I terminated transference-focused psychotherapy (TFP) with my therapist, Dr. Lev, in December 2016. TFP treatment typically lasst one to three years. We met twice weekly for 11 years.
It wasn’t until I started working with Dr. Lev in 2005 that I understood just how ill I was. She was transparent with me and explained to me the Kernberg conceptualization of personality organization. She told me at the beginning of my treatment that I fell into the low borderline organization classification.
I don’t know what her prognosis was for me when we started working together. She kept that to herself, but I do know that she didn’t give up on me. Not after she needed to hospitalize me six times in the first 18 months and we worked together due to my having detailed plans for suicide. Or in 2014, when I broke our contract and attempted suicide. TFP calls for a therapeutic contract when individuals begin therapy. One of the conditions outlined in my contract stated that if I attempted suicide, Dr. Lev would do everything she could to save me, then she would end our treatment. When I was in the psychiatric hospital and received word that she had decided to see me again, I cried out of relief. That was a turning point in the therapy. I was able to acknowledge my angry feelings for the first time and our work took on an intensity that had been lacking.
There have been multiple 10-year follow-up studies of patients diagnosed with borderline personality disorder. I’m not quite at the 10-year mark from when I terminated therapy with Dr. Lev; it’s been more like nine. But call me curious.
One ten-year longitudinal study stated, “The fact that the patients with BPD improved more than those in the comparison groups reflected their having lower baseline functioning. The initially more severe level of the BPD sample’s functional impairment tended to converge toward the levels of both comparison groups over time. As measured by mean GSA (Global Social Adjustment) scores at 10 years, BPD’s social adjustment (3.1) lagged considerably below that found for MDD (2.7), bipolar I disorder (2.9), and bipolar II disorder (2.8) after 14 to 15 years.”
Another study, which focused more on interpersonal features, reported, “The last interpersonal feature to remit, that is affective consequences of being alone, has been identified in clinical theory as a core feature in BPD. Modell, Winnicott, and Masterson described the processes relevant to the developmental milestones of separation and acquiring the ability to be alone.”
Yet another study found that “that recovery from borderline personality disorder, with both symptomatic remission and good psychosocial functioning, seems difficult for many patients to attain. The results also suggest that once attained, such a recovery is relatively stable over time.”
How is good psychosocial functioning defined in the context of BPD? According to one definition, “Good psychosocial functioning that involves both social and vocational competence is difficult for borderline patients to achieve and maintain over time. In addition, their vocational functioning is substantially more compromised than their social functioning.”
It seems that the common thread running through these studies is that recovery may be difficult to attain but once a certain level of stability is reached, relapse is uncommon. How is recovery defined? First, as no longer meeting the DSM-5 criteria for the condition, but also reaching a level of good psychosocial functioning.
Acknowledging that I was privileged to have some of the most intense and effective treatment available over three decades, I consider myself fortunate to have made a full recovery. I was treated with DBT (dialectical behavior therapy) on a BPD-dedicated long-term inpatient unit for almost 10 months, then for 18 months at a dedicated BPD/DBT day program while residing in a halfway house. Years later, still struggling, I was referred to Dr. Lev for TFP and she generously lowered her fee so I could afford to work with her. Today, I continue to see her for medication management. It’s hard to believe it’s been 20 years since I first stepped into her office.
I am thriving and, at 64, living my best life. I’m a licensed clinical social worker and I have finally found a job where I look forward to going to work and I’m valued. I go into the office in Manhattan two days a week and work from home three days a week. I’m also an adjunct instructor at a local college, where I teach counseling classes online. I’m a published writer and a blogger on mental health and recovery. I never married nor had children and I have no regrets. I have a small but close circle of family and friends whom I see and speak with often. As a writer, I need to spend more than an average amount of time alone and I relish these moments, especially after a busy day at work. I’m an insomniac and I find that my most productive time is early in the morning when the sunrise is imminent and the world is quiet. I have a memoir-in-progress and I work on it as often as I can. And of course, I have my baby, Shelby, my rescue dog and we will celebrate her sixth home-aversary on Memorial Day of this year.
I hope this post gives other people with BPD and their loved ones hope. Especially if for some reason DBT was not effective for them. Full and sustained recovery is possible. It takes a lot of work and painful exploration, but a good life is achievable.
If you or someone you love is contemplating suicide, seek help immediately. For help 24/7 dial 988 for the National Suicide Prevention Lifeline, or reach out to the Crisis Text Line by texting TALK to 741741. To find a therapist near you, visit the Psychology Today Therapy Directory.
