Daily Archives: April 14, 2019

I’ve been told that all personality disorders are egosyntonic, and that therefore if I wonder about having BPD I don’t, and should not see a doctor. Is this true?

Ask yourself this, Dan. Would you find the following egosyntonic: afraid that everyone despises your very presence. How about this: you fear close emotional relationships based on the “crazy” closeness that you experienced as a small child. Add to that … Continue reading

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I think my therapist is retiring.She knows I have abandonment issues.I think she is testing me.Something about the way she is acting makes me feel she’s getting ready to tell me she will be leaving. Do therapist test their clients? How can I tell?

No, I can’t imagine a competent/ethical therapist “testing” any patient. The best way to handle this, and likely a good step for you, would be to talk to your therapist about your fantasies of being abandoned by her. I suspect … Continue reading

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Should there be a government agency dedicated to reducing the number of psychopaths, sadistic people and people with anti-social personality disorders to improve public health and the overall quality of life?

In short, no. I can’t imagine giving that kind of intrusive power to the state. It smacks of the worst sort of authoritarianism. Education about mental illness and providing sufficient public funding for mental health services would be wondrous. I … Continue reading

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Yuya, this is an insightful question that seems to trap most inexperienced therapists. I welcome such communications. It often reveals a benchmark of change when the patient can challenge me. This challenge is exquisitely dangerous to the patient as s/he thinks I will become angry, withdrawn, maybe rejecting, haughty or even narcissistically demand that they the retract the objections if they wish to continue working with me. These are usually transference based expectations. However, many patients run into inexperienced or un-analyzed therapists who’ve yet to resolve their issues in this fragile domain. When this happens, the rule is thus for the therapist: do not attack, do not withdraw from the patient. Accept the patient’s point of view and search for the truth of it. Once the therapist can acknowledge the delicate parts of the patient’s experience as real and crucial, then, with great tact and skill, the therapist might inquire into the transference aspects of the communication. A competent therapist will acknowledge her/his contribution to the interaction. S/he will then be able to assist the patient in looking at the historical antecedents of the criticism,, and the patient’s fears of stating her or his truth to the therapist whom they feel, rightfully, injured them.

Without knowing a great deal more about you and what you consider “paranoia” I would be taking huge liberties with you. Those liberties would be crummy psychotherapeutic help; in short, no help at all and very possibly misleading and unethical. … Continue reading

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