Friday, February 6, 2009

Becoming a constant object w/the BPD patient

I recently read a book called: Becoming a Constant Object in Psychotherapy with the Borderline Patient. Authors, Charles R. Cohen and Vance R Sherwood

As a disclaimer, I will tell you that my DT did not diagnose me with BPD – of course, we all know that you should only use a “Diagnosis” for insurance purposes. I have complex PTSD, but a few weeks ago she said that I displayed “some” traits of a borderline – and she has pushed DBT for MONTHS.

Being the “diligent student” again (I graduated years ago!) I began researching the “clinical treatment of a borderline”. Since DT has become so closed off in her “therapeutic approach” my goal was to try on the “treatment plans” and see if I could find the one that “fit” her “new style”. And I think I’ve found it!!!!!!

I should provide you with some history of my “therapeutic relationship” with my DT, but for the purpose of this post, I really want to talk about the book I mention above, so I’ll save the “history” for a later time.

According to the authors of this book, you must establish “object constancy” with the “borderline” prior to doing any therapy work at all. This process can take well over a year and the basis of it is this: “STAND STILL”.

Now, like you, dear reader, when I read that, I wondered, “what does that mean?” Stand still? That’s the revolutionary treatment for a “borderline”? But how does one “stand still” in the therapeutic relationship.

Well, let me give you the cliff notes:STANDING STILL: The goal is to form an “attachment with the BPD patient, which (according to the author) will only happen if the therapist avoids responding and intervening, as they would with “most patients”. The therapist should be restrained and do not even intervene when the patient is virtually demanding help or relief! The author compares the structure of the therapy with the borderline to a seriously ill patient, stating little can be done to make the ill patient feel better, so we must accept the patient’s discomfort and not demand the patient feel better. (I have to interject a comment here: I watched my father-in-law die from terminal cancer – and there are ways to make “ill” patients feel better – and not just “watch the process”)…..

The author claims that the therapist not try to change or help the patient at all! But instead just “stand still”. (Now, that must be an easy way to make $150.00+ an hour!) It is appropriate for the therapist to offer “occasional” empathetic reflections of the patient’s state of mind – just to demonstrate awareness of the patient’s “difficulties”. But 99% of the time, the therapist should say NOTHING. Just be present. No matter what the borderline talks about, just sit silently. It doesn’t matter what the “context” is….just sit quietly. And each week, the therapist should greet the patient the same way, “smiling”- and inviting the patient into his/her office – no matter if the patient is angry, sad, happy, or hopeless- the only thing that matters is that the therapist is the same, just standing still, week after week, after week.

Now, of course the patient will see the therapist as inactive and unresponsive and that’s okay – because (according to the author) even though the patient will not feel helped by the therapist, the restraint is aimed at important dimensions of “borderline pathology”. Even if the patient pushes the therapist away, the therapist should remain “standing still”, and have the confidence in their own “potential meaning” for another person to believe that the patient will return. (Wonder how many therapists have lost clients utilizing this “technique”?)

I personally feel that Carl Rogers and Irvin Yalom would be shaking their heads at this approach. What happened to “creating a treatment plan for EACH patient”. If we follow the “standing still” approach, I have an idea that could same these therapists some time! How about we take 20-35 “borderlines” and for an hour each week, they can attend a session with ONE therapist, and they can bitch and moan and complain, while the therapist “stands still” in the front of the room, occasionally nodding head, or looking inquisitively at the “borderlines”. What a great way for a therapist to increase his/her income 10 fold! And of course, according to the authors of this book, the “borderlines” will return week after week, pay $100.00 at the door, and be *happy* because they know the therapist will be there. And after a year of this “standing still” the patient will suddenly slap their foreheads, just like in the V-8 commercial and say, “Holy smokes! I suddenly believe (after paying $5200.00 to sit in a room with a therapist) that my therapist is a “real, constant, object”. This is amazing!” and then the patient would put on a “half-smile” (which he/she would have learned in DBT training, of course)!

What a bunch of BS! How degrading is this to a borderline patient, who already feels like they have stage 4 cancer, just by receiving the diagnosis! Maybe the therapist can also show the patient a ball, then hide that same ball behind her back- and then ask the patient if the ball still exists!

Why the hell would I continue to see a therapist if that therapist was not HELPING ME, but just silently standing in the room like a stature? I can spend $10.00, go to a museum and talk to a stature for an hour and get the same effect! What is this about????????? I think it’s ridiculous! How about trying to “figure out” why the patient lacks “object constancy” in their life? Gee – maybe her parents left her in a hotel room ALONE For THREE days when she was a year old…..maybe she was beaten and raped by her father. But none of that matters….as long as her faithful therapist “stands still and shuts up” for a year or two, she is sure to learn that not everyone is like her parents. (Well, of course we aren’t factoring in the fact that the “Therapist” is getting paid to do nothing but “show up”. Where can I get a job like that?????

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