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Borderline Personality Disorder and Cognitive Analytic Therapy - a personal account

Here I aim to talk about Borderline Personality Disorder (BPD) and how Cognitive Analytic Therapy (CAT) can help you make important and lasting changes to your life, and what to expect during the therapy process. It has been my experience that there is so much jargon and confusing information for BPD and sexual abuse, particularly on the internet and the information is aimed at therapists and health professionals and not patients. I hope that by reading this you will come to better understand BPD, the therapy process and how this impacts you and your endeavour to seek lasting change and inner healing.

The term Borderline Personality Disorder is used by health professionals to describe people like us, who have difficulty in relationships and suffer with depression, feeling anxious, feeling very angry “rage” and directing the pain we feel either at others or inwardly at ourselves through self-harm. There is nothing borderline about you. I know being diagnosed with BPD can be a scary prospect, as the symptoms described are all of the things that you detest about you or are too scared to confront. It can also be freeing, I know when I started therapy it felt good to name and recognise how I was feeling and to know that I was not a “freak!” Borderline Personality Disorder is actually more common than you think, and is nothing to be ashamed of.

it felt good to name and recognise how I was feeling and to know that I was not a “freak!”
 

When I was first diagnosed I remember feeling angry and hurt, as I felt they had just stuck a label on my head. Now I realize that it is my choice to either live up to the description and diagnosis and behave as they describe, or work out ways of changing how I respond in situations, but more importantly work on changing how I feel about myself on the inside. You have that choice too.
There are many studies into BPD and exactly what causes it and there are some conflicting results, but most people who have BPD suffered greatly as children, and this is something all health professionals agree on. From the time you are born you are like a sponge, taking in information from the world around you. As a baby you are completely dependent on your parents and need them in order to get all of your needs met. We can only view the world based on what we experience. We take in from the world words and ways of behaving and beliefs about ourselves based on how others treat us. If you were abandoned as a child, as I was, you might grow up believing that you are not loved and unlovable. If this is then confirmed like it is when you are abused then you grow up feeling that you are bad, relationships will always be bad, you don’t deserve to be happy, and it was your fault.

This is then how you see the world, and because the world is not safe we devise ways of protecting ourselves, we put up defences and learn how to act “normal” or how society expects us to even though we feel empty on the inside. We want and need to feel safe, but never do. We push people away when we want them close. The very thing we want we either push away through fear that the other person will reject or hurt us, or we become attached to that person and overwhelm them so they back away and reject us. This then confirms what we believe about ourselves and the world, and so the cycle continues.

During abuse we manage and cope with it in different ways. A common way to cope is to go somewhere else in your head and pretend it’s not happening. This is called dissociation, it happens to everyone at different stages in their lives. Did you ever go on a journey in a car, where you know the road well and get to the other end and have no recollection of parts of the journey? That is dissociation and thank God for it, it protected you and me when things happened that were out of our control, things that were too painful for us to cope with as children. The problem is our brain doesn’t realize that we are safe now, and during times of extreme stress and anxiety we switch off.
We feel like we aren’t real - I know that when I switch of my face goes numb and I can’t feel a thing. One way I used in the past to make myself feel again was to cut myself, when I cut I felt release, I could feel again. It can be really hard to stop cutting, and people who don’t understand us think it’s a way of seeking attention. There are other ways of coping with these unpleasant symptoms, but ultimately you have to want to change for you, and seeking therapy is a good start.

It can be really hard to stop cutting, and people who don’t understand us think it’s a way of seeking attention
 

People who have suffered as children, especially abuse, have difficulty relating to others and to themselves. This is because when you are abused your boundaries are trampled on; your personal space is invaded. As you try to cope and make sense of all of this you create ways of coping ways of protecting yourself. The legacy of what happened to you as a child, if left undealt with will continue to manifest itself in your adult life, in your interactions and relationships with others but more importantly in how you think or feel about yourself. This bears much weight because your self-image or lack of it, is what leaves you vulnerable to abuse from others. It may not be abuse of the same kind you endured as a child; it may be that you learned as a child that if you behaved in a certain way you would escape the inevitable abuse “if I am good then....... won’t happen.” This continues into your life now so you try to please others all of the time and so conform to their wishes even if you don’t want to.

You will find it hard to think about yourself and care for yourself, because you believe you don’t deserve it on one hand, but on the other hand crave affection, acceptance and intimacy. The problem is you have no clear sense of who you are because you have had to learn to respond to the world around you, rather than being centred and assured on the inside. This means you are constantly changing in how you act or react with others, in psychology they call these changes in mood “state changes.” Boundaries are an important way of defining where you end and the other person begins, people like us cannot do this because we have no clear sense of who we are because who we are is defined by outside experiences.

The good news is, you can bring about lasting change, it won’t be easy and you really have to commit to it and stick at it. Therapy won’t change you - only you can do that - but it can give you a safe place to learn to look at yourself and reflect on your life with someone who understands your inner world and will support you.

The good news is, you can bring about lasting change
 

There are many different models in psychology that are based on different theories. Cognitive Analytic Therapy is what is known in psychology terms as “integrated,” meaning it takes parts from all of the main schools. What this means to us patients is our therapists will be able to use lots of different tools to help us in our endeavour to understand ourselves.

Before you start therapy you will be assessed, this means meeting your therapist to see if you can work together, and it gives you a chance to ask any questions you might have.

I remember when I first started therapy, I was scared of what my therapist might “do” to me, and I was so concerned with what CAT was and refused to let her alongside me. CAT focuses a lot on the therapeutic relationship, and anything this might bring up for you will be looked at, as it is a magnified version of what happens in other relationships you have in your life.

It’s a funny kind of set up really, your therapist won’t talk about their own personal lives, but that’s because the therapy is for you. There is also no contact outside of sessions which last for 50mins. Your session will always be on the same day and at the same time each week. The relationship you have with your therapist is an important part of the process, and in time you will grow to trust the relationship and what it stands for. CAT is a time limited piece of work and can last for 24 weeks there is then a follow up each month for 3 months. And yet even though this all seems rigid and calculated in my experience my therapist has provided me with the most sincere, honest and caring relationship I have ever experienced. There are limitations to what she can offer me, but what she can offer me is a place and space to look at myself and try to make sense of my inner world so that it holds less power over my life, with her alongside supporting me and helping me to look at things in different and new ways.

your therapist will be able to look at your life with you, without getting hopelessly lost, in a place where he/she can be of no help to you

 

The structured and boundaried relationship that CAT creates means that your therapist will be able to look at your life with you, without getting hopelessly lost, in a place where he/she can be of no help to you. After getting to know each other normally around the fourth session, your therapist will work with you on a “reformulation” of your life so far. Your therapist will write you a letter, in it will be a snapshot of how things are for you and what the difficulties in your life are, as you have shared with your therapist. It will describe patterns and problems which you feel stop you from getting to where you want to be in your life, and your therapist may set some goals around these so that the work you do in therapy has clear direction, as it is a time limited piece of work.

During therapy you therapist will use maps and diagrams as a way of thinking about cycles you get into, this is done with you in the sessions and can be added to as therapy progresses. You can then take the map away with you each week and use it to see if there is a pattern to how you relate with people in your life. In my experience the maps provide a new way of thinking about my life, almost like I can observe my behaviour and the behaviour of others. The map also lets me understand why this behaviour is happening.

Towards the end of therapy, your therapist will spend time with you looking at the goals you set at the beginning and you both talk about how well therapy has or hasn’t worked for you. On the last session you will both read each other a “Goodbye” letter. This is because ending any relationship is difficult, but the therapeutic alliance you have both worked so hard to create can be difficult, as you feel unsure about embracing your new life without the weekly support of a therapist. There will then be a follow up appointment monthly for three months after.

In my experience real therapy is pure unadulterated hell. As I said before you really want to have to change for you and in order for it to work you must make a real commitment. CAT certainly doesn’t have all of the answers, but will help you to work out what is right for you. There were times when I really wanted to quit, but I stuck with it and I am glad that I did. Change doesn’t happen overnight but CAT can help you to begin.

I hope that reading this has helped you feel less unsure about CAT and starting therapy. And I hope you find the courage to embrace therapy in a way that has real meaning. And I hope therapy helps you to continue on your journey in life in new ways. You cannot change your past, or cure the pain completely, but you do have the power to take control of your life and get to where you want to be, and therapy really can help you to start over with a different perspective of yourself and your life.
I wish you success in your therapy journey.

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