On Borderline Personality Disorder And Hope.

“There's a light on in the attic.
Though the house is dark and shuttered,
I can see a flickerin' flutter,
And I know what it's about.
There's a light on in the attic.
I can see it from the outside.
And I know you're on the inside... lookin' out.”

- Shel Silverstein*

A client recently emailed me and asked if we could talk before our next session. Something was bothering her from our last one. Oh no, I thought, what might I have communicated without realizing it? We set up a call.

She told me she didn’t know what to make of feedback I’d given her about the inevitable negative impacts on her life if she doesn’t address her wounds and open up to change. She’d been told it before, she explained, but always by people in her personal life, and always when they were mad at her (“Your life is going to be a disaster if you don’t stop acting this way!”). Since I’m not in her personal life, and I’m not angry with her, and I wasn’t shouting it, what exactly did I mean? 

We talked about it. We talked about what it has meant for her before, to hear from loved ones that her behaviors will threaten her outcomes if she doesn’t choose to address them. At the same time, therapists had typically felt sorry for her, so she was never challenged to engage in change. And, since change can be exhausting, she’d opted not to. But now someone was sitting with her who did not have the strings of family attached, who liked her, who cared about her, who was not angry with her, but who was definitely deeply concerned for her future and wanted her to know it. 

Then, quietly, she said, “You work with this a lot, right?” I said yes. “So in your experience, for someone like me… do you think that there’s hope?” The softness was different. Where she usually speaks with authority and self-possession, she now spoke as a child. “Is there hope for someone like me?” she said. I said yes.

But why had my client felt hopeless? Did she make that up on her own? Or is it pop psychology and social media that says this is a forever fight; is it what the people in her life have told her, not out of malice, but because it’s all they’ve been told, too? Is it what her consistently intense thoughts tell her to believe, because the struggles have been present for so long? Does that make the thoughts correct?

• • •

When I last worked in a nonprofit setting, I provided therapy to people with severe psychiatric diagnoses through a program funded by the County. Quickly upon getting started at the organization, I was told it was important to not diagnose anyone with borderline personality disorder because – per the County – it was not treatable, and therefore there was no reason for the County to fund their treatment. Why pay for something that has no chance of working? 

The majority of people with borderline personality disorder will not always meet the criteria for that diagnosis. The majority of people tend to come out of it – not all, to be sure, but many. And the ones who don’t experience a full amelioration of their symptoms still often experience relief, healthy relationships, and academic and professional success as they define it. Los Angeles County was wrong (impossible!)– BPD is not untreatable. It is, in fact, particularly treatable, it’s just that sometimes the treatment is long, and it isn’t simple. I never realized that it’s only worth it to expend energy on people if treatment is brief and straightforward.

• • •

I got another call, this time from a prospective client. She told me about her extensive trauma history, her experiences, her thought patterns and emotions and behaviors informed by BPD. She told me about the therapy she’d tried that hadn’t been effective, and the many areas of her life where she’s felt misunderstood. How it had started to feel useless to work toward change; there were no reasons, anymore, to keep dreaming. I told her about the work I do, and how awesome it is to support people with personality disorders in part because it is so fun to get to sit beside them as they make strides we’ve both been told were not possible. That sometimes you might be stuck in the attic, in the dark, afraid to move in case you knock into anything, but I’m just out here standing on the sidewalk, looking up into the window of the attic, seeing the crevices where the light shows so dimly that your eyes haven’t adjusted to it yet. If you let me, I will point out every drop of light until your vision settles and you trust your eyesight to guide you in walking down the stairs of the attic, into your safe home.

Before we hung up I thanked her for sharing all of her information with me and asked how she was feeling. She cried. She’s been working at all this for a long time. She took a breath.

“I feel hope.”

*A childhood favorite of mine; it can’t all be Shakespeare.

The client described at the top of the entry has reviewed this material and consented to its public posting.