder to be a part of my identity. Don't get me wrong, I struggle with certain issues at times, and I have a vulnerability that I know I need to be careful to nurture and respect. But I've learned that my experience with this in the past really doesn't intrinsically make a damn with respect to my ability to empathize (or react) to others with similar issues. All I can do is the best I can do with what I've got.

I'm not quite sure what I'm saying... But this board was a board in which I was to have a 'professional identity' and not self-disclose about my history at all. And yet... Pinksoil's post has led me to do so. Maybe I'll regret it... But the synethesis... If people can give me some insight into different ways of doing that... I'd be grateful.

Self disclosure is a tricky thing and I think the internet anonymity decreases the more one posts, especially if you are posting multiple places and pointing people to those places.

I especially like your previous post prior to this about intentions and trying synthesize and also good faith.

For me, is it good faith or good intentions (internet or otherwise), insight or awareness to post something so revealing and self-disclosing and then not discuss it? - no.

I don't you've done that.

& while I think everyone can empathize with Pinksoil's struggle, after all -that's what we're in the business of doing - I find it hard to really speak about it objectively - since the boundary leaked in terms of her really, really inviting us into her private life - especially the particularly graphic postings on psychcentral.

I think there is a really big chasm with someone who appears to be very invested in being severely mentally ill, and needing to have that be such a big part of their identity (and pretty publicly), wanting or is in need of inpatient hospitalization, and what you're saying about yourself, now, in this context.

I would be careful, though Toby, to over-identify with pinksoil, maybe it rang your chimes and you could identify with it on a personal level. Because something might resonate with you on a messge board, it's a far cry from disclosing IRL. Personally, I would avoid disclosing personal things, in a professional context. That's what supervision is for.

It's important to be able to step back and process your emotions. That is especially true for the internet, where most everything is preserved forever.

I also think it's telling all the drama this generated, with a noticeabley absent OP.

Just my .02

 

[psm1776]

double post - sorry

 

[michalita]

Not to freak you all out but check out sites like Intelius (www.intelius.com) to find out just how much info people can find out about you online. Recently, an inpatient found the cell phone number of one of the mental health counselors where she was being treated. She didn't even have her last name (or so it was assumed b/c it wasn't on the counselor's badge) and somehow found it. Most people assume their cell phones aren't listed, aren't available. Anyway, just some food for thought.

I agree with those who have said that it's one thing to have a dx or a hx of a d/o and have it reasonably "under control" and treated (which requires extremely good insight, judgment, and outside supports) vs having an active and impairing d/o. It is our obligation to be aware of our own limitations and to not put our patients/clients at risk when we are not well enough to treat them. (This also relates to another thread on the board regarding an individual with an active eating disorder). It is a highly individualized decision, however, and cannot be worked out on a board such as this. *Many* individuals in the field have some sort of a personal experience (past or present) with issues of a psychological nature and it behooves us all to be aware of our emotional boundaries. It does not, however, completely rule out a career in psychology or psychotherapy if you have or have had a d/o.

I know I'm probably repeating a lot of what was already said... Apologies for the repetition.

 

[sunlioness]

I have a history that is much the same as Pinksoils. Something that I struggle with is how much to identify with a diagnosis of borderline personalty vs how much to identify with being a fairly competent professional. I worry about how much I'm running away from my issues when I'm in the role of a fairly competent professional. I worry about how much identifying with having had borderline personality disorder is something that is more likely to facilitate the return of my symptoms and the return of behavioral dysfunction.

Personally, I don't see a diagnosis as something to base an identity on. I think doing so is a part of the healing process and maybe a necessary step on the healing process, but in the end one's identity is so much more about who one is as a person rather than a diagnostic label. And if one is identifying strongly with that diagnostic label it's not necessarily a bad thing, but is indicative that there is still more work to be done. Kind of like the point in the therapy where the client is getting better, but then freaks out because s/he realizes that being healthy is scary because of all the inherent responsibility. I think that's a valid and almost universal step in the process, but that ultimately the responsibility to live healthily as an adult needs to be accepted before one works with their own clients.

I have a concern about how much consumer boards base in-group identity on severity of symptoms. The thought is that the person who self harms the most and who exhibits the most severe emotional dysregulation is the most important member. The thought that the person who self harms the most and who exhibits the most severe emotional dysregulation is the most authorative when it comes to generalizing their experiences to the experiences of all people who have had mental health issues.

I've heard something similar to that described as "woundology". The idea that being hurt or dysfuntional gives one a community of similarly wounded people to feel validated by. Again, it's part of the process, but the problem is that staying in that community requires staying sick, which is ultimately counterproductive. It's like when I read about sexual abuse being described as the "sacred wound." There's nothing sacred about it, in my mind. Healing is sacred, but not the wound itself. Wounds just hurt and make you sick.

I have a concern about a person who was sexually abused reading sexual abuse (as the only way) to make sense of anothers symptoms. So that person starts asking the question: 'was I sexually abused? was I sexually abused?' Then has a dream... And since sexual abuse is (it is thought) the only rational response for their symptoms then the dream must be veridical and so lets haul uncle xxx off to court for having sexually abused me. There are dangers of a person needing to identify with being a sexual abuse victim in order to gain acceptance by a forum. There are dangers of a person saying to another 'either you have been sexually abused and you are in denial or you don't really have dissociative identity disorder. And if you don't have dissociative identity disorder then your experiences do not matter and there is nothing that you can say to me unless you have been precisely where I have been. And so piss off out of our forum now thank you very much - unless you are prepared to admit that you have been sexually abused'.

The actual abuse is never the point of appropriate therapy for the dissociative disorders. And we know just because of how memory works that stuff that comes up in therapy may or may not be objectively true and there's no way to ever know. The good news is that except in a court of law, it doesn't matter one whit. It's all about the process in the present moment. Processing the underlying trauma is part of treating dissociative disorders, but not the only part or even the most important part. And you don't need to have suffered sexual abuse to have a dissociative disorder. I think digging around for that stuff instead of dealing with what comes up naturally through the course of therapy is entirely inappropriate and likely even unethical. But I guess that doesn't stop lay people from doing so on an internet board. Which goes back to "woundology" again and the in-group stuff.

This has been a really interesting and thought-provoking conversation. My thanks to everyone.

 

[socialcog]

I also think it's telling all the drama this generated, with a noticeabley absent OP.

Just my .02

This resonated. One of my mentors described borderline's as those who have such interal pain and chaos without the ability/strength to examine, organize or make sense of it. As a result, there is a proclivity to externalize and project this chaos onto those in 'close proximity' (ie: relationships...intimate, familial or otherwise).

I can't help but notice the obvious ripple effects of the OP initial post in this thread.

 

[Psyched77]

Please articulate why you feel that people who are pointing out the concerns with this situation are personally attacking you. If I remember correctly, you are the one who laid out your private life on a public forum.

Ok. I agree with a lot of the concern that has been expressed (particularly Jon Snow's comments). However, I have to say that I am disappointed with the tone in which many responders have used to address the OP. As clinicians, hopeful/future clinicians, researchers, & hopeful/future researchers, I am relatively disappointed in how many here have responded to a person regarding their MI. Don't get me wrong; you can certainly be direct & lay out your case, but a pro can do it without it coming across as snide, snotty, arrogant, or personally attacking. (I believe that Jon Snow did this well...direct, yet pleasant & professional.) If the posters can't read back over this thread & see incident after incident of why the OP feels personally attacked, then perhaps these particular posters need to hone their observational skills before they get any deeper into the world of psychology. Ok...that being said, I'm particularly disgusted at how nasty some people have been to the OP CONSIDERING that one of the OP's diagnoses is BPD. If you know anything about BPD beyond what the DSM says, you should well know that the sorts of jabs handed out to the OP on this board (no matter how much the OP may try to hold their head high & defend themself) are just the sort of thing that can send a person with BPD into a self-injurious, self-loathing spiral. (Some studies, which have been summarized in the Monitor in the past year, have stated that persons with BPD are more observant than the general population when it comes to sensing the moods, mood changes, & attitudes of others.) Considering all that, I think it is quite disturbing that psychologists & wanna-be-psychologists would "turn the soil," so-to-speak, to ready it for self-harm. I don't know what else to say at this point, other than I am very disappointed.

**Edit to add: I wrote this when I was about 85-90% through the posts. I have to say that I'm less disappointed after reading the last few.

 

[Psyched77]

I've found this thread hard too. I find it hard because my natural inclination is to react rather than to respond. Something that I've learned is that my reactions tend to escalate the situations whereas my responses sometimes go some ways towards diffusing it.

Wow, Toby. I have to say that when I read your earlier posts on this thread, I was quite bugged, but I read this entire post very carefully & am quite impressed with what you've shared. You've changed my mind on your level of sensitivity. I'm glad you posted this, & I thank you for it.