• “We don’t accept clients with BPD.” Ending The Stigma

    It was a rare occasion where I had some time to spare and answered the office phone myself. A tired and defeated sounding client was on the other end of the line. After setting up their appointment, I asked how she had come across our practice. 

    They sighed and explained that they had been hospitalized and released. Upon release their therapist stated that the client needed more intensive treatment than they could provide. They called other places to secure continued care, and when she shared her diagnosis, she was told ” we don’t accept clients with BPD”. 

    My heart shattered. I pictured being tired and raw, after an admission, calling office after office to schedule. Sometimes, no answer, and other times being told the diagnosis was not one they were willing to accept. 

    I was reminded of an earlier time as an Intern. I was working in a treatment center. In the break room, one therapist turned to the other and commented that a client was “so BPD”, using the acronym as a synonymous term for being “untreatable” and beyond help. I suddenly felt my cheeks grow hot with shame, and I left the room. That would not be the last time I had heard that term used as a pejorative by a mental health professional. 

    I was not only startled at the lack of professionalism, but by what the comment implied they may have thought about my own journey if they had known. What if I had been vulnerable and shared with them my hospitalization at age 17? What if they could open up that old chart, likely long ago shredded, and see the diagnosis written by hand on the first few pages? 

    During clinical staffing, when determining which clinician would be assigned which client, I begun raising my hand each time the words “borderline personality disorder” were mentioned. I had recovered, so many years earlier. These clients deserved a chance to experience life without the disorder as well. I had long ago ceased to meet the diagnostic criteria disorder, and I believed each sensitive, intelligent and persistent individual like me deserved the same treatment. Furthermore, that treatment should be provided with dignity.  

    It is for this reason that I found the story of Marsha Linehan intriguing. Sitting in graduate school, listening to how not only a woman with BPD had overcome it, but became the world’s expert on the treatment of her disorder. I had tucked that image into the recesses of my mind. I didn’t have a burning desire to specialize in the care of those who suffer from BPD until I was exposed to the professional stigma around it. 

    In fact, there is possibly no other disorder that is acceptably spoken about in professional circles in such a way. If. for example, someone spoke about OCD the way they spoke about BPD, there would be outrage. 

    I wanted to make meaning of this. I respected my colleagues, liked them, even spent time outside the office on occasion. I believed they were people like me. People who wanted to provide unconditional positive regard for all clients. They went into this field understanding everyone deserved help. 

    It took me a while to wrap my mind around these professional phenomena. Clinicians thrive on being able to help and comfort people. They feel discomfort when they feel like they are failing to help. Relapses, harmful choices, and resistance all can feel to clinician as though they are failing. These are all symptoms that are highly concentrated in this population. 

    The stigma amongst some mental health professionals towards those suffering from BPD does not come from malice, but rather frustration. There is nothing in our foundational education or training that prepares us with the very specific skill set needed to support this population. A therapist could seek out this training via continuing education, however by that point in their career they may have already been spoiled on the idea based on watercooler talk and inexperienced experiences. 

    One of the ways I attempt to build empathy in colleagues for this individual is to imbue knowledge about Complex PTSD (CPTSD), mostly thought to be the cause of BPD.  Sharing “The Body Keeps the Score’s explanation of why one with CPTSD can have a physiological addiction to trauma can often be a lightbulb moment. The brain damaged by early trauma is specifically addicted to reexperiencing event. Meaning, an individual may seem to continue to “put themselves” in the same situation time and time again. Thus, leading to compassion fatigue. 

    Another thing inspired me in grad school. Long before my desire to care for people who suffer in a manner that I once did.  It was a really simple thing, actually. My professor, Scott Peterson introduced the importance of person-first language. 

    “An individual is not an addict. He is a person suffering from addiction.

    A person is not homeless. She is a woman suffering from homelessness. 

    They are not the BPD patient; they are an individual struggling with BPD.”  

    It is my pleasure in this world to support other mental health professionals in overcoming their own bias, and seeing those suffering with BPD as a person, first. 

    Mikah Watford, LPC, LCDC

    Advanced Certified Trauma Counselor 

    Clinical Director and Founder of MW Psychotherapy