Kathy Lisborg is a Licensed Clinical Social Worker (LCSW) in Niagara Falls, New York. Kathy works in the areas of trauma, grief, personality disorders and dual diagnosis. She is currently pursuing her doctorate of social work at the University of Buffalo.
The Q&A with Kathy is only the second guest post by a mental health professional that I have published on Talking About BPD. (The first, and very different post, was by researcher and MBT therapist Dan Warrender).
What do you like most about working with people with BPD? I enjoy working with people who have complex issues [complex meaning made up of several parts]. I work hard to help people understand the layers of their mental health issues and how they interact and impact them. BPD is often very complex [consisting of lots of parts] and often goes hand in hand with PTSD, depression, generalized anxiety and other mental health issues.
I also find that most people with BPD want to learn and want to get better. They often want to understand why they act the way they do when they are overwhelmed. They are invested in treatment.
What tips would you give to health and social care professionals working with someone with BPD? I would encourage health and mental health professionals to discuss their caseloads with their supervisor to make sure they address any responses to clients that might interfere with their ability to be empathetic, understanding and, most importantly, patient. It takes patience to work with any client who has a mental health diagnosis.
BPD is a complicated and nuanced disorder that requires a lot of work on the part of a client to overcome and that takes time. It is not a linear process. There are 'relapses' and improvements. Sometimes the improvements are smaller and the relapses seem bigger. You have to be able to have a long-term view of things. I would also want to remind any clinicians that this disorder comes from a combination of genetics and environment (which often includes trauma). You have to understand that the behaviors are separate from the thoughts and feelings and that although the behaviors might feel like they are choices, they usually don’t feel that way to the person with BPD.
What advice would you give to someone newly diagnosed with BPD? First, take a big breath and don’t google. Or, if you do google, be very particular about your source of information. There is a lot of bad information about BPD out there. People use derogatory language to describe some 'typical behaviors'. I would recommend doing your homework and finding a good therapist who has experience working with people with BPD. I would ask them what their BPD practice consists of --- do they use DBT? Schema therapy? CBT? EMDR? A combination of those?
I realize that asking questions of a profession can be difficult for some people. When you have BPD you might already be struggling a great deal within your relationships and add to that a dose of social anxiety and sometimes it can be difficult to ask a professional to explain themselves.
It might help to have a list of questions you can read or send them by email and have them answer over the phone or during your first session. One thing I would want is to have a therapist explain what BPD is and how people develop it. I think that will show if they have biases against people with the diagnosis. What would you say to someone with BPD who is feeling hopeless and like things will never get better? I know it’s hard not to feel hopeless. I know this disorder can be so hard to manage and feel like you aren’t making any progress. One thing my clients and I talk about is how BPD lies to them. It lies to you every day. It lies to you that you aren’t worthy. It lies to you that you aren’t lovable. It lies to you and tells you that you aren’t getting better. They are all lies. Try to think of all of the coping skills you’ve learned that don’t fix it, but help a little bit (sometimes). You are making a little bit of progress every day (or week or month). Some days you slide back, but overall you are moving forward. Learning and understanding how this disorder affects you is progress. Learning a new coping skill and practicing it, even when it doesn’t feel like it’s working is progress. Baby steps are progress.
I would like to say a big thank you to Kathy for sharing her insights from her professional life supporting people with BPD. I particularly like the point Kathy raises about clinicians needing to address any biases they may have towards people with this diagnosis. I feel this is a key part of removing discrimination and stigma from mental health services.
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