Tuesday, November 10, 2009

Keep Your Eyes on Hers


The referral letter read, "borderline," and my first glimpse reinforced its assessment. Tight jeans, low-cut blouse, anatomy pushing out of every available space. Keep your eyes on hers, I reminded myself -- therapists are human, too. Once she began to speak, I realized I would have no problem because her story was compelling. She had a highly placed position with a large firm in San Diego, had a comfortable income, but she'd gotten into debt, and couldn't understand why she'd taken the job to begin with. It was everything but the dream of a lifetime. Having few close friends, she'd begun sleeping more, had no energy, and finally overdosed on some nondescript medication.

She took a leave of absence, hoping some time away would help, and attempted suicide a second time. Two serious efforts at self-harm, young, female, prone to dress in a manner some might call provocative (others merely stylish), and it was decided she must have borderline personality disorder. Unfortunately, it's an easy mistake to make -- psychiatry tends to lie a little more on the art side of the medical spectrum anyway, and particularly when your predispositions color your judgment.

But borderline seemed not quite right -- her emotions were fairly stable, her recent impulsiveness was uncharacteristic, she didn't abuse drugs or alcohol, and she didn't have the off-on, in-out history of multiple relationships you often see. She was depressed, felt her choices were less her own and more those of boss and boyfriend, and she had become desperate. As we talked, I felt increasingly embarrassed about my initial impression.

You've heard it said, I'm sure, that appearances can be deceiving. It's very tempting to become so attached to a diagnosis that you're loathe to abandon it, even when the evidence that you should is absolutely glaring. You end up trying to force someone to fit your expectations and miss the real person sitting right in front of you. In this case, she was a young woman who gradually demonstrated a tremendous capacity for self-reflection and change. By the time our work together had come to its natural conclusion, I was no longer certain which of us had learned the most. And those are not only sometimes the best kinds of therapy, they're also some of the best kinds of relationships.


(Public domain image of an unknown young woman via Wikipedia)

(Note to the reader: some details have been altered and/or fictionalized to preserve patient anonymity -- the lessons learned by the therapist, however, are quite real)
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