How do therapists know "who’s the sick one?" When a couple enters either individual or couples therapy there are a number of parameters that most professionals look at to ascertain the validity of the individual and the couple.. this may vary from therapist to therapist, but most of the basic criteria remain..
Patterns of behavior, past and present are evaluated in a number of open and subtle ways. Questions are asked about previous relationships, other relationships in both parties lives..
While for most bp’s (but not all), the majority of the crazy-making is directed at the primary relationships, those with bp most often display some signs of the disorder’s behavior in other relationships in their lives. Much of this is done through anecdotal (first person questions and responses) evidence.
Each of the criteria for making a determination of bpd or bpd traits (or other personality disorders) can be asked and ’researched’ in the context of the first few interviews with a couple. Some therapists prefer to see the couple both individually and as a couple for several sessions.
When I maintained a private practice and had a large number of couples in couples therapy, I would see the couple once, together, then each person individually for one or two sessions each. I would ask them to put together a written biography, and give several ’homework’ assignments, which might include written responses with specific information that was designed to get a ’large picture’ of the person’s life both before the current relationship and during.
Questions can be asked that relate to each criteria for a specific condition or disorder.. like bpd or npd or other disorders.. Questions like: how did your last relationship end? Do you see that person? Do you have a relationship with your former ex or friends that you shared? How do you deal with betrayal by friend/family? Those with this disorder (or related disorders) often display extreme variations in other relationships.. they have inappropriate boundaries, making ’instant’ friendships.. they often have few relationships aside from biological ones that endure over time.. they won’t, for instance, have friends from childhood or high school that are interacting with them on a regular basis as adults or middle aged individuals.
Lots of ’what if’s?’ questions allow for the therapist to look at patterns of thought and problem solving.. If the person who makes the initial appointment presents as disjointed, reports a pattern of sleep deprivation, of feeling like all the problems in the relationship are only their individual responsibility, if they indicate that they have been given an ultimatum of ’find help or else’, I go into the initial interview with a list of questions designed to give some ’framework’ to what the possibilities are. If both partners are ’mirroring’ each other in an ’uncanny’ way.. time to look further.. family histories, genograms-making a picture of each person’s family of origin is very often used to get a lot of information in a low stress manner.. like addictions, mental wellness issues often run in families..
If I see a pattern during the sessions, of one partner blaming the other excessively while denying their own responsibility, I again ask more questions.. Especially if the other person accepts that! After some time, many therapists get ’gut’ feelings.. and move on from there.
Any time I felt that I was on my way to the Land of Oz, that my observations and suggestions were being completely discounted by one party (one sided), I would go back to the initial information gathering phase. If I felt that further investigation was war rented, I’d refer the person to a psychiatrist or psychologist for further testing.
While it’s hard for friends and family to make the distinction between who’s really ill and who’s traumatized, it is usually (but not often, there are many therapists with personality disorders and worse.. I was married to one) easier for those with the training to make a distinction.
It is often harder for the Non in the situation to accept that it isn’t all their fault , exclusively. Most healthy people will assume their own share of personal responsibility for what’s happening in a relationship. Those in denial or addictions, those with personality disorders or active delusional or paranoid issues will most always blame everyone around them for what’s happening, but accept little if any responsibility. It is important to note that many otherwise healthy people do go to therapy, when they have a life situation that requires more resources than they currently have. One very big myth out there is that only crazy people go to therapy.
It is important to remember that YOU are the consumer in the mental health supermarket.. you have the right to ask any question that you have about the process, the therapist’s suggestions, to ask WHY anything is happening.. It’s your mental wellness here.. no one is an expert with all the answers.. Therapists are human beings.. and finding one that works for you and your partner is crucial.. I had one therapist who said: this week we let him beat you up and next week it’s your turn.. There was no next time.. I looked for another therapist.. I did not feel safe given that my partner at the time was behaving in an abusive fashion and the therapist did not set appropriate boundaries for what was appropriate.. You, as the consumer, can also set a boundary at any time in any therapy session.. You do not have to have the therapists permission.. you do not have to give reasons for why you have that boundary.. no need to
The second question about how we as Non’s are affected by the disorder and pick up traits of the other’s sickness is also a real and valid one..
There is an old proverb that begins: Children learn what they live.. People also learn what they they live, and LIVE WITH. When our reality is continually challenged, when our perceptions, feelings and thoughts are minimized, denied, discounted, over and over, our normal defenses and problem solving strategies often disappear or become ineffective. We begin to ’take on’ the behavior of that person.. in Non language, we call it ’catching bpd fleas’. Those of us who had parents or primary care givers with a personality disorder can be more intensely affected.. tho all of us are damaged in so many ways.. we are more prone to getting involved with partners who are unhealthy.. we are more prone to depression, to have less than healthy personal boundaries.. we unconsciously look for someone to ’work out’ the issues that were unresolved with our primary care givers.. "we go to what we know.. "
Another strong influence in the dynamic is related to the intense euphoria that is often experienced in the early part of a bpd/Non-BPD relationship. We want to get it back.. will do what ever we can to find that majick.. that feeling of total joy/ecstasy that we felt.. that, along our intense ability to love so intensely, and our often deep desire to keep promises and commitments keeps us in a revolving door of in and out.. we will put our own mental wellness and physical safety at risk by staying in a relationship that may be unsafe at many levels.
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Disclaimer: The information on this site (http://www.bpd411.org) is based on personal experiences of the authors and members of our e-mail mailing list. It is NOT meant to replace professional advice or take the place of counseling, therapy or additional personal research.
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