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Are you the Doctor? ...

Are you the Doctor?

Doctor's Assistant: No. I'm the Psychologist's Assistant.

How does one make an appointment to talk to the doc I have insurance that isnt a problem to pay for this but I have some issues relating to my relationship with my girlfriend I would like to discuss

I have a problem with my girlfriend and frankly I am running out of ideas on how to deal with her. I don't want to end my relationship but I am running out of ways to give her positive help or feedback. My Girlfriend is 54 years old and I am 51, she has a history of sexual child abuse by her step father, a failed marriage of 27 years where her husband cheated on her multiple times (7) to be exact. She has anger issues, she suffers from at one time and I am not sure she has stopped from alcoholism and bulimia. I want to help her, I want her to have the good life she deserves to have.

When she moved out of her step fathers house on the demand she put out or get out, she lived on the streets she ate very poorly went to school and slept on a park bench. She has been a prostitute at one time early in her life and later on she had sex for money one time.

She lives in my home, she pays no rent I provide for her food, shelter, give her money to spend, pay her car insurance her telephone bill. She seems hell bent on causing our relationship problems. Just tonight she called another guy a friend she has never met while talking to me on the phone, telling me to hold on she was almost done talking to me.

I try my best to be supportive, I tell her how much I love her and care for her and want to provide for her

I love her to death, I want to help. I am here in Japan but I see her not eating properly and I definitely see an issue on the mental health side of the house. We argue over the stupidest of things and I am constantly being reminded of something I said in the past that she seems to not let go of. I am not sure what to do anymore to be honest. To end the relationship would be easy but that doesn't help someone I consider to be my best friend and one day I hope to be my wife.

Submitted: 1 year ago.Category: Mental Health
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Answered in 12 hours by:
3/9/2017
Mental Health Professional: Dr. Mark, Psychotherapist replied 1 year ago
Dr. Mark
Dr. Mark, Psychotherapist
Category: Mental Health
Satisfied Customers: 5,334
Experience: Dr. Mark is a PhD in psychology in private practice
Verified

Hi, this is Dr. Mark; I'll be glad to try to help you with this issue. I see that your question has been here for a little while and no one answered until I logged on. I think the reason is because there is no easy answer to give you about the relationship with her. But let me ask a few questions first to help in understanding of the situation.

It sounds as though she is in desperate need of professional help. Is she in therapy at all? Would she be willing to go? Has she ever been in therapy?

The instability you discuss sounds like it is very trauma based for her and has been going on long enough that it would not be able to be resolved without very intensive treatment. Are you willing to accept that she will be like this, unstable and impulsive and sometimes perhaps not loyal as a way of life?

Now for the tough question: and that you aren't going to be able to change that about her? That this is what she will be without very intensive professional treatment?

Any extra information that will help, feel free to share.

Dr. Mark

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Mental Health Professional: Dr. Mark, Psychotherapist replied 1 year ago

Hi. I see you haven't yet responded to my follow up questions to you. I would be very interested in hearing back from you with your responses and then moving forward on your question if it is still an issue.
Let me know,

Dr. Mark

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Customer reply replied 1 year ago
I guess a question I have is there someplace I can get information on where or what I can do to support her. She is going to a counselor and that is a start but I feel what she needs is a psychiatrist. I agree this is a very personal kind of trauma, I would like to see the demons in that skeleton closet taken out for some fresh air.
Mental Health Professional: Dr. Mark, Psychotherapist replied 1 year ago

Hi, I'm glad you replied because your girlfriend's situation is indeed a very serious mental health issue. I want to broach with you the possibility of Borderline Personality Disorder (BPD). My questions above were all aiming to rule it out or confirm. I want to show you the diagnostic criteria for BPD and I'll paste them in at the end of my posting so that you and perhaps she can see them and see for yourself how even a brief description like you gave would lead us to see if this is the problem. I didn't edit it. It's from the BPDtoday website.

I'll continue also with what you can do to support her. The resources I'll write about are in the US because I don't know what's available in Japan. I'm sharing them with you so that you can see what they are like and then search for equivalent services in Japan.

Now, that all said, even if she doesn't feel she has full blown BPD, the tools and efforts I'm going to discuss below will still help her. They don't need a diagnosis to be useful to her.

I don't know if there is any way to reach her but I would like to make an attempt. So, I'm going to take a pause here from talking to you and to address her directly. So you can print out my answer and have her read it or at least that portion:
I can imagine how overwhelming this situation must be for you. You are using all your internal resources just to maintain any equilibrium given all the emotions you feel. I am truly impressed with the efforts you are making to not let all the overwhelming bad feelings overtake you at this point in your life. The history and feelings must sometimes be truly overwhelming. And it seems that these feelings are indeed overwhelming you and driving you to take actions you know may result in completely uprooting the stability of your life.

And this is what I very much need you to consider and think about. You will gain the most in trying to help yourself if you will look into a disorder called Borderline Personality Disorder (BPD). It may be the problem you are facing now that has been present within you throughout your adult life and is now overwhelming your feelings. And why is calling it BPD important?
Because BPD has a truth you need to get to if you are going to find lasting relief. Because the steps you are about to take are going to destabilize you and you will find you will be in a spiral of continually overwhelming feelings.

That truth is that relief, your personal salvation, is not going to come THROUGH YOUR FEELINGS!
You're not going to FEEL your way toward feeling better. Yes, that sounds like a contradiction. But, the key for you is going to be whether you are going to be able to learn to approach life from something other than feeling. Because feelings are too overwhelming. They keep changing. And they are telling you different things all the time. This is the way feelings are for you. So, life can be good for you but only if you have the patience and willingness to LEARN how to approach it from a different part of you than how you feel. Especially when your feelings are so intense. So that you aren't always so often overwhelmed by what you're feeling and searching for relief.
You need help in learning how to manage your feelings that were shaped during your youth which was so difficult. For you, then, to learn how to approach life from something other than feeling, the best type of therapy is Dialectical Behavioral Therapy (DBT). I want you to learn the skills that DBT offers. So, start with the following website put together by people who aren't psychologists but who have gone through DBT themselves. Try as many of the self-help options they have. Mindfulness is particularly important for you and a good place to start there. Here's their web address:
http://www.dbtselfhelp.com/
If you connect with DBT, then find a therapist in your area who works with DBT. Even better, find a DBT group to go along with individual therapy. Please take the time to do this. It will help you TRULY bring your feelings into a state of calmer relief.
If you need more resources here's a commercial website. They have a chat group that you might want to join:
http://www.borderlinepersonalitytoday.com/main/
Okay, I'm back. You need help and resources as well. Randi Krieger wrote a book you will find in the library though it's very popular and may be checked out. So you may want to buy it online. It is called Stop Walking on Eggshells. Her is the American Amazon page for it:

http://www.amazon.com/Stop-Walking-Eggshells-Borderline-Personality/dp/1572246901/ref=sr_1_1?s=books&ie=UTF8&qid=1284441698&sr=1-1

She also has a wonderful online group called the Oz Online Community for Family Members. You need to really get to know her resources because they'll help you. She's a very nice person, too. Here's the web page:

http://www.bpdcentral.com/support/email.shtml
Okay, I wish you the very best!

My goal is for you to feel like you've gotten Great Service from me and the site. If we need to continue the discussion for that to happen, then please feel free to reply and we'll continue working on this. If the answer has given you the help you need, please remember to give a rating of 5 (Great Service) or 4 (Informative and helpful), or even 3 (Got the job done) button. This will make sure that I am credited for the answer and you are not charged anything more than the deposit you already made by pressing any of these buttons. Bonuses are always appreciated! If I can be of further help with any issue now or in the future, just put "For Dr. Mark" in the front of your new question, and I'll be the one to answer it. All the best, ***** *****

Borderline Personality Disorder DSM IV Criteria
A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
1. frantic efforts to avoid real or imagined abandonment. Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.
2. a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.
3. identity disturbance: markedly and persistently unstable self-image or sense of self.
4. impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.
5. recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior
6. affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days).
7. chronic feelings of emptiness
8. inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)
9. transient, stress-related paranoid ideation or severe dissociative symptoms
The DSM IV goes on to say:
The essential feature of Borderline Personality Disorder is a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity that begins by early adulthood and is present in a variety of contexts.
Individuals with Borderline Personality Disorder make frantic efforts to avoid real or imagined abandonment (Criterion 1). The perception of impending separation or rejection, or the loss of external structure, can lead to profound changes in self-image, affect, cognition, and behavior. These individuals are very sensitive to environmental circumstances. They experience intense abandonment fears and inappropriate anger even when faced with a realistic time-limited separation or when there are unavoidable changes in plans (e.g. sudden despair in reaction to a clinician’s announcing the end of the hour; panic of fury when someone important to them is just a few minutes late or must cancel an appointment). They may believe that this "abandonment" implies they are "bad." These abandonment fears are related to an intolerance of being alone and a need to have other people with them. Their frantic efforts to avoid abandonment may include impulsive actions such as self-mutilating or suicidal behaviors, which are described separately in Criterion 5.
Individuals with Borderline Personality Disorder have a pattern of unstable and intense relationships (Criterion 2). They may idealize potential caregivers or lovers at the first or second meeting, demand to spend a lot of time together, and share the most intimate details early in a relationship. However, they may switch quickly from idealizing other people to devaluing them, feeling that the other person does not care enough, does not give enough, is not "there" enough. These individuals can empathize with and nurture other people, but only with the expectation that the other person will "be there" in return to meet their own needs on demand. These individuals are prone to sudden and dramatic shifts in their view of others, who may alternately be seen as beneficent supports or as cruelly punitive. Such shifts often reflect disillusionment with a caregiver who nurturing qualities had been idealized or whose rejection or abandonment is expected.
There may be an identity disturbance characterized by markedly and persistently unstable self-image or sense of self (Criterion 3). There are sudden and dramatic shifts in self-image, characterized by shifting goals, values, and vocational aspirations. There may be sudden changes in opinions and plans about career, sexual identity, values, and types of friends. These individuals may suddenly change from the role of a needy supplicant for help to a righteous avenger of past mistreatment. Although they usually have a self-image that is based on being bad or evil, individuals with this disorder may at times have feelings that they do not exist at all. Such experiences usually occur in situations in which the individual feels a lack of meaningful relationship, nurturing and support. These individuals may show worse performance in unstructured work or school situations.
Individuals with this disorder display impulsivity in at least two areas that are potentially self-damaging (Criterion 4). They may gamble, spend money irresponsibly, binge eat, abuse substances, engage in unsafe sex, or drive recklessly. Individuals with Borderline Personality Disorder display recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior (Criterion 5). Completed suicide occurs in 8%-10% of such individuals, and self-mutilative acts (e.g., cutting or burning) and suicide threats and attempts are very common. Recurrent suicidality is often the reason that these individuals present for help. These self-destructive acts are usually precipitated by threats of separation or rejection or by expectations that they assume increased responsibility. Self-mutilation may occur during dissociative experiences and often brings relief by reaffirming the ability to feel or by expiating the individual’s sense of being evil.
Individuals with Borderline Personality Disorder may display affective instability that is due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days) (Criterion 6). The basic dysphoric mood of those with Borderline Personality Disorder is often disrupted by periods of anger, panic, or despair and is rarely relieved by periods of well-being or satisfaction. These episodes may reflect the individual’s extreme reactivity troubled by chronic feelings of emptiness (Criterion 7). Easily bored, they may constantly seek something to do. Individuals with Borderline Personality Disorder frequently express inappropriate, intense anger or have difficulty controlling their anger (Criterion 8). They may display extreme sarcasm, enduring bitterness, or verbal outbursts. The anger is often elicited when a caregiver or lover is seen as neglectful, withholding, uncaring, or abandoning. Such expressions of anger are often followed by shame and guilt and contribute to the feeling they have of being evil. During periods of extreme stress, transient paranoid ideation or dissociative symptoms (e.g., depersonalization) may occur (Criterion 9), but these are generally of insufficient severity or duration to warrant an additional diagnosis. These episodes occur most frequently in response to a real or imagined abandonment. Symptoms tend to be transient, lasting minutes or hours. The real or perceived return of the caregiver’s nurturance may result in a remission of symptoms.

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