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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 21 of 21. This is the beginning of the thread.
Posted by yellowbird01 on January 13, 2009, at 19:03:36
I have a T who apparently loves labels/diagnoses. I love my T to death, aside from this one thing. Borderline personality disorder seems to be a favorite diagnoses of hers (went to an inservice? I dont know). My other clinicians in the past have disagreed with the diagnosis for the most part, but just today my T brought it up again and referred to "my personality disorder". In the same discussion, she talked about challenging negative/irrational thoughts. The thing is, BPD doesnt feel to me like exactly a "positive" diagnosis. Quite the opposite. The focus on "me and my personality disorder" really tears my self esteem to shreds... and it was bad enough to begin with. It makes me doubt my own feelings and my own judgment in everything in my life. I know I'm not perfect and I can be negative and even irrational... if everything was perfect, I wouldnt be in therapy. But to insist that my issues with being labeled this way are irrational and just me being negative just feels wrong to me. It hurts my trust in my T as well. I think many rational people would react badly to it. I'm not crazy.
Does anyone have any advice? I plan to talk to T about this, but I've done it before and I dont think she truly understands how hurtful the label can be. I think she's hearing what I'm saying about it through the lens of me being "borderline". Otherwise, she's wonderful. I just cant keep seeing her if she's going to push this again. It just destroys me.
Posted by yellowbird01 on January 13, 2009, at 19:59:38
In reply to Hurtful diagnoses, posted by yellowbird01 on January 13, 2009, at 19:03:36
This is a lesson to keep my mouth shut and stop being too honest in therapy. I've been told before (by an old counselor) that it's possible to be too honest in therapy. I gave up that idea when I switched to my current T because how can you be TOO honest? I've never been mean or nasty, nothing directed towards T herself, etc. Lesson: GIVE IT UP. Remember to watch what you say.
Posted by seldomseen on January 14, 2009, at 7:00:36
In reply to Hurtful diagnoses, posted by yellowbird01 on January 13, 2009, at 19:03:36
I'm not a big diagnosis person myself, neither is my T. Not too long ago, the word bipolar came up in my therapy. After a freakout by me and eventually him, it got dropped. We've adopted "bipolar tendencies" as a working label. I suspect that too will fall by the wayside.
It has been my experience that some people actually find diagnosis to be comforting. That they just aren't floundering out there feeling bad, but fit into a described set of symptoms that can be treated.
I would definately talk to your T about your discomfort with her willingness to attibute a label to your feelings. It almost sounds as though she is using it as a weapon to challenge the way you are thinking. While, there is a significant amount of challenge in therapy, I'm not sure I agree with that therapeutic approach. Simply presenting an alternate point of view is, IMO a better approach.
I also strongly disagree that there is such a thing as being too honest in therapy. I think the only way to get the most benefit from therapy is to achieve a marked level of honesty with your T.
Again, I'm not sure your T is handling it the best way, but that is not any fault of yours. It's something that you two together need to address.
Seldom.
Posted by Wittgensteinz on January 14, 2009, at 8:38:31
In reply to Re: Hurtful diagnoses, posted by yellowbird01 on January 13, 2009, at 19:59:38
Yellowbird,
Please don't give up! I disagree, I don't think you can be 'too honest' in therapy. You should be able to say everything and anything that comes to mind regardless of how strange, crazy etc. you may feel it is. As long as you don't act out on those things you speak, then you are keeping within the boundaries and doing what you are obliged to do as a client. It sounds like somewhere along the line you were punished in some way for doing this.
My therapist has the opposite view about diagnosis. I have to push him to even talk about it.
He once referred to it as 'name-calling' (his exact words were "throwing terms around like borderline and other personality disorders seems rather like name-calling"). His view is that it isn't constructive to dwell on labels, he would rather work with me and who I am as an individual than worry about how I might best be labeled/categorised. I suppose this view hangs on what the therapist believes the use of the DSM manual to be. Why use labels? Obviously for insurance purposes it can be helpful. It can be necessary to get certain kinds of help e.g. if you would benefit from receiving help at a centre for people with personality disorders, then you'd first need a PD diagnosis.
Perhaps your therapist has the view that by focusing on the diagnosis she can best work to help you with certain symptoms or traits? Perhaps it is her way of 'keeping on track'? I'm curious what kind of therapy she practices. It sounds like you want a therapist who will tailor the therapy to you specifically and not just to 'people with your diagnosis'.
I would find it very difficult too if my therapist kept bringing up the diagnosis. I would feel depersonalised I think - I would also start thinking that he was looking at a label and not at a person, me.
Something else my therapist said once was about culpability in relation to ones diagnosis - that if someone is too focused on their label, they might tend to say "well it's not my fault, I'm an X and therefore I behave in this way" - so the diagnosis becomes a means of justifying or even reinforcing behaviours rather than moving toward other ways of coping. Personally I find the term 'personality disorder' frightening. A person's personality is their essence - to tell a person that their very essence is 'disordered' or damaged is hard to get ones head around. If your therapist's tactic of emphasising your diagnosis makes you want to go 'underground' or hide parts of yourself, then it does seem to be counter-constructive.
I hope you can voice some of your thoughts to her. Ask her why someone's diagnosis is so important. The DSM is by no means infallible :)
Witti
Posted by Phillipa on January 14, 2009, at 10:32:09
In reply to Re: Hurtful diagnoses » yellowbird01, posted by Wittgensteinz on January 14, 2009, at 8:38:31
Seems different labels are used by different T's didn't know a T could diagnose thought just a pdoc or doc? I feel many have borderline tendencies no one's perfect just be honest. Phillipa
Posted by Sigismund on January 14, 2009, at 13:09:37
In reply to Hurtful diagnoses, posted by yellowbird01 on January 13, 2009, at 19:03:36
Look, I can't help.
What I do is say to my doctor
'What you are saying is that I am immoral'and I basically make him say it
and then I never see him again.
So that doesn't sound particularly helpful
but at least it's calling a spade a spade.
Posted by raisinb on January 14, 2009, at 14:29:43
In reply to Hurtful diagnoses, posted by yellowbird01 on January 13, 2009, at 19:03:36
I once left a therapist for diagnosing me with a personality disorder. I knew the traits and knew I had (and have) tendencies--but don't qualify for a full-blown label.
I felt it was partly the way she used the label at the time that was so destructive.
Posted by backseatdriver on January 14, 2009, at 15:03:42
In reply to Hurtful diagnoses, posted by yellowbird01 on January 13, 2009, at 19:03:36
These names really do hurt. They're feel like maledictions, in a way. Curses. The words go under the skin and lodge there. And once there, it can be very hard to get them out.
Being "thick-skinned" is a great defense if one can muster it -- but if I myself could muster it with any regularity, I doubt I'd be in therapy.
I wish therapists would stop using these words. But they can't seem to give them up. Sometimes I think diagnoses are transitional objects for therapists. They use them when they don't know what else to say, yet feel compelled (always a bad sign) to say something.
Posted by obsidian on January 14, 2009, at 18:04:47
In reply to Hurtful diagnoses, posted by yellowbird01 on January 13, 2009, at 19:03:36
> I have a T who apparently loves labels/diagnoses. I love my T to death, aside from this one thing. Borderline personality disorder seems to be a favorite diagnoses of hers (went to an inservice? I dont know). My other clinicians in the past have disagreed with the diagnosis for the most part, but just today my T brought it up again and referred to "my personality disorder". In the same discussion, she talked about challenging negative/irrational thoughts. The thing is, BPD doesnt feel to me like exactly a "positive" diagnosis. Quite the opposite. The focus on "me and my personality disorder" really tears my self esteem to shreds... and it was bad enough to begin with. It makes me doubt my own feelings and my own judgment in everything in my life. I know I'm not perfect and I can be negative and even irrational... if everything was perfect, I wouldnt be in therapy. But to insist that my issues with being labeled this way are irrational and just me being negative just feels wrong to me. It hurts my trust in my T as well. I think many rational people would react badly to it. I'm not crazy.
can I say yuck?? I can understand why this bothers you so :-(
I would be tempted (perhaps in a passive aggressive way ;-) to then call her out on then what "specifically" (if we are going to think about things in a narrow minded medical model sort of way) what type of therapy/treatment this particular diagnosis necessitates
it's quite a reductionistic approach isn't it? neatly packaged and all
it might be much more helpful to think about patterns of behavior, patterns of coping, patterns of relating, etc. rather than a label
I mean what the f*ck can someone do about a personality disorder? it's like saying 'well, your self is just f*ck*d up-the essence of who you are is an illness'
how about some useful information which furthers self understanding and therefore more adaptive means of coping??
feelings by the way don't tend to be rational, who'd want to be rational all the time anyway
> Does anyone have any advice? I plan to talk to T about this, but I've done it before and I dont think she truly understands how hurtful the label can be. I think she's hearing what I'm saying about it through the lens of me being "borderline". Otherwise, she's wonderful. I just cant keep seeing her if she's going to push this again. It just destroys me.I might ask her what this particular label helps her to understand about you and then how does this label help your work together. You sound like you feel invalidated, which is ironic because much is written about the "invalidating environment" as a contributing factor to the development of borderline personality disorder.
I mean why not say "you feel this way because you're a woman..or because you're white...or a republican etc."
I hate the judgment.
Posted by Poet on January 14, 2009, at 18:45:41
In reply to Hurtful diagnoses, posted by yellowbird01 on January 13, 2009, at 19:03:36
Hi Yellowbird01,
If my T or pdoc tried putting a label on me that I disagreed with I would definitely bring it up. I argued with T last session over my sensory defensive label. As she put it, "not this argument again."
I hope you bring it up and your T is ready to listen why you disagree with the label and why you don't want to be labeled- period.
Good luck.
Poet
Posted by rskontos on January 14, 2009, at 18:51:17
In reply to Hurtful diagnoses, posted by yellowbird01 on January 13, 2009, at 19:03:36
You know yellowbird, I wish you could talk to my t about borderline. He is so much more upbeat about BPD and how it is can be treatable but with the right t. He says he has treated many and they have all done well with him.
The one thing about him is he never focuses on dx's. He just focuses on you and how to help. But he is how to say, been around a while. Had a lot of life experiences and patients. And boy is he patient.
We discussed it because my mom, gone now, was probably this, never dx'd or treated, and she just spiraled out of control.
Anyway, he was very positive about it that with treatment BPD patients can do excellent.
rsk
Posted by yellowbird01 on January 14, 2009, at 19:00:50
In reply to Re: Hurtful diagnoses » yellowbird01, posted by obsidian on January 14, 2009, at 18:04:47
Thank you everyone for the wonderful responses. All the responses feel very validating to me and that's exactly what I needed I think.
I definitely plan to ask her clearly how exactly I qualify for BPD. I may even bring the DSM criteria with me (although I'm sure she has them too) and let her explain to me step by step how I qualify. If she can give me a good explanation, fine, but I really dont think it's there. What everyone said about this is right on the mark... the label itself, and the focus on it, feels very invalidating. I like what was said about "diagnoses are like name calling". That's exactly how it feels! I've tried to explain that to T but it never seems to get through. I work in mental health and with patient's diagnoses... I KNOW how borderline is thought of within the field and it isnt pretty.
I'll admit that a few years ago maybe I did qualify... I'm not sure. But I've grown a LOT in the past 2-3 years - from multiple hospitalizations and being unable to work, to now successfully doing a full time job and functioning fairly well. It makes me feel like just throwing my hands up and giving up on all the things I currently work so hard at and all the progress I've made. If I'm working this hard and STILL this terribly flawed... to the extent that my entire personality, in every area of my life, is severely disordered... it doesnt feel worth the effort to continue what I have been doing because "healthy" is going to be totally unreachable. As I said before, I know therapy is work, and often slow work. I know I'm not perfect and still struggle. Heck, it'd save me a LOT of money to quit therapy! I'm willing to work. I dont even care so much what T *thinks* in her head... she can diagnose me whatever she wants in her mind as long as I'm still having productive therapy. But this just isnt fair and it HURTS.
My T is wonderful in so many other ways. She's smart, empathetic, right on top of things most of the time. This is one issue we just cant seem to get past.
I'm tempted to email my T and explain this to her, no response requested. E-mail is very much okay with her. But now I'm fearful... afraid that by emailing between sessions or harping on this topic or anything will be further evidence of BPD. I'll think on that a bit tonight.
((((((Everyone)))))) thank you.
Posted by no_rose_garden on January 14, 2009, at 22:55:33
In reply to Hurtful diagnoses, posted by yellowbird01 on January 13, 2009, at 19:03:36
I think most T's don't like to give diagnoses...they'd rather treat the problem...and not "categorize" people.
I think partially b/c they don't think it's especially helpful in treatment, and also b/c they know it can be hurtful to the "client/patient". At least that's it seems.
My first T told me he only made a diagnosis b/c they have to for insurance....and he was hesitant to tell me what it was b/c he knew it could upset me and wasn't that important for me to know.
I think it's really insensitive for T to say that. I hope she was just trying to help and didn't mean to hurt you.
((yellobird))
Posted by Dinah on January 15, 2009, at 2:18:02
In reply to Re: Hurtful diagnoses - to all, posted by yellowbird01 on January 14, 2009, at 19:00:50
I fought with my therapist for a year over his thinking schizotypal personality disorder fit me. I didn't want him to think my personality was disordered. It sounded like I wasn't a nice person to know.
I admit I brought it up far more often than he did. I mentioned it the first time because of something my least favorite pdoc had said. And I brought it up for at least a year after that on a regular basis. He rarely brought it up himself, but he refused to back down. To this day he has some things that he'll start to say then say "uh oh. I had better not say that. I know you hate it when I say that." Things like "transference" or "schizotypal".
The funny thing is that he's now backed off a number of his previous positions on the topic as he got to know me better and understand me better.
If she brings it up often, or brings it up in connection with your behavior, I think it's fair enough to ask how that's relevant. I think there are probably other ways for her to get her point across than to use labels.
It is a poor choice of terminology on the part of the psychiatric community, I think. I think the whole system should be revamped. I think it would be better to rename them "characteristic ways of coping". But they never listen to me at the DSM-V. After all, if Linehan is right, a major part of borderline personality disorder is easy arousal and slow return to baseline. That's biological. And some aspects of borderline personality disorder can be brought on with the "physostigmine challenge". That would tend to point to biological issues as well.
Posted by Sigismund on January 15, 2009, at 2:19:21
In reply to Re: Hurtful diagnoses » yellowbird01, posted by obsidian on January 14, 2009, at 18:04:47
Truly, I would say...
'Do you think I am deformed?'
and see what happens.
>But to insist that my issues with being labeled this way are irrational and just me being negative just feels wrong to me.Exactly.
Posted by Abby Cunningham on January 15, 2009, at 8:49:16
In reply to Hurtful diagnoses, posted by yellowbird01 on January 13, 2009, at 19:03:36
I am so sorry your T is doing this to you. Borderline is a difficult thing to diagnose, and I wonder where she is getting this, especially if other T's have disagreed.
I know someone whose daughter age 19 is a diagnosed borderline for the past several years and she is very very disturbed and refuses medication. I see the havoc she wreaks on her family. I don't know you but I can imagine how painful this is for you. I would definitely go for another opinion if it were me.
> I have a T who apparently loves labels/diagnoses. I love my T to death, aside from this one thing. Borderline personality disorder seems to be a favorite diagnoses of hers (went to an inservice? I dont know). My other clinicians in the past have disagreed with the diagnosis for the most part, but just today my T brought it up again and referred to "my personality disorder". In the same discussion, she talked about challenging negative/irrational thoughts. The thing is, BPD doesnt feel to me like exactly a "positive" diagnosis. Quite the opposite. The focus on "me and my personality disorder" really tears my self esteem to shreds... and it was bad enough to begin with. It makes me doubt my own feelings and my own judgment in everything in my life. I know I'm not perfect and I can be negative and even irrational... if everything was perfect, I wouldnt be in therapy. But to insist that my issues with being labeled this way are irrational and just me being negative just feels wrong to me. It hurts my trust in my T as well. I think many rational people would react badly to it. I'm not crazy.
>
> Does anyone have any advice? I plan to talk to T about this, but I've done it before and I dont think she truly understands how hurtful the label can be. I think she's hearing what I'm saying about it through the lens of me being "borderline". Otherwise, she's wonderful. I just cant keep seeing her if she's going to push this again. It just destroys me.
Posted by Sigismund on January 15, 2009, at 15:57:23
In reply to Re: Hurtful diagnoses, posted by Abby Cunningham on January 15, 2009, at 8:49:16
Once my T had to write a court report that I was going to have to see or hear.
She was very concerned about this and told me that previous therapeutic relationships had not survived the experience.
However I was flattered:
She said 'He is the most deprived patient of my clinical experience', which was fine with me when most things are not.
Posted by yellowbird01 on January 17, 2009, at 10:02:31
In reply to Re: Hurtful diagnoses, posted by Sigismund on January 15, 2009, at 15:57:23
It makes me feel good to see that I'm not alone in being uncomfortable with this - throwing around serious diagnoses in session, etc.
Good point about using diagnoses for insurance purposes. Unfortunately, I know that isnt the case here. For one, I pay out of pocket without using any insurance. Otherwise though... On my receipt when I pay her, she always writes the code for "adjustment disorder NOS". I asked her once how I'd landed that diagnosis, and she said she writes that on almost everyone's receipt/insurance info because it's so bland and doesnt tell the insurance more than they need to know. I appreciate that from her.
I was pretty hurt and bothered by this Tues, the day it occured, and for a few days after. I'm feeling a lot better now. To me, my coping with this and the placed I'm at now with it, even though it bothers me, is further evidence that I'm NOT all the things she's labeling me as. Not once did I call or email her about it, or hurt myself in any way, or do anything really over the top. I know it'll hurt just as bad the next time she says it, and it's still definitely something I want to discuss with her next session (every 2 weeks), but for now, I can accept that she is just wrong about me and that's her problem if she wants to argue otherwise. I think that's a healthy mindset. I do think that everyone's support and validation here had a big hand in that too though. Thank you.
Posted by Wittgensteinz on January 17, 2009, at 12:28:21
In reply to Re: Hurtful diagnoses, posted by yellowbird01 on January 17, 2009, at 10:02:31
You're strength and positivity is a testament to your good coping skills. I think you should be proud of the progress you have made. It sounds like you have worked very hard. I'm glad you can see that even though hearing those things from T are painful - they'd be difficult for anyone to take, including her I expect.
Witti
Posted by yellowbird01 on January 19, 2009, at 16:45:45
In reply to Re: Hurtful diagnoses, posted by Wittgensteinz on January 17, 2009, at 12:28:21
I had a conversation with my old T today regarding this. I called her because I know that she knows how I struggle with hearing that label, and I know she'd be honest with me if she thought it fit, but she has never said she thought that. The conversation was helpful. She said that a year or so ago I may have qualified for BPD, but feels like anyone would have a hard time diagnosing me with that now. I can agree with that. We talked a little about how to best approach it with my current T to make her hear me and hear what I'm saying NOT just as a further example of my "disorder", but as a valid concern. I see my T next Thurs (10 days from now) and will address it with her then. :)
Posted by movingforward on January 23, 2009, at 14:48:38
In reply to Hurtful diagnoses, posted by yellowbird01 on January 13, 2009, at 19:03:36
Borderline is a collection of symtoms to help you learn about your behavior. It is a difficult prcoess, and have some awful stigma among mental heal professionals. Borderline is often mis dx with bipolar because bipolar can be treated with meds. Borderline is intensive therapy and ongoing support from a trained and compassionate t.
Borderline can be hell but you first need to understand how you got there...
This is the end of the thread.
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