Oh Joy!

1.    A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.

I guess from a medical perspective todays blog might relate to the above diagnostic criteria for BPD (called splitting).  I’m not sure though.  I accept that I do have a tendency when an important or professionally influential relationship has a more intense moment, to polarise my opinions about the person to either good or bad.

For example, in my work I (my company) took on a fairly large project.  It was working in partnership with another organisation and a project steering group was established to keep the project in line with the aims and objectives agreed with the funder.  One person on this steering group was a “Maverick” or a “loose canon” or in terms of meeting funding requirements, “a total nightmare!”  As the person who was responsible to the funder, and for the running of the whole project it was my job to deal with her.  She did not respond well to any form of training / support / being told politely to come in line.  In the end I saw her as completely cancerous to work with (i.e. malignant and needing to be removed), I became ill and had to recruit a new director for the project.  She is still causing problems for the project now, and I still see her as 100% impossible to trust or work with.  The person who took over for me is nothing less than a saint.

Now you could say that fits with the diagnostic criteria shown above, and if it does, so be it.  The bottom line is, my opinion of her as a colleague and team member is totally right.  End of!

So, back to DBT.  I thought things were developing OK with Joy.  I didn’t 100% trust her, but then it’s early days.  I’ve only seen her seven times.

The last session didn’t start off particularly well.  I had completed a worksheet as homework and we set about discussing it.  There was one bit where she wanted me to see something differently.  I didn’t agree.  The question on the sheet asked for one thing and I answered it.  She thought I should have a different answer and set about trying to make me agree with her.  There wasn’t much radical acceptance going on here and I wasn’t feeling like a doormat either.  In the end I realised she wasn’t as good at disagreeing with me as other CPNs I have known.  For example, John can put forward an alternative point of view without it feeling like a confrontation – and he can even tell me I’ve got something completely wrong without making me feel useless.  He can also acknowledge when things have got a bit tricky and communicate he is still ok with me.

Having realised I was winning the argument I went and quoted the sheet to her and the logical nature of my response.  She gave up at that point and now I’m not sure she is able to help me. 

 At the end of the session she told me she had received the occupational health report request relating to my recent job offer.  She said she had dictated it the day before, it would be typed up that day and sent out the day after.  I let five days pass from the day it should have arrived and then phoned occupational health to see where things were up to.  The report had not arrived.   

I phoned Joy to see what had happened.  She said it was in her tray for checking, and then she would send it later on in the day.  I protested that she had said it would be sent the Thursday before.  She denied saying that it would be dealt with the week before.  It would’ve been ok if she’d said, “sorry, I didn’t manage to get it done then, but it will go today!”  That would’ve been disappointing but no harm done.  However, in denying what she did say to me she has broken trust.  She is unreliable and not honest.  This is not an example of “good / bad” relationships or splitting.  It is just a fact.

It gives me a dilemma regarding DBT.  

• ·         If I sack her as my therapist I lose the opportunity to do DBT and I really need and want to do it. 
• ·         If I challenge her formally it will be her word against mine and hers will be the winning voice because her team will back her up and I’m just a “Bolshy Borderliner” anyway. 
• ·         If I do nothing I will not get the benefit of the therapy because I don’t trust her.
• ·         If I talk to her about how I feel at our next appointment it might help but it will probably make things worse.

As the saying goes, “I am between a rock and a hard place!”

A Cut Above...

For many of those who live with BPD this is the most misunderstood and stigmatising aspect.

Please note, anyone who struggles with self-harm etc. may find this blog entry triggering.  There is discussion of methods so be careful.

1.      Recurrent suicidal behavior, gestures, threats or self-injuring behavior such as cutting, interfering with the healing of scars (excoriation) or picking at oneself.

Self-harm and suicide are lumped together in the diagnostic criteria, but I am going to treat them separately.  Today’s blog is about self-harm.  I might discuss suicide another day – or maybe not!  It is probably the actions and behaviours covered by this criterion that give us with BPD the reputation of being attention seeking and manipulative.  I say self-harm is not intended to be either (well not in my case anyway).  It is a way of reducing pain and distress.

The slippery slope of self-harm as a coping strategy started for me by accident when I was about 9 years old.  I was plagued by Styes on my eyelids.   One day I discovered that if at the first hint of pain I plucked the eyelash from the sore bit, the brewing stye went away.  I also found the process of plucking completely distracting from my feelings and stresses.  Very soon I was plucking my eyelashes completely and not giving them chance to grow back.

By 11 or 12 I was desperate for comfort from the isolation I felt and the sense of being invisible, and in that sense I recognise that this initial stage was a cry for attention.  However, it was not an “I want to be the centre of attention” demand, but was a cry of abandonment and pain that having been ignored for year on year, had to get louder and stronger.  To this end I tried so hard to break my own arm – and failed.  In my attempts I caused some bruising the pain of which made me feel more alive and calmer.  If I hurt I existed.  I was able to survive outside my own imaginary world where love, care and feeling safe were the norm for a while.  This on-going stress relief was always done in secret.

At 16 I saw a documentary about teenage alcoholism on television.  The teenagers featured had social workers, support workers, worried parents and teachers all involved in helping them.  I wanted, no, needed a piece of that.  I was still invisible (Penny 1 was anyway).  Penny 3 took the lead a lot of the time in those days.  During the programme they mentioned a statistic that if an average 15 year old drank a certain amount of cider for a short number of months they would be physically dependent on alcohol, and as I saw it, therefore going to get all that help and support.  Lucky for me before the end of the time it took to become an alcoholic two things happened.  One, I looked young for my age and had limited money so my source of cider ran out.  Two, I got involved with the Christian Union at School and became a believer and it seemed appropriate not to be an alcoholic after that.

My faith was, and still is helpful in keeping a check on the self-harm habit.  I’ve not managed to stop completely though.  What usually happens is I stop one thing and without thinking replace it with another detrimental behaviour.  Over the years the things I have done (and not all at once) includes; pulling out hair (head and eyes); cutting; hitting; burning; excessive use of laxatives; binge eating and comfort eating; peeling my fingertips; mini-over doses of prescribed drugs; infecting wounds on purpose.  You get the picture I’m sure.

I can’t communicate strongly enough how much I HATE this aspect of myself and how ashamed it makes me feel.  It has been my dark secret till recent years when I started to accept I can’t sort this out by myself.  I do hope you can read and not judge for this, “coming out” as a self-harmer is a risky business.  

It isn’t just me who struggles with this either.  Joe lives with me living with a self-harm habit.  Years ago, when I confessed what my injuries were after he hinted he knew it was very difficult.  My self-harm hurt him deeply, he did not understand nor could he get his head round it.  He had never known a “self-harmer” before and for a while it was a thorn in our marriage.  He doesn’t like it and never will (rightly so I think), but he is now able to react with compassion and support.  Being the partner of someone with BPD can be very demanding – and also amazingly good.  We are some of the most sensitive, empathic and compassionate people around when not in crisis.  If I steal a phrase from C.S.Lewis in a grief observed, “with great joy comes great pain.”