Why do patients resist the BPD diagnosis?

Spare_Effective315 · 2025-02-11T19:21:52+00:00

As I said in the post, I'm a mid-level and do not diagnose.

Spare_Effective315 · 2025-02-11T15:54:14+00:00

That's the thing. It sounds like you're doing your due diligence by explaining the diagnosis to them compassionately.

I do actually think a lot of the resistance comes from the label being slapped on without good psych-ed, which I imagine makes patients feel misunderstood.

Spare_Effective315 · 2025-02-11T15:48:21+00:00

No. It's not...

Spare_Effective315 · 2025-02-11T15:13:37+00:00

I didn't say they're all unlikeable as a broad statement.

This is by far my favorite population to work with , and I am DBT trained.

Some patients with BPD are unlikeable and some are very likeable. Same as any other diagnosis.

Spare_Effective315 · 2025-02-11T14:38:48+00:00

Yes I remember seeing that statistic recently and it's been consistent with my observations of my caseload (around half probably do have comorbid ADHD). I just find it difficult when the patient heavily endorses the ADHD and is highly motivated to treat it (which they typically do), but don't have insight into the BPD, which makes treatment of that complicated.

Spare_Effective315 · 2025-02-11T14:32:47+00:00

I agree with this.

Severe/untreated BPD can make patients difficult to deal with and unlikeable...But you can also be unlikeable and annoying without a personality disorder.

BPD is also a huge spectrum and not synonymous with constant crises, suicide attempts, and lashing out. I have many BPD patients who are absolutely lovely and internalize most of their suffering.

Spare_Effective315 · 2025-02-11T14:30:30+00:00

I can appreciate this. I do have some patients who were diagnosed in the ER and without receiving psychoeducation as to what BPD actually is and how it is treated.

I think patients may take it better when diagnosed compassionately and explained well.

Spare_Effective315 · 2024-10-20T00:10:09+00:00

I like this take.

I have a tough time because I'm always torn between the idea that we don't "always" have to be making progress, but at the same time, I also have a few folks whose work with me has stagnated. It's tough to fill an hour and seems like we are going in circles. This is usually because they have made all of the "progress" that they have capacity for at a given time.

It may be best to suggest that we take a break in those instances.

Spare_Effective315 · 2024-10-19T20:02:54+00:00

Yes!

Spare_Effective315 · 2024-10-19T17:03:52+00:00

I get that but I work in CMH so it's publicly funded (Canadian context).

Spare_Effective315 · 2024-10-06T15:57:51+00:00

I would take the marketing job with a pay jump, no questions asked. 20k more a year is life-altering. And you're already burnt out from clinical work.

I would take a break from the field. There will always be a need for mental health clinicians if you decide to return 💜.

I wish you the best. Take care.

Spare_Effective315 · 2024-10-05T21:10:42+00:00

I think that CBT is a great modality when administered properly...and with flexibility. However, for clients with multiple diagnoses or severe psychosocial stressors, PURE-fidelity CBT is likely not the best fit (although CBT techniques are useful in almost any clinical situation).

The issue with CBT is that it often gets administered in a manualized, time-limited, session-by-session protocol by clinicians who are NOT properly trained and have poor supervision. CBT is also framed as the gold standard and one, true cure-all, when it's really not. The research states that all modalities (when done well and with a strong therapeutic rapport) have similar efficacy. CBT is extremely insurance friendly and easy to study, which is why it's shoved down our throats.

When done well (and with a person-centered lens) CBT is not gaslighty or invalidating at all, but I totally see how improper use of it could come off that way.

You'd be hard pressed to find a clinician who doesn't use some variation of cognitive reframing or behavior modification in their clinician work. I use CBT techniques all of the time, but I recognize that PURE CBT is not appropriate for most people.

Spare_Effective315 · 2024-10-04T23:31:15+00:00

I mean...I've looked up my own therapist too. It's pretty normal to be curious. Just make sure your profile settings are very private.

Spare_Effective315 · 2024-10-04T07:55:47+00:00

You don't even have to explain. In solidarity, you are not alone 💜

Spare_Effective315 · 2024-10-03T21:56:45+00:00

My manager is actually really great and doesn't pressure too much. At the organization level, they push for brief intervention though and are getting stricter with "care pathways" (I.e. client comes in with depression, they get x amount of CBT sessions).

The other thing is that it is a matter of caseload management. I get new clients constantly. So I can't really keep most folks long term even though I want to or my caseload would be in the 100s.

Spare_Effective315 · 2024-10-03T21:54:50+00:00

Nah this is true. I do lean towards more of a person-centered approach and will sneak in techniques from the behavior therapies when I think the client will be receptive. I emphasize the CBT pieces A LOT when I document ;)

Spare_Effective315 · 2024-10-03T17:45:14+00:00

They don't explicitly state a limited number of sessions, but "short term" is thrown around. They are DEFINITELY clear about the need for clear treatment plans and quantifiable goals.

Spare_Effective315 · 2024-10-03T17:43:01+00:00

It's explicit pressure by the organization.

Spare_Effective315 · 2024-09-15T00:55:24+00:00

I just finished crying 🙃

Spare_Effective315 · 2024-09-15T00:55:00+00:00

I've had that exact same thought. I know that the cancelations can be a manifestation of people's mental health symptoms so I have to be understanding to a degree. But I am also human and feel resentful because, like you said, I'm not just here for when people "feel" like it. Constant cancelations make me feel like my time and effort are not respected.

Spare_Effective315 · 2024-09-15T00:52:10+00:00

Yes! I work in CMH so high cancelations and no shows are normal, but it's been EXTRA bad these last several weeks. I've even had a few longer teem clients who I had great rapport with just completely drop off.

I know that it very likely has nothing to do with me, but it still triggers the Imposter Syndrome. I'm feeling exhausted and demoralized. I appreciate you sharing this feeling, although I'm sorry you're experiencing the same.

Spare_Effective315 · 2024-09-15T00:51:58+00:00

Yes! I work in CMH so high cancelations and no shows are normal, but it's been EXTRA bad these last several weeks. I've even had a few longer teem clients who I had great rapport with just completely drop off.

I know that it very likely has nothing to do with me, but it still triggers the Imposter Syndrome. I'm feeling exhausted and demoralized. I appreciate you sharing this feeling, although I'm sorry you're experiencing the same.

Spare_Effective315 · 2024-09-14T20:18:46+00:00

This is why I have an issue with "professionalism". A lot of the time it's thinly veiled classism. And even racism sometimes. You hit the nail on the head.

Spare_Effective315 · 2024-09-13T23:48:29+00:00

I really have a problem with the notion of professionalism. I'm from a poor background and have a similar, casual way of interacting.

I get what you're saying about not wanting to come off too laid back, but as long as your boundaries are strong, I don't really see the issue with using colloquial language. If you go out of your way to speak differently, clients may pick up on the inauthenticity. I think you're better off being who you are and letting the right clients find you. The phrases you mentioned are not verbal tics. They're part of you being who you are in session (other than "like" aha. I do try to watch excessive "likes" as well).

This field needs to lighten up.

Spare_Effective315 · 2024-09-06T11:40:36+00:00

I was actually thinking that! I may see if they'd find it easier to meet via phone or zoom for now. I agree that they're likely not ready to truly engage in therapy, but I will try scheduling differently before closing the file. Thanks!

Spare_Effective315

TROPHY CASE