Destigmatizing Borderline Personality Disorder | Jamie Sedgwick of the Trauma Specialists Training Institute

I think that it's a population that's really misunderstood and I think that there is a lot of this belief that it isn't treatable or just that it's difficult to work with. So I've seen incredible things happen, incredible healing happen. And it makes me sad for people that have that diagnosis when then they kind of get re traumatized because they're getting bounced around to different providers and hearing like, I can't help you or I'm not going to help you, and it creates a whole different set of negative belief systems then that they really can't be helped and healed. So my passion is to help providers see that this really is treatable, that it can be really rewarding work, and to also support providers in taking care of themselves and understanding what comes up for them and doing that work so that they don't experience burnout when they're doing it.

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welcome to the Mental Health Entrepreneur Podcast. I am your host, Rachel Harrison, and with me is Jamie Sedgwick, who is a therapist and trainer specializing in Borderline Personality Disorder. I know a lot of times on this pod we are really focusing on innovation in the mental health space and entrepreneurial ideas and thought processes and, and today we are still talking about innovation, but we are going to be challenging the way that we treat people who have a certain diagnosis, and that diagnosis is going to be Borderline Personality Disorder. So, Jamie, let's dig in. Talk to me about BPD and how it has historically been viewed by the medical community and the mental health community.

Yeah, so I actually started working with Borderline Personality Disorder as, as an intern because I had the opportunity to support a DBT group and then I was doing individual sessions. So it was in that environment that I started working with bpd. And it was a unique experience because it was not stigmatized there because DBT is created to treat bpd. So I was kind of sheltered from the stigma that does exist. So it wasn't until I got out of that internship and got licensed and started working in other settings that I realized that other clinicians, other providers, really did not want to work with Borderline Personality Disorder. Even someone having that diagnosis in their chart, for instance, could change the way that they're treated or whether or not someone takes them on as A client. So it is definitely one of the more stigmatized diagnoses, even in the mental health field.

Yeah, I agree. I've heard clinicians over the years say something like, I don't take any clients that are borderline personality disorder. I don't treat that disorder. And even I have heard a lot of things historically that this is an untreatable condition. So that's another thing that I think is maybe a myth that's out there that is sort of in that category of, oh, well, we can't do much for you.

I actually tell people that of all the diagnoses that you could possibly receive, this is one that when you walk out of my office, you will no longer meet criteria for this. I feel confident that we have the treatment modalities to make that a possibility. And you're not going to need medication either.

That's a pretty big promise.

It is, but I've seen it happen so many times that I feel confident in it. The real secret really is emdr, because when you start to understand, truly understand bpd, you understand that it is, I say it's a particular brand of attachment trauma. So we can use EMDR to treat that attachment trauma. And we know that emdr, or eye movement desensitization and reprocessing is an evidence based therapy for treating trauma. And we're just talking about trauma. We can use that, we can treat it.

Okay, but I want to go back a little bit to how did this come about? Why do you think that this disorder is stigmatized? Like what's going on there?

I think it's fear. I really think that it's fear because especially when we talk about some of the safety concerns that may come up when working with borderline personality disorder, specifically the suicidality is the one that I see. Clinicians in general just were trained to make it stop. I could do a whole nother podcast about that. But it induces fear, that suicidality. And so I think clinicians, that's a piece of it. And I think it's also the interpersonal piece. When we talk about BPD as a form of attachment trauma. I really do believe that some of the symptoms, for lack of a better way to explain that, that, that we see show up in relationships, were an effective way of getting their needs met at one point in time. And they're probably coming to treatment because it's no longer effective in their present day setting. However, those dynamics are going to show up in the therapeutic relationship because that's the only way they know right now how to get their needs met. So they're going to try to get their needs met in that relationship that way, too. And I think that that is another piece of it. Because as therapists, you know, we have to be very aware of our own countertransference. And when some of those relational pieces are happening, the countertransference happens. And if we aren't willing to be aware of that and look at it, it's going to. I don't love this word anymore, but trigger the therapist, too.

So what are some of those behaviors or dynamics that you're referring to? What are some of the symptoms that can appear?

The first one that comes to mind for me is the suicidality. So this is not. I'm not generalizing this. This is just some ways that I've seen it show up. But sometimes that suicidality is just a way of trying to get a certain need met. Right. Like, I'm expressing how much I'm hurting. I'm expressing that this is the degree to which I'm hurting so that you can really fully understand it. And you give me what I need, whether that's more attention or an extra session or an extra phone call outside of session, It's a way to get that need met. And so starting to look at, like, hey, you could just tell me that you're needing a little bit of extra support this week, or it feels like you need a little bit of extra support. And if you are having that suicidality, I'm happy to talk about it, but you don't need to use that as a way to get that need met.

I like that. I know early on in my career when I was trained about borderline Personality disorder in person, they would term it as the cry of a borderline personality disorder client. And that would be, I hate you. Don't leave me. So kind of this, like, piece of, like, maybe a lot of negative energy, a lot of angry energy, but also then fear of losing the relationship. So talk to me a little bit about that. Is that an accurate description? Hey, everyone, this is Rachel, host of this podcast and owner of the Trauma Specialist Training Institute. I wanted to just reach out and tell you a little bit about something that we have coming up. It's called borderline Personality Disorder through a trauma lens. Destigmatize bpd, gain skills and reduce your fear. We're having this training on December 12, 2024, and it's designed for all levels of learners and does not require EMDR basic training to register. I know. I have talked to so many clinicians that feel like borderline personality disorder is a scary thing to treat. It can be something that as clinicians sometimes makes us feel overwhelmed and unsure of what to do. But I would like you to learn more about this and conceptualizing BPD through a trauma lens. If you're interested in that, then this training is for you. This one day virtual training will help you feel more confident in your ability to treat BPD with concrete trauma informed skills and techniques. You'll also gain insight into how BPD manifests in the therapeutic relationship. And only for you, our podcast listeners. You can use this code mhetraining that's mhe dash training to get $20 off your registration. So check us out, go to the website www.traumaspecialiststraining.com and join us on December 12th to take the first step in reducing fear and effectively helping your clients heal.

I think the, the classic I hate you, don't leave me is really speaking to a disorganized attachment style. And it's a little bit of I want the closeness, but then the closeness feels really scary and so then there's a push. Sometimes it's prove that you are as invested in this relationship as I am. But I think that that's a really generalized way of speaking to the disorganized attachment style that we often see when we're working with Borderline Personality disorder.

Okay. You kind of talked about how you experienced this disorder in your internship. How did you get involved with specializing with these folks?

I love it. I find the work to be so rewarding. But I really, it was that, that background in DBT that then when I got provisionally licensed and that was really, you know, as a new therapist and I'll be honest, I didn't know what I was doing, but I did have my, I did have my skill set of, of dbt. And so that was really how I, I really operated using dbt. I think there's also, I'm a firm believer, I don't know how many other people might think this as well. I think our specialties choose us. We don't necessarily choose them. But I think that maybe my willingness and openness and not having that stigma about BPD allowed me to see how prevalent it was in my caseload because there are so many different presentations. Like any diagnosis, there's hundreds of different ways that this could present. And I think when people think of BPD and stigmatize it, they're probably thinking of a, like a very small subset of presentations. So I think that many therapists don't even realize how often they are working with bpd. So it's a little, little funny to me sometimes when I hear people say I don't work with BPD and I'm like, if you work with trauma you are okay.

What is your sort of personal passion and mission to kind of advocate to destigmatize this population? I'd love to hear kind of what you're passionate about.

I think that it's a population that's really misunderstood and I think that there is a lot of this belief that it isn't treatable or just that it's difficult to work with. And in my experience when working with any kind of personality disorder, quite honestly, but with BPD in particular, when you can hold space for and really hear the person's experience and understand what, why they are interacting in relationships the way that they are or responding to different relational things the way that they are, it shifts the dynamics. It gives us lots of opportunities for some of what's called disconfirming experiences in therapy to start to shift how people experience and interact in relationships. So I just think that I've seen incredible things happen, incredible healing happen and it makes me sad for people that have that diagnosis when then they kind of get re traumatized because they're getting bounced around to different providers and hearing like I can't help you or I'm not going to help you and it creates a whole different set of negative belief systems then that they really can't be helped and healed. So my passion is to help providers see that this really is treatable, that it can be really rewarding work and to also support providers in taking care of themselves and understanding what comes up for them and doing that work so that they don't experience burnout when they're doing it.

Yeah. So what is your idea, maybe just broad strokes of how you would go about a treatment plan or different treatment modalities with this group of people.

So as an EMDR trainer I am very passionate about emdr. I've already spoken to that is a big part of the treatment plan if that is what the client is wanting. Because of course like we're always going to shape that treatment plan around what the client is wanting and needing. But I would be advocating for the use of emdr. Of course. One of the things that is unique when using EMDR to treat BPD is that phase two work, that early phase one and phase two so the client history taking and the preparation. So for me personally, I'm doing a lot of relational work. So really focused on using opportunities to create those adaptive relationship experiences in the therapeutic relationship when it presents itself. Using some DBT skills to help with stabilization, if that's needed. Definitely some ego state or internal family systems work. Because we are usually seeing more clinically significant levels of dissociation when we're working with borderline personality disorder. So that's kind of the preparation before we get into trauma reprocessing. And then when we get into the trauma reprocessing phases of emdr, making sure that I'm pulling the right protocols out of my toolbox to best support the client and their reprocessing, really with a focus on keeping them within their window of tolerance, like we would do with any client that's doing trauma reprocessing. So that's not really different, but just maybe a special consideration to making sure we're supporting there.

So what about clinicians that are not EMDR trained?

I think that people that are not EMDR trained can still do wonderful stabilization work. So when we think about the three stages of trauma treatment and that first stage being stabilization, again, whatever their style or their preferred modalities are for helping establish stabilization would work wonderfully. But special attention also to the therapeutic relationship and how those moments of immediacy within the therapeutic relationship can be used to start to model and reshape the way the client experiences relationships. That they can have an emotion and express an emotion and not get punished for it, for instance. And that we can also, as therapists, model healthy communication in those moments.

Bits, I love that. Yeah. If you could pick something that you would want, someone who either feels like they struggle personally or they know someone who struggles with borderline personality disorder, like, what would be the takeaway, the message that you would want to give to those folks?

There is hope and there is an opportunity to heal. And I see it happen all of the time. Like I said, I. You said it was a big promise. But I do believe that people coming in with that diagnosis can. Can leave treatment without that diagnosis.

Yeah. And then how about a word to therapists that might be listening or people that know a therapist? What would you want the message to that group to be?

Openness to learning more. An openness to understanding more, with an emphasis on making sure that they are taking care of themselves in that process. If they are open to learning more and doing work with people that are coming in with presentations of bpd.

Yeah. And last one, if we kind of go a little more macro on this to kind of advocate for destigmatizing this group of people. What do you want just anyone to know about this disorder? Or they may hear something or they're walking around in the world. How do we advocate that what is

often stigmatized with this diagnosis are really ways that these folks got their needs met. And don't we all need to get our needs met?

Yeah, we all do.

So they learned how to do that in early life. They learn those skills. I mean, they're really skills. They become maladaptive later in life, but they were adaptive at the time that they learned them in order to get those needs met.

Yeah. This is really inspiring, Jamie. I love this new take on kind of changing the way that people look at borderline personality disorder, changing the way that it's treated. If you just had one last sort of word of advice or inspiration, maybe to somebody who is thinking about a disorder differently or treating something differently, what would be your word or worse?

You're asking me big questions, Rachel. Honestly, I go back to the values that I'm treating my clients, so I think empowerment. When we empower our clients and the people around us, really, anything is possible.

Awesome. Thank you so much for being here today for my audience. If you want to learn more about Jamie, all the things that she's doing, all of that information will be in our show notes. So thank you for being here, Jamie, and thank you for being here and listening, everybody.

Yeah, it was a pleasure.