All these labels actually give very little useful information. The question is NOT the particular pattern of behaviours a person exhibits, but the strengths that will allow him/her to learn new ones and overcome the old habits.

And, it seemed to me that the diagnosis got in the way of their being able to find therapists who were willing to work with them because of the negative reputation people who have such a label have, no matter where they are in the process of healing and self-transformation.

Finally, as a psychodramatist, I find it more useful to work with people in terms of the roles they play and the role choices they make because this allows us to experiment with different ways of playing roles than seem important and drop the roles that they find no longer serve them.

Also, I want to reiterate that to practice nonpathologizing therapy does not require one to believe that pathology doesn’t exist. Non-pathologizing means viewing a person as greater than their problems. It does not mean problems do not exist, it means NOT viewing the problems as the whole person or the whole person as the problems. In nonpathologizing therapy we try to “do no harm” and because the PD label is often times harmful and at least unnecessary for treatment, we don’t use it.

Noah :)

I rarely use a PD Dx, but, if I agree to accept insurance reimbursement, I must also accept the tool (DSM) that they and the APA have made part and parcel of that agreement.

Until the APA and the insurance industry change the DSM, I say let practitioners list PDs.

As far a personality disorders go, I agree with you 100%! No one is a borderline or even a depressive.

As a mental health professional, I am disheartened by the profession’s useage of 3rd person language… ie.. a BD, a schizoprehnic..etc. Again, NO ONE is a diagnosis.

The concept you are utulizing.. empowerment.. actually has been around for sometime and came from the peer movement. Various peer and family mental health organizations have to stand up and take a bow for using their leverage to graciously impart the concept of empowerment and respect to professionals, who sadly enough usually took the “medical model” route of thinking about mental health clients.

I have had the privilege of working at a mental health linic in Denver, that is maintained in a partnership of clients and professionals who believe that empowerment is of utmost importance, in helping individuals gain quality of life.

As trauma survivor of debilitating depression and anxiety, I found stabliization via the appropriate medication. However, it was through empowerment oriented suppport groups and organizations, that I found my calling - helping others to acheive the same qaulity of life - via becoming an empowerment mental health professional.

I am interested in sharing with others my experiences and theirs in addition.

I am so tired of therapists and doctors labeling clients PD then in essence giving up on them. I had a recent incident with a client that I have worked with for 6 months. She attenpted to get more help by entering a day treatmnt program for her ED and was told by the MD, who has only read her chart that with her “PD” and SI was too severe for the program.”

Of course the client calls after 3 hours of Binging and Purging saying “What PD???” Uggg!! I talked to the MD and she was so cold, compassionless, and in my opinion irritated by the client! Well, if you think she is PD (x3 BTW) then the last thing you shoud be is irritated.

I can recall working in several inpt. tx centers as a mental health tech before I got my MA and hearing the staff talk poorly about the patients, esp. the BPD ones. If someone walked in with a BPD dx, you might as well hang a target around their neck! Where is the COMPASSION? If BPD is so difficult to manage as a therapist, imaging how hard it is for these people to live with! It is not a choice…neither is bulimia, binge eating or anorexia BTW.

If you are burnt out, get out!

I love my job!

I thought the article was really excellent.

You might like to check out forthelittleonesinside.com
It’s Robyn Posin’s website; very unpathologizing, and deeply humanizing.
All from a fairly radical woman’s point of view. However, I have plenty of men in my practice who have bought her deck of “Rememberances” cards and find them extremely helpful.
If you do look at it let me know what you think.

Peace,
Nicole

In the spirit of empowering my clients, i view all diagnoses in the same light. I allow my clients to decide how useful or irrelevant it is to their treatment. When/if a client asks about a diagnosis, I use the metaphor of a Band-aid. I say, “Diagnosis are like band-aids. Sometimes a band-aid can be useful to isolate a wound from the environement, to help keep it clean and promote healing. Other times, band-aids can actually cause a wound to fester and worsen, because it hinders the person’s ability to create the conditions for healing. In the end, the band-aid itself has little or nothing to do with your actual process of healing. If it is useful for you to have a name for your experiences or to know that there are enough other people who struggle with the same kinds of things you are struggling with, for there to be a band-aid/label created for it, then use the Band-aid. If it hurts to have a label, or creates obstacles to your healing, then disregard it. Remind yourself that it is only a band-aid, a way doctor’s came up with to isolate something so they could learn to heal it. The label is not the wound. Nor is the label the process of healing. Use a band-aid if it helps, but if it causes the wound to fester, toss it in the trash.”

I worked with a teen who was deeply wounded from a long trauma history, before I knew about IFS. Somewhere she heard someone refer to her as “borderline personality disorder.” She called me between sesssions with anxious questions. She wanted to know what it meant. I read her the symptoms from the DSM-IV. She could identify with many of the symptoms listed. Then, i explained the band-aid metaphor and healing. And I added, “if i had been through what you have been through, i also would fit some list in this book. It may not be the same list because each person responds differently, but i guarantee you, that your experience is human. The psyche splinters to protect itself; it is just what the mind does in response to trauma. None of your experience is outside of humanity. You are 100% human.” i asked her was this useful information, she said, “yes”.

Some clients have parts that feel better having a label for their experience. It allows them to feel power over, gain distance from, feel relief or bring more awareness to what feels like an out of control life. Others find it stigmatizing. Whatever the case, I trust the person’s system to tell me what is most useful for their healing process. I generally do not discuss diagnoses with a client without being asked about it. I also get many questions, as i also work with children who are in residential treatment, who come to our agency already bearing a list of diagnoses. While the kids never ask, parents need a lot of information about labels. Many of our families have adopted children who carry a wound of separation from the biological mother as well as severe trauma histories, which greatly impact the child’s ability to be in relationship. In these cases, the whole family must heal together, and the parents must be willing to engage in a lifelong healing process for and with the child. I give them the same band-aid metaphor. Some parents thank me for seeing the their child as a unique, valuable being, others use the labels because it helps them understand and realize the issues are not always about how they are parenting.

So, I unabashedly use whatever promotes healing for the client(s).

I also agree with Murray who wrote in his comment to my post that in his practice, “there has been no one stating their presenting problem is a personality disorder. They come to therapy because of symptoms and/or behaviors that are bothering them.” Likewise, very few people have come to me using a PD label, the handful that have were given that label by their former therapists who were unable to help them.

I haven’t posted on this subject yet, but I believe there is an alternative classification and diagnostic system which would prevent shame and simultaneously allow for providers to communicate. Such a system might also prevent the rejections you are concerned about. I will post more about this later. Until our diagnostic and classification system change, the best that I feel I can do on GoodTherapy.org is to provide clear cut concerns, worded in common everyday language, so people can more easily identify the symptoms they’re experiencing and adequately share these with their provider. This is a project that we’re in the process of now. When we’re finished we’ll update our list of concerns with more of these psychological based symptoms translated into easy to understand language. I believe this will prevent the rejection you’re concerned about.

I also want to say that a part of me thinks that anyone and everyone in a mental health role would benefit from learning how to work with people who have deep wounds and strong protectors. I don’t think we can easily avoid contact with people who are deeply wounded and defended, especially as clinicians.

Lastly, I think it’s a therapist job to prescreen his clients, to ask questions which will determine if the persons “stuff” is beyond their scope or know how. But I agree that even then it can be hard to tell and much of the “stuff” doesn’t show up until some time down the road anyhow. Noah