Please note: No offense is intended to anyone in the mental health community – whether that is a person with mental health issues or their workers, or someone affected by a family member – from this post. It is based solely on my own professional and personal experiences. I fully recognise I am generalizing by appearing to paint all people with a specific mental health issue with the same brush, and that is not my intent.
The thing about being a counsellor is that the skills never leave you, even when you spend most of your time hanging out in your lounge reading ‘Can You Moo, Too?’ over and over and over and…
I don’t mean to suggest that skills aren’t honed by experience, and that I’d be able to just waltz right in the consulting room and see five people a day after having such a long break. But the things I have learned, in my training and in experience with clients, stick with me.
Like, let’s take my dad’s primary mental health issue: Borderline Personality Disorder. This is like the personality disorder. Billed as ‘untreatable’ in some circles, and certainly it is very hard to work with people with BPD. It often comes hand in hand with other issues, such as alcohol or drug dependency. BPD itself also often means that clients are also self-harming, impulsive, etc etc.
But the main reason why we were warned off BPD so many times? It’s the problems with forming attachments and relationships. People with BPD can be really, really exhausting to work with. Even very experienced counsellors/psychotherapists might have their own personal rule of only having one BPD person on their caseload at any one time.
Its difficult to explain why to someone who hasn’t worked – or lived – with these people. Maybe you can just take my word for it?
The other major thing that can come along with BPD is a tendency to see things in black and white, which is why these people (ie: my father) can have difficulties with relationships. For example, it is either all loved up and perfect …or a huge, festering shit roast party in hell. There is no in between.
Your girlfriend does something that you see as abandoning you? Well, obviously that’s a shit relationship and you hate her and you don’t fucking need her….but if she leaves me that will be so horrible i can’t be alone please please i need you and will kill myself if you leave…..but i fucking hate you. Etc etc.
Sometimes in counselling circles there is talk about a ‘parallel process.’ This means, in very simplistic terms, if your client is obsessed about money, you may become obsessed about money as you talk to your supervisor. Or in more easy terms – your client is fucking in love with the colour blue, so you are weirdly fixated on the colour blue….in supervision or with this client. And if you’re not good at sectioning things off in your head, the blue thing may leak a bit into your personal life.
And god help us if you already had a preexisting problem with blue, because working with this client will force you to reexamine your own blue-related issues. To question if your reactions to what they are saying are truly about the client, or yourself.
With BPD, I had some issues. Having experienced massive trauma as a child and young adult in relation to this disorder, among other things, I developed a curious ability to bear deep pain in my clients. This has worked to my advantage, mostly, though my old therapist and a past supervisor suggested I would always need to make sure I was taking care of myself – because I could bear to hear my client’s deeply traumatic shit meant I would hear it. People sense if you can deal with these things, I think, and consequently I dealt with a lot of people who wanted to go very deep.
This was a blessing, I think, derived from my childhood.
On the flip side, I seem to draw clients with (usually undiagnosed) BPD to me like a moth to a flame. On my counselling training, a pat phrase we heard a lot was ‘You get the clients you need.’ I agree with this….to a point.
BPD is very, very difficult to diagnose. It is not my place as a counsellor to diagnose. However, in one counselling placement alone, I had three major cases of clients with BPD walk through my consulting doors. None were coming to therapy about this as an issue – they were coming for other issues. One particular person had not disclosed the issue during their initial assessment, and the therapist did not ‘catch’ it.
Oh, no, leave that to Super Existere, the counsellor with antennae 8 miles long for people with attachment issues.
The thing is, working with this person – even for the brief period I did – left me totally fucked up. I was going blank after sessions, unable to remember stuff. And the gut feeling I had in sessions? Very familiar. I was so upset by this person….who outwardly was certainly charming, intelligent, and someone I liked (I hate to put people in boxes, but again, this is ‘typical’ of BPD)….that I was reeling.
My supervisor said she felt I was in real danger. I sort of laughed. I said this could probably be explained away by my past history, especially taking into account that I grew up with a primary attachment figure who had BPD. I dutifully spoke to my manager at the placement, though. She did a bit of digging, and it turns out that this client had in fact been diagnosed with BPD by their psychiatrist (many of my clients also had psychiatrists), and…they had lost control in previous counselling sessions and their counsellor was at grave risk. Needless to say, I stopped my work with this client.
Because sometimes being a good counsellor means knowing when you are in above your head.
I don’t know how I got into a lecture on the mechanics of counselling, and this is feeling long, so cheers to you if you’ve read this far.
The whole point of this entry was for me to say that I tend to go all ‘parallel process-y’ on this blog in relation to my dad, only talking about the bad stuff. In real life, I am what psychotherapists call ‘integrated’….meaning I’m good at finding the middle ground, seeing things more realistically. It’s a good way to be, but it makes the necessary ‘black and white’ things difficult for me.
There were good things about my dad. I feel like I want to write about them, as part of a mourning or grieving process.
But actually, maybe I just needed to come here and say: I was a really good counsellor. But in counselling, I made a conscious decision to take a break from people with severe mental health issues (like BPD, for instance) and work with people who had more ‘ordinary’ problems – though often quite traumatic and extreme (because, again, I draw hardcore cases to me), but sometimes blessedly mundane.
I felt I was more helpful to people without severe mental health issues – maybe because the MH client group is prone to not turning up to appointments, etc etc – but also because I was making a choice to take care of me.
If I could do that professionally, maybe I can do it personally.