Question:
Dear Dr. Heller,
I have BPD and I am currently quite unhappy. My current
therapist practices rational emotive behavioral therapy.
I like him very much but I keep getting the sense that
he is overwhelmed by me. The other day he admitted that
he never really treated someone with BPD as long as he
has treated me and that they usually went away. I have
intense feelings of attachment to my therapist and I do
not want to leave him. At the same time, I feel I really
should be seeing someone who specializes in BPD. My BPD
has diminished my life from what it could have been.
I
completed a PhD. in neurobiology and I currently work for
myself successfully as a consultant and writer, but I
can't shake a pervasive feeling that I have completely
failed in life. I feel empty and alone. Working for
myself is alienating, I want to be with other people but
I hate them so much and fear them. Psychotherapy
terrifies me and I fear falling into depression or
self-destructive behaviors. I feel like I love my
therapist, then I hate him, then I love him. I
manipulate him and he lets me. He just wants to help. I
went to see someone else, a DBT and transference-based
psychotherapy specialist. He says I have BPD. Should I
see him? What about my other therapist who I completely
adore? I can't leave him. The REBT has helped somewhat.
I see that my relationships have gotten better and
easier to deal with, but now I love my therapist so much
that I feel desperate from the pain. Then he does
something to disappoint me from my idealized image of
him and I freak out. I really want to be a normal person.
Is it possible? I really want to learn to temper this
disorder. I suffer so much.
Thank you for your time.
Dr. Heller's Answer:
If you broke your leg you'd need it medically treated
and healing before you do the therapy. The same thing
is true with a neurological illness like the BPD, which
is a form of epilepsy in the brain's "trapped, cornered,
wounded animal" response area. It's probably a disease
of the brain's support cells ("glial cells") in that
area.
Malfunctions in that area cause unprovoked mood swings,
chronic anger and/or irritability, emptiness and
boredom. Prozac (fluoxetine) at the right dose stops
these symptoms completely. None of the other SSRI's
work as well.
When stressed or in a bad mood an epileptic seizure
develops causing dysphoria (anxiety, rage, depression
and despair) and sometimes dissociation. Most
self-destructive behavior and relationship manipulation
is a result of trying to lessen the severity of
dysphoria. As needed medications, and possibly regular
use of the epilepsy medication Tegretol (carbamazepine),
are what's needed here.
A good therapist can help enormously with the BPD once
the medication is right. I'm against therapy that goes
over one's past repeatedly. Doing this usually causes
dysphoria (anxiety, rage, depression and despair). The
most important thing is to heal mind, body, and spirit
and move on with life.
Many brilliant people succeed with the BPD in some
endeavor, but the chronic and intermittent BPD symptoms
make relationships (both personal and professional)
extremely painful and usually unsuccessful unless the
medication is used properly.
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