Everyone gets a label stuck on them sometimes. At home, at work, or through your friends and loved ones. Lazy, overeager, perfectionist, selfish, but is that label correct? I have experienced it myself in extreme form. I was labeled ‘a borderliner’
Which label suits my behavior?
Being in a difficult relationship where it was my partner who kept pointing out to me that it was my behavior that caused and aggravated all the problems between us, I decided to seek help. Of course, I understood that my emotional outbursts of anger did not contribute to a good relationship. When, in a fit of absolute despair and distraught, I threw half the dishes at his head, I knew that this could no longer continue. I had no idea where to start so I called the General practitioner. She listened to me and wrote a referral letter. She couldn't tell me much about who I should contact. Her advice? Google is your friend.
But if I Google 'stomach ache', I only have to read three articles to be sure that, according to Google, I will die of colon cancer in two months. But I didn't know that at the time. You want to have what you hear from the 'professional' confirmed. So I had a serious problem and was looking for a serious solution.
Diagnosis labyrinth in mental health care: What is my problem or condition?
I started searching and soon felt hopeless. I randomly called some institutions and always heard that the waiting lists were endless. Couldn't I have been more specific about what exactly my problem or condition was? Yes, if I only knew. What didn't help was that my partner mainly thought it was "my problem" that I had to solve myself. As a result, I experienced this search not only as difficult but also as very lonely.
I eventually ended up seeing a psychologist at the local community center. During the first three sessions, she was busy trying to clarify what exactly my condition was. I felt more like a patient with every session. Due to her meticulous completion of the standard questionnaire, I did not have the feeling that she was listening to what was bothering me in any way.
The search for one label in DSM 5? The business side of Mental Health Care
I asked why it was so important to put 'a label' on me first. Before I could even say a word about why I came for help or what had happened. She explained to me that it was necessary to make a diagnosis before treatment, otherwise, she would not get paid and my health insurance would not cover it. I almost fell off my chair. Wow, I thought, is this what mental health care has become in this country?! Surely any sane person would want to smash a plate on that?
After three sessions, with random questions such as: do you think it is separation anxiety or more fear of commitment? Another psychologist came along, and without introducing himself, he fired a few questions at me in a matter-of-fact and very distant manner. After spending ten minutes leafing through another version of the DSM 5 together, their conclusion was: Borderline personality disorder with a bit of histrionic personality disorder. That last bit made me laugh, exaggeration is my middle name, as anyone who knows me knows, but to turn that into a disorder?
But the 50 minutes were almost up, so I was hurriedly given a stack of printed assignments from the folder 'BORDERLINE'. I had to fill them out at home and it was: see you again next week. Sad, because it turned out that my health insurance only reimbursed eight sessions with a psychologist in the case of a borderline diagnosis, and we had already wasted three of them leafing through a book.
I walked home with my copies more confused than ever. The exercises given were rather clumsy, to say the least. The too often copied sheets had assignments such as: When it turns black before your eyes, count to 10. And when you feel the storm coming, find a safe place to take shelter. I could do very little with this and I felt like anything but a borderline person. After reading a bit more, I couldn't imagine that these assignments would be of any use to someone with serious borderline or other problems for that matter, especially without further explanation or guidance.
I did another session with the psychologist in question, who actually didn't know how best to guide me. Maybe I could consider meditating and, above all, continuing to complete my assignments. Then we could discuss my answers in the remaining sessions. I already felt alone when I started looking for help, but now I felt quite desperate in addition to being alone. Who's crazy here?
The diagnosis and label circus: Welcome to assembly line therapy
After a long search and hearing dozens of times: no, sorry, our waiting list is longer than the DSM 5 is thick, I ended up at PsyQ, an agency with a hip label and a place relatively quickly, which is not surprising because it is like a factory. Assembly line work, as it turned out. I registered properly and was whisked away upon arrival by a very sweet girl of no more than 20. Hi, I am borderline, what are you, I thought cynically. She indicated that she was an intern and would help me with the intake. She asked me about my history and I told her that I had been to a psychologist who diagnosed me as having Borderline Personality Disorder.
This was quickly written down and I immediately received an adapted questionnaire with 250 questions: "If I'm angry then…
A. no one notices." - That's right, sometimes I'm the ninja of emotions, more discreet than a spy in a field of sunflowers.
B. I raise my voice, Yes, but I also do that when I sing along to the radio, vocal virtuoso that I am.
C. I explode, sure, I identify as a walking firework, always ready for New Year's Eve.
D. Am I cutting off someone's throat, seriously?! Do they mean with a plastic sandwich knife during a game of Monopoly?
When I struggled through all those questions, I was convinced that there was or must be a lot wrong with me. The following week I was invited for an interview with a psychologist and intern, who also had no interest in my story. But did have explicit questions for me, such as: Do you ever think about hurting your child or setting the dog on fire? So to speak, he added jokingly. Illustrious detail, after two sessions of endless questions, I was assigned a different psychologist at my next appointment because the previous one had been suspended. (Definitely set his dog on fire, so to speak, I thought jokingly)
The magical questionnaire that can always find a label
I completed four questionnaires in total and it turned out - how surprisingly - that I had a borderline disorder, in combination with a histrionic personality disorder. So yes, they could help me, what a relieve! Two therapy variants were offered for the treatment of Borderline Personality Disorder: Schema therapy and DBT therapy (Dialectical Behavioral Therapy).
You couldn't choose yourself, neither did the employees, the computer would randomly assign me to one of the two. Nice and personal (disorder), I thought. This entire process took almost 6 weeks in total, after which I was told that I would have to attend group therapy and individual therapy once a week for one year.
According to this institution, the definition of Borderline Personality Disorder is if you regularly suffer from:
unwanted conflicts with others
instability in relationships and self-image
impulsive and erratic behavior
often fear of being abandoned
experiencing changing moods, sadness, irritability
you regularly feel crisis-like, panicky, or very tense
self-harm or tendency to do so
thoughts about not wanting to live anymore.
I remember thinking, that's a bit general and short-sighted. Not everyone who is impulsive or has separation anxiety can be labeled as borderline and vice versa, people with suicidal thoughts cannot all be labeled as borderline.
Anyway, I had a very extensive intake, more than 1000 questions answered. I have now spoken to a variety of therapists and counselors about very different matters and statements. So bring on that therapy! In a year I will be a different person and my relationship will be completely fine again.
Group sessions with others with identical labels
I was assigned to the lucky ones who were allowed to follow DBT therapy. A therapy invented by Marsha Linehan, who combines cognitive restructuring with acceptance, mindfulness, and education. It meant very little to me before I started this year-long commitment. I read about it and got excited about it. Sounds good, right? Mindfulness and acceptance, that is something for me, I am open to this. The following week I went to my first group session in good spirits and a little nervously. Together with nine others and two supervisors, we sat in a circle for a whole morning. The group was not homogeneous, there were people who had almost completed their journey and people like me who continuously entered as newcomers, which was an interesting mix.
Everyone seemed nice and I was in luck because there was a fun group assignment where we all had to sit on a balloon. Then and now I still have no idea how that was supposed to help, with any problem, but that's beside the point. Everyone was allowed to have their say and reflect on the past week, since the last group session. It felt a bit like what I imagined an AA meeting to be like, although luckily we didn't have to stand and we didn't get a coin for each milestone achieved.
We worked on the books of Prof. Linehan, which seemed to be scanned through rather haphazardly. After a few of these meetings, I was a bit shocked. In the wonderful world of therapy, supermarkets turned out to be the stage for unexpected confrontations. For example, one of the participants described that she had been triggered by something as simple as an annoying noise and had attacked someone in the checkout line. Then there was that session in which the chairs were not just for sitting but quickly transformed into emotional projectiles and literally flew around our ears. After such a spectacular outburst we received the classic: And how do you feel about this? Analyzing, you might wonder if this was therapy or an audition for the latest Tarantino. After all, it was all filmed.
You can cherish your label if therapy can combat the symptoms
As we got deeper into the workbook, more mindful suggestions were made. Do you feel anger rising? Immerse your face in ice-cold water. Do you feel like a conversation is getting out of hand? Say “stop” out loud and walk away. Besides the fact that this sounded as if previous patients had that advice up their sleeves and I seriously had the feeling 'easier said than done', I also had the strong feeling that the therapy was based on symptom control. While now I was dealing with the sticker borderline on my forehead, I just really wanted to know how I got it and more importantly how I got rid of it.
I decided to give it 110%, then the logic would probably start to dawn on me. Even though I found the long therapy sessions with people who experienced short circuits on a daily basis tiring. Almost no one in the group managed to have a normal job or stable relationship with anybody in their life. I did not recognize myself at all in their serious daily struggles. I started to wonder how the rest of us had gotten their Borderliner badge, who of the nine of us really had it?
I mentioned this in the individual therapy I had with a very nice recently graduated psychologist. Who, according to the photos on her public Facebook profile, mainly hung around drunk in nightclubs, but that's beside the point. She looked at me with understanding every time, made manageable drawings of everything on a flipchart, and filmed every meeting for learning purposes (a requirement to even qualify for treatment is that you had to agree to be filmed, this material would remain available for years)
Using your label as an excuse
I repeatedly indicated that I did not recognize myself in the image of a person with borderline described in the reference work. Also, I had the feeling that since I had been given this diagnosis, my problems, the excessive arguments with my partner at home, only became worse. He had scoured the entire internet and recognized all the characteristics (and more) in me as a borderline person.
This became a stick to beat with. Every wrong look, word, or action was translated by my partner as an unstable borderline trait. After all, I had been given the label. This was so frustrating that I just made less and less of an effort to solve a problem or argument. Of course, I'll throw a plate at your head, after all, I was a borderline, right? Then that's allowed. Then I too had something 'heavy' to tell in the weekly group sessions. At least there, I received support from nine others, who all said: Oh yes, I feel you! My partner should just shut up, I was mentally ill after all. Learn to duck all that I throw at you, my friend!
From bad to worse: Living according to your borderline label
I didn't feel helped. Of course, I understood that you shouldn’t throw plates at someone's head. I didn't get any better at throwing dishes either, most of them still missed target. I wondered: I never had the urge to do that to anyone else, I only had this very dark frustration and uncontrollable need to destruct something, during the endless arguments I had with my partner at home. Of course, the arguments had an after-effect on the relationship I had, with our children in particular. They were certainly the victims, but I never threw anything at them, not even play-doh.
I felt not seen at home or by those around me, who were now being told by my boyfriend that I was a borderline patient. I had been dismissed as unstable with a poor throw. This wasn't working out. If I accomplished anything, it was that I understood even less about myself, became even more insecure, and convinced that I was the root of all evil. I felt even further removed from my partner than ever. Quite depressive thoughts crept into my head more and more often.
In retrospect, not surprising of course. If you hear every day that you are an unstable borderliner, to try and stay strong and tell yourself that it isn't so, was impossible. I started to believe it and abuse it myself.
Can you just shed your label?
After six months it was time for an evaluation at the institution. I honestly admitted that even though I did all the assignments, told my story, and listened to the stories of others with interest, I did not feel helped or at the right place. To my surprise, this was agreed by the care providers involved. But yes, if I left the program, they wouldn't be able to help me anymore. So I became a dropout and was 'finished' after six months. I was offered to do the intake again to see if another disorder would emerge, with which they might be able to help me.
I thought this was strange. It's not about the label that I get, is it? Do I even have a disorder if it's been looked upon so indifferent, I started to wonder. I want help and guidance with the problems I am experiencing. I don't want to be put in a box where my problems come closest to a very pragmatic diagnosis, this is the world upside down. What does the (DSM 5) book say? Oh, then according to the guidelines you have disorder so and so and that must be true. Let's label!
I also noticed this during the intake of the initial borderline therapy, I was expected to commit to several hours of therapy per week, intensive training, group discussions, and 8 workbooks for a year, and yet it said in small print:
'At the end of the dialectical behavior therapy, it is examined how any follow-up treatment will be provided'.
It made me hopeless. What also didn't help was that my partner became even more convinced that the problems between us were entirely due to me and 'my disorder'. He had absolutely no intention of seeking help with me, why? I was a borderline after all, there was little he could do about it and the problem lay with my behavior and not with him, he was completely fine and had no problem whatsoever. He had now turned it into a colorful anthology about how my childhood had affected me, my relationship with my parents, and how the character of my father influenced my mental development as a child. It won't be long before he could graduate as a fantast(ic) psychologist himself, I thought.
Functioning fully with a borderline label, how is that possible?
We muddled along, and the problems became bigger, not only was I officially labeled as unstable with multiple disorders, but a lot was happening around us. My dear mother-in-law started to suffer from dementia and since her children were not there, I took care of her and everything that needed to be arranged, this was emotionally draining. My boyfriend's teenage daughter came to live with us from a bad home situation. She also had a lot of practical matters that had to be arranged immediately (for example, we built a room on a weekend and I called all 48 schools in Amsterdam to find a place for her within a week).
Strangely enough, there was no doubt about my mental and emotional abilities at the time, because yes, my boyfriend was away from home and his family was nowhere to be seen. So, with all my inability, ignorance, and unbridled instability, I was allowed to take care of everyone who was thrown over the fence. My feeling of loneliness only got worse and so we went round and round in the same circle.
Until, during yet another argument, with yet another accusation of me being an unstable borderliner, I desperately packed my bags and called the only person I could think of: Ben. I knew he was doing coaching, not that I cared at the time, I mainly wanted to get away and he was the first inspiration.
If therapy doesn't work, is coaching a solution for my label?
I remember arriving at Ben's house and throwing out my whole story while sobbing at his large kitchen table, confused, emotional, and with quite a bit of self-pity. Ben looked at me understanding, nodded at the right moments, and asked a question here and there. After I finally finished. Ben said that he would be happy to help me if I was open to it.
When I first heard about coaching, I imagined a colorful mix of hipsters, housewives, and expired yogis in linen pants. I thought that after a weekend course at Shirley's attic, - among the boxes of Christmas decorations and a dusty hometrainer - John and everyone who felt like it, could walk out with a self-made certificate and call themselves a coach. In retrospect, it is safe to conclude that I may have been a bit biased.
So here we went, I could at least tell my story, if it doesn't help then it won't hurt, right? So as I told my story, Ben tailored his approach by listening. A win-win, I could finally tell my story, and he made a thorough and ultimately mega-effective approach. In the beginning, it was mainly about gaining knowledge of how coaching works and we did some yellow-note sessions, so far so good. But the deeper we went, the more the finger was put on the sore spot.
Who decides if I am really a borderline?
I soon found out what it really means to 'work on yourself'. After all, I had been willing to admit for years that I, like so many others, had not had such a pleasant childhood. My rage bordering on aggression, which surfaced when the wrong buttons were pressed long enough, must have come from somewhere and was causing problems. I noticed that I experienced quite a bit of resistance when it came to light that recognizing that you have a problem also means that you take responsibility for it yourself.
Because I already suspected that that borderline diagnosis was incorrect. But unconsciously I also started to live by it a bit, I no longer felt so responsible for my actions and reactions because I had borderline after all. Ben's approach suddenly made me accountable for my actions. With some small exercises in the beginning, I was given the tools that gave me the confidence that I could actually do something about it myself. But that also brought with it a responsibility.
Coaching as a sticker remover for my borderline label
From day one, Ben and later other coaches said: stop with the label, you are not sick. You have a few 'thought patterns' that could be made more useful. In doing so, he did not downplay what I initially thought, after all, I had been given a huge stamp of dysfunction in regular healthcare, right? But it became more accessible to work on. What I later understood was that I did not have a scary mental illness that others had to do something about to get rid of, but that I could learn the tools to 'normalize' myself.
Coaching, as opposed to regular therapy, addressed my perception of reality, which was somewhat distorted. But who doesn't have that? It turns out that everyone has it. Ben pinpointed where it got out of control for me at some points. But Borderliner? You need something more for that.
Your perception of reality is fed by third parties and yourself.
What was even more confrontational is that 'my truth' has nothing to do with reality in many areas. Through a combination of what you are told (certainly by institutions), what you have been taught, what you have experienced, and what you have come to believe, we all look at the world through glasses that we have put on ourselves. Once you have those glasses on your nose, it is quite difficult to change frames again. Because this is your interpretive filter, we all have it.
We give meaning to what we see, experience, and hear, through our past experiences, sounds quite logical, right? This interpretive filter is disturbed by distortions, which we all have to a greater or lesser extent. For example, a distortion I had was 'negative prediction'. I often assumed that it would all end badly or that I wouldn't be able to do it after all and expressed that with all the associated negative words and actions.
I learned about cognitive distortions, something I had never heard of before. Of the twelve most common cognitive distortions I was able to identify a few as recognizable. Because in addition to negative predictions, I was also great at exaggerating things and although it might've been funny when I told a nice anecdote, it was actually also a serious problem.
I had unconsciously started using terms like 'terrible', 'always', 'never', and 'horrible' more and more. Now you may be thinking: so what? But essentially I blew up every little problem into a major issue, as well as every reaction. Strong language and intonation result in violent behavior. Basically you start to believe in what you say.
What is really the problem with my 'problem'?
I experienced relief: Some things I took for granted, such as being unstable and borderline, were not actually true. But I had come to believe that. Also painful because how do you start to “disbelieve” that again. And if that wasn't true, what was the problem I had? I learned not only about the interpretive filter and the cognitive distortions but also about the different states we all have.
Do you recognize that? That something goes wrong or that you receive criticism and that, no matter how well-intentioned, it sends you into a completely negative spiral? Suddenly everything sucks, you no longer see the point and a dark thundercloud almost literally forms over your head. You snap at someone else or become completely silent. Only negative words and meanings come into your head or out of your mouth, words like never, always, terrible and horrible. You -unconsciously- fall into a negative state. I really excelled at getting into these kinds of negative states and actually didn't feel responsible for it. If you said something mean to me, I got angry, sad, or frustrated and I threw it all out in a nice and unregulated manner, the dishes were already flying.
In coaching, I learned to recognize my different states because, in addition to negative states, I also had calm, fun, exuberant, and euphoric states. I learned that I had an influence on the state I adopted, I was responsible for it and learned to choose which state I wanted to be in and how to adjust my state in different situations.
Essentially everyone has a disorder that can be labeled
What started out of frustration and a vague notion of problems that lay within me, but which I also blamed the outside world for, started with a diagnosis that took away my own accountability.
Because, yes, everyone essentially has a disorder, especially if you ask the 'professionals'. No matter how small that disorder may be, it can have a major impact on how you feel, think and behave. But as you may be able to tell from my story, the solution can sometimes be much more simple than you think.
My search was perhaps unnecessarily long in detours, but getting to the essence of 'my problem' was short and powerful. Naturally, the coaching involved much more than described here, because the coaching process is personal and different for everyone and it is something you have to continue to work on. And yes, I still make mistakes or end up in a negative state sometimes but I leave the plates in the cupboard.
It is a given for me that coaching was the solution for me to discover that I was not at all a borderliner, but that I did have a few thinking styles that could take me to any state. If you make something simple, it is also simple to solve. That has proven to be the case. We do not need labels and assembly line therapy for this and it also frees up space on the long waiting lists for people who really benefit from psychiatrists such as those who work in mental health care.
By sharing my story I do not want to claim that a coach is the solution for every problem or for everyone. Firstly, because unfortunately there are tons of coaches who visit Shirley and after that visit go out into the world unencumbered by any real knowledge or skills and call themselves an 'expert'. And secondly, because there are of course people with conditions who need more or other help than a coach can provide.
But if you get stuck in your journey in regular care or with a coach, request a second opinion from renowned coaches such as Jos van Boxtel, Aranka van der Pol, Wassili Zafiris, or one of the many others. They all use different methods during their coaching and have a toolbox of exercises to help you become your true self again. Believe me, experienced as these coaches are, they recognize when you really need to go to the Mental Health Service and they will always refer you.
