Resistance to treatment in Borderline Personality Disorder is very common. There can be as many reasons for this resistance to treatment on the part of people diagnosed with Borderline Personality Disorder (BPD) as there are individuals with BPD. As someone who recovered from BPD in 1995 I can honestly say that knowing what that resistance is about from the inside out because, I too, often, in the process of my recovery, when I was in therapy, would present resistance and defense that blocked my learning, gaining insight, awareness, and my taking personal responsibility.
One of the biggest issues of resisting treatment in those with Borderline Personality Disorder, which I also had to work through in my own recovery, has to with the rigid all-or-nothing black-and-white thinking patterns which are largely negative, caused by and built on by the maladpative defenses created by the Borderline False Self that are the legacy of the Core Wound of Abandonment in Borderline Personality Disorder.
Another major reason for resistance in treatment for people with Borderline Personality has a lot to do with the dissociative nature and the reality of triggers. Triggers which cause the re-experience of emotional dysregulation that is intense and overwhelming that most with BPD are unable to cope effectively with until they actually get enough treatment to learn how to cope – treatment that is often blocked by fear, negative thinking, resistance, fear of triggers, shame fear of abandonment and the maladaptive coping mechanisms built up over the course of life of the person with BPD. The major challenge of the reality that people with Borderline Personality, often consciously unaware of what they are actually thinking that leads to their intense feelings, are often trying to escape those feelings at all costs. Magical thinking, believing that what one feels is really real and what is, along with not being aware of the cognitive disortions in thinking that are causing their feelings most with untreated Borderline Personality end up feeling helpless and hopeless and can’t cope with those feelings either. What anyone with Borderline Personality will greatly benefit from is learning to become more aware of his/her thoughts and way of thinking and then engaging in some process of treatment that helps them learn to Change Thoughts and Change Their Feelings and gain new healthier perspectives on their styles of relating to self and to others.
There is often both a strong desire to get out of the pain that is experienced when one has Borderline Personality and an equally strong need to protect against the very treatment process being undertaken to create relief, to build coping skills, and to find the lost authentic self. I, as a BPD Coach and Peer-therapist who has been there, from the inside out, totally understand this duality. It is not a duality that most with BPD can be fully aware of in the beginning of treatment or coaching with me or any therapist for that matter. I do, however, have a specific methodology of working to help people with BPD with is very crucial paradox of desire to get well and the need to block that process which presents as resistance to treatment. I have developed this methodology from my own experience of this very painful and primal struggle that I too have been through and that I was able to get beyond to recover from BPD.
People with Borderline Personality will benefit from gaining more awareness about what is required in the first steps of recovery from BPD and from learning more about how to begin to find Hope for relief from pain and for recovery.
For so many who seek treatment with BPD it is this resistance paradox that both sees therapists (mental health professionals of all different disciplines) often give up on patients or clients with BPD or get stuck in their own frustration and counter-transference with the Borderline client, over-medicate them, and/or simply refuse to treat them any longer. It is also this Borderline resistance paradox that is not well understood by those who have never been where I have been, had BPD and made it all the way through to recovery – all the way back to know what this paradox actually is, to identify it as I have done and to then figure out how to work with people with BPD without allowing frustration to interfere with compassionate care and a dedication to loyal supportive and validating continued work with BPD clients.
This resistance paradox is very confusing and not well understood by many with BPD who seek treatment and then feel failed by therapist after therapist. It is also a method of self-sabotage on the part of those with BPD though it rarely is a very conscious process.
I have learned in the last 11 years of my work as a BPD Coach and Peer-Therapist with thousands of BPD clients that it is crucial to understand and to know how to support clients though this resistance paradox because treatment no matter the methods or modality or combination of said cannot be successful without this paradox. This paradox is a part of the process of unwinding the defense mechanisms of Borderline Personality Disorder which is one key part of the recovery process and which borderlines resist the most out of fear and mistrust and an inability to cope emotionally. It can be for some the most formidable aspect of treatment and often what drives them out of treatment that fastest.
This is why I believe it is so important for people with BPD to come to understand what this resistance paradox in BPD represents, why it happens, and with my clients, in the way that I work to treat and coach those with BPD to wellness and recovery it can be a central and on-going theme that must be re-visited many times over. I don’t see this as a negative or a reason to give up on someone. I see this as a natural part of the process of what it truly takes to recover from the actual cause of Borderline Personality Disorder because it is not a “brain disorder” or a “chemical imblance” in the brain and it cannot be cured with any medication. Psychiatric medication is not the answer to recovery from Borderline Personality. I will have an in depth audio available soon at Phoenix Rising Publications about this treatment resistence paradox in and of itself as well.
© A.J. Mahari, January 12, 2012 – All rights reserved.
