What is misunderstood about the misunderstood
Or my past experience being pregnant and working with people who carried the diagnosis of personality disorders
I was first introduced to the theories of personality in my second semester at grad school. Until then, I had an inkling of what personality disorders were, but they mainly remained a mystery. I found the name itself, personality disorder, deeply unsettling; the whole person is disordered? Like, all of them? That seemed a bit harsh.
Back to that class. In an overpriced NYU course with a professor who yawned more than talked, I heard about the ever illusive personality disorders and how to diagnose them. Between yawns, the professor said that treatment was mainly ineffective with people who carry this diagnosis- that it was in essence “incurable”. So who they are is disordered and they can’t be helped? Harsh harsh harsh.
And very fascinating.
8 years into my clinical work, I think that professor was full of shit. While I did partake in the “diagnose your whole family and social circle and not tell them” part of psychotherapy studies, the diagnosis of personality disorders was reserved for those select few who’s interpersonal interactions baffled me and mainly scared me.
Having worked at a private practice that specialized in treatment resistant personality disordered individuals (I did not know this when I started), I began to interact daily with whom my yawning professor deemed the “unchangeable”. In all frankness, I did experience a myriad of reactionary emotions while working with these individuals; mainly frustration, defensiveness, intense concern, anger, and deep sadness. There was something about these interactions which rendered me moved and bothered. The content of the sessions was not what was so jarring to me, but the way it was communicated in our dynamic. I had a lot of processing to do outside of these sessions so it wouldn’t spill over into the professional nature of my work.
I questioned myself repeatedly on what may be behind that reaction I was having. It was as if my ability to stay neutral was thrown out the window; I was preoccupied with these people outside of our sessions and I felt utterly helpless. My then supervisor frequently asked me why I kept setting the table for these people after hours. This was not the clinical helplessness I was familiar with when faced with profound trauma. This felt personal. I wanted to help the person change and work on their problematic interpersonal dynamics, but was struggling to remove my feelings from the equation.
That was it- I felt that I had to remove myself, even cancel myself, and it was pissing me off.
And I was also wrong.
They were making me feel how they felt, which can feel intrusive and uncomfortable, but is nonetheless a brilliant way to insert yourself and make yourself seen. What a clever (and infuriatingly effective albeit maladaptive) coping mechanism! My response to them was mirroring a feeling of theirs; they were reflected in me. They had the power to effect another which likely points to a profound sense of usually not mattering. This made them matter in all the ways they didn’t want to, but still, they mattered.
I no longer think of personality disorders as anything resembling what the yawning professor professed. I think it stems from attachment trauma that, when not explored, leads to further isolation. It was an effective way to survive in the past, and is now more detrimental than beneficial. I think it’s as “incurable” as any human condition. We are not meant to be cured, because we are not broken. The lens of curiosity allows for far more growth and less judgement, in my view. Let’s explore and ask questions. Diagnostics can be lazy.
I am now visibly pregnant with my second child and am remembering the responses my clients who carried this diagnosis had to my first pregnancy. Be it my impending leave, which may be perceived as abandonment, or the fact that they were not the baby in the room, which had brought up a lot of confessed feelings of resentment, distance, and anger. This time I see myself in them and understand; I too share these concerns sometimes. I too want to matter and be proven that. I too don’t always know how to go about getting my needs met. Their diagnosis was information, but the relationship was where treatment began.
What is misunderstood about the misunderstood
You have a great understanding of those with personality issues. Knowing that you are feeling how they feel through transference/ counter transference is the beginning of helping them to heal. Spot on.😘