[Desklamp]

Psychodynamic method twice weekly for 6 years, now probably quitting due to this issue:

4 years ago she diagnosed me with F60.3 borderline personality disorder and put it in writing. I never much identified with the DSM criteria and repeatedly tried to go through them with her bus she shot down every attempt.

Because it's wrong of me to question her, because I ought to trust her, I ought to accept the illness, should not see shame in being labeled etc. So I believed her fully.

This diagnosis, many studies are done on it, I read some and their conclusions were terrifying to me: 10% death by suicide, likelyhood of passing of the ilness' genetic component to offspring et cetera. My father was very concerned and lost much sleep over it, I took the diagnosis certificate to a Dr who medicated me intensively for it causing mayor side effects. Also I was always scared my employer would find out and that my colleagues would find out. This because I work at a hospital so a visit to the ER would mean my colleagues read my medical journals.

Turns out the borderline diagnosis was false. Recently I got an independent, exhaustive, through assessment from an unrelated psychiatrist, the diagnosis was removed, medications quit and I feel just fine.

I confronted the psychologist about it and she claims that her diagnosis is correct because when she diagnoses borderline personality disorder she does not use the criteria from DSM, but her own "Psychodynamic criteria" and which ones these are she will not share with me. Also she does not consider relevant the WHO's definition as a serious psychiatric illness. She claims I was wrong to be scared by statistics because "statistics don't say much".

I inquired as to why she wrote F60.3, which is strictly a DSM diagnostic code, if she does not use DSM criteria when diagnosing. So she backtracked and said she uses DSM sometimes, after having claimed the opposite the last 4 sessions.

Then she claimed it's no issue because she only told me about the diagnosis, when in reality there is written communication between her and a Dr I previously had where she used the DSM label.

I've been discussing the topic with her for 5 sessions now and when I ask her to speak her mind on it she will remain silent and stare at me for 10 minutes silently.

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Being wrongly diagnosed has affected negatively my career, my somatic and psychic health, dented my self esteem, given a grim vision of the future and caused much suffering to me and my family.

I maintain errors can be made but using DSM labels without looking at DSM criteria is stupid negligence. I'd be willing to forget and move on, keeping her as therapist, if I were to get an apology but she will block any attempt at conversation by becoming a mute.

I find this very insulting and see no choice but to fire her, not due to her having done a mistake, but due to her unwillingness to fix it.
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What is your take on the situation, please?

[JaneTennison1]

I would fire her. If you trusted a mechanic to do something and he kept telling your brakes were faulty even though they seemed fine, charging you to fix them, then when you found out it was actually the tires he admits he never even looked at the brakes because his experience as a mechanic told him he didn't have to - would you ever think of returning to that person? This is your life she has in her hands and she is not in anyway helping yo. I would fire her with a call and not pay another cent for this "service"

I'm sorry you went through this and glad you are on a better path now.

[SoupDragon]

I know even T's are human and can make mistakes, but as you say, this mistake has had huge consequences for you. It doesn't sound very professional in terms of her "doing her own thing", when diagnosing you. The DSM is there, for consistency in offering labels. Personally it would be a big trust issue for me and would also make me question her credibility.

On the flip side, have you found any benefit from seeing her?

[AllHeart]

I'd fire her and call a lawyer

[zoiecat]

It is my understanding that if you're in the US and you're using insurance they have to use the DSM codes to have insurance pay that being said they should be using DSM criteria to meet those diagnosis. I understand your concern about being labeled I'm in the same boat my psychiatrist disagrees with my therapist and they reported two different diagnosis to my insurance company but my insurance company is the only one that sees that diagnosis besides my mental health Team so I'm not really all that concerned it just aggravates me that the psychiatrist is saying I have something that I do not believe I have. As for staying with your therapist personally I don't like the psychodynamic option but that is totally up to you do you feel that you've made progress after 6 years of seeing twice a week if not it may be time to try a different form of therapy with someone that will give you more feedback if you ask a question.

[atisketatasket]

Originally Posted by zoiecat

It is my understanding that if you're in the US and you're using insurance they have to use the DSM codes to have insurance pay that being said they should be using DSM criteria to meet those diagnosis. I understand your concern about being labeled I'm in the same boat my psychiatrist disagrees with my therapist and they reported two different diagnosis to my insurance company but my insurance company is the only one that sees that diagnosis besides my mental health Team so I'm not really all that concerned it just aggravates me that the psychiatrist is saying I have something that I do not believe I have.

I would be concerned that a false diagnosis was on my insurance record, particularly if it was stigmatizing. There have been horror stories about mental health patients showing up the ER with something totally unrelated - lije a broken ankle - and getting treated like **** because the staff could see their electronic health records and learned of their mental illness. Maybe that wasn't supposed to happen, but anytime you have a huge faceless impersonalized bureaucracy things like this can happen, as even my therapists I used insurance for admitted.

OP - many therapists while giving insurance diagnosis codes will use less stigmatizing ones, like adjustment disorder, depression, PTSD, partly because of the scenario mentioned above. So right away I don't like that she did that, and second - when she was just farting around in her own head, she diagnosed by her criteria, but to get paid she used DSM's? What a hypocrite.

And, it sounds like she offered you absolutely no guidance or support in dealing with her "diagnosis." She's right that statistics are not definitive, but it was on her to offer you reassurance about them.

I'd dump her if you can, and yeah, I might consult a lawyer too.

[Desklamp]

Originally Posted by SoupDragon

I know even T's are human and can make mistakes, but as you say, this mistake has had huge consequences for you. It doesn't sound very professional in terms of her "doing her own thing", when diagnosing you. The DSM is there, for consistency in offering labels. Personally it would be a big trust issue for me and would also make me question her credibility.

On the flip side, have you found any benefit from seeing her?

Thank you. Yes, many benefits from seeing her. I paid for it all privately because it used to be supportive and lead to personal growth in many aspects. This makes the firing her decision hard. We're in EU and the cost is not as much as you'd expect, so it was money well spent.

Mistakes are acceptable and I believe she menat me no harm. However when giving the diagnostic code shou should have added "but keep in mind, I don't use the official criteria"and all would have been fine.

Mistakes are acceptable but I strongly believe there's a correct, adult and mature way of dealing with them. That is that the group involved put aside all blame and shame and, together, for personal development and betterment's sake, openly find what part of the process was flowed. Then committ to improving.

My boss at work, this woman is great. Yesterday a patient didn't get her insulin twice and she started a report (rough translation from my language: abnormal event cause investigation). Nurses freaked out and got defensive, boss explained no body is out for blood we are here because we want to be the very best we can, this time we didnt tho. So let's talk about what happened to identify where we improve, not who we punish. And we all learned something new.

The other day a patient had to have a leg amputated, which got done too late so she came very close to dying from among others infection. Again we sat down and like supportive, civilized people figured out what part of our routine is defective and must get improved.

That boss, she has the right attitute. The psychologist on the other hand, in my eyes, acts like a scared little girl lying a bit on this a bit on that, backtracking, getting defensive and blocking the talks.

This is the obstacle I can't overcome, but her mistake, yes I can forgive. **** happens.

[Desklamp]

Originally Posted by atisketatasket

I would be concerned that a false diagnosis was on my insurance record, particularly if it was stigmatizing. There have been horror stories about mental health patients showing up the ER with something totally unrelated - lije a broken ankle - and getting treated like **** because the staff could see their electronic health records and learned of their mental illness. Maybe that wasn't supposed to happen, but anytime you have a huge faceless impersonalized bureaucracy things like this can happen, as even my therapists I used insurance for admitted.

OP - many therapists while giving insurance diagnosis codes will use less stigmatizing ones, like adjustment disorder, depression, PTSD, partly because of the scenario mentioned above. So right away I don't like that she did that, and second - when she was just farting around in her own head, she diagnosed by her criteria, but to get paid she used DSM's? What a hypocrite.

And, it sounds like she offered you absolutely no guidance or support in dealing with her "diagnosis." She's right that statistics are not definitive, but it was on her to offer you reassurance about them.

I'd dump her if you can, and yeah, I might consult a lawyer too.

I can tell you a few horror stories because i work at the ER as a med dr. So first is the colleague that, looking at the list of incoming patients, öh **** **** no not another one of these dumb borderline *****es, they just want attention, take 3 hours of your time they have nothing. We shouldn't cure not even bandage them because that reinforces their behavior". The girl, patient in question, had pneumonia and just needed chest xrays fluids and antibiotics. ï'm going to make her wait really long also".

(I reported him to my boss).

Also there's the general "i don't like psych patients they should just keep them at psych emergency all", there's the lady in strong pain that gets no painkillers while we wait for bloodwork to return because the journals say she has an anxiety problem so "she's just here to get high".

and so on. discrimination is real. terror was real for me, once i was very sick and had someone drive me to another ER 5 hours away because I couldn't go to my colleagues, they read the BPD diagnosis. I lived in terror of gossip, discrimination is real.

This she has done to me. An apology would be enough, but I won't get it.

[Desklamp]

Originally Posted by AllHeart

I'd fire her and call a lawyer

I see your point, thank you for replying. I proposed that i contact her Supervisor to get an independent opinion on the issue. Mediate.

"that you want to contact him exactly proves that you have borderline!"was her comment then she refused to hand out the supervisor's contact information.

I find this juvenile, shady, flaky and irresponsible.

[Moment]

So you have seen this person for years? Presumably you have had a trusting, beneficial relationship with her?

I'll be totally honest and I am wondering if you are engaging in "splitting." You seem to be blaming this therapist for all suffering and bad things that have happened to you since this diagnosis.

You want her to apologize and she goes mute. From her point of view, she has nothing to apologize for. All of these diagnostics are subjective. Even the DSM criteria are subjective. She felt you met the criteria for what she considers to be borderline. And, from her perspective, your intense anger about this and your vilifying her (splitting) feels like further evidence that you indeed have this disorder, since those are some of the criteria.

I guess the question I'd have is, what prompted you to get an independent evaluation at this particular time? What was the motivating trigger? Why trust the independent evaluation over someone who has known you for years? Do you not think it is possible that two therapists could disagree on a diagnosis? And what's more, do you not think that these diagnoses are somewhat subjective in nature? It is not like you get a blood test. I feel like borderline and other disorders exist on a spectrum, with some people meeting the criteria to a T and others tending towards borderline traits.

I also personally think that a diagnosis is not, in the end, all that meaningful. What matters is who you are and how you deal with things and how a therapist can help you achieve your goals, both emotional and otherwise. Does your therapist help you? If she does, I can't understand firing her over this. The two of you do seem to be at an impasse. In my experience in therapy, ruptures can be the most productive part--if they are repaired. Only you can know what your relationship with your therapist was like, but if there were good things about your relationship, and if she was able to help you, maybe really, really try to see if you guys can work through this. If all you are doing is demanding an apology that she will not give, you are not going to get anywhere, and you may lose a relationship that has been valuable. Could you explore with her what an apology would mean to you? What it means to you if she doesn't apologize? Can you envision any way the two of you could go forward without an apology? Can you see it from her perspective at all? Do you think she has any legitimate point of view?

If this has been a valuable relationship to you I can't see why you'd want to lose it.

[StickyTwig]

Im sorry this diagnosis has been so tough on you, it sounds as if it was a lot to go through.

As Moment said, your therapist hasn't been proven to have made a misdiagnosis. Two different professionals have had two different opinions, thats all.

DSM criteria are very broad and loose, and just about anything can be made to fit them or not fit them. It is down to a trained professional to make their own judgement based on experience. I'm guessing what your therapist meant when she says she doesn't really use the DSM criteria is that she uses her own experience which is far more complex and nuanced (but will always still be based on the criteria, just not in a straightforward black and white way). All psychiatrists/psychologists do this, otherwise any person off the street could make a diagnosis. If it was just a case of a simple ticklist, why would you need professional opinions at all? I see it as OK for her to diagnose based on her experience, then use the DSM code for official purposes.

Its also totally fine for you to disagree with her professional option and stop working with her. That is your right. But sorry to say, you wont get her to admit to a mistake because in her view she hasn't made one.

[Wonderfalls]

I don't mean to get side-tracked, but Desklamp, if your hospital is making very serious, potentially fatal mistakes by twice forgetting insulin and letting an amputation go too long and your supervisor's response is kindly refusing to assign blame, instead pointing these incidents out as "learning experiences", then I hope I never end up there. If someone's deadly neglect nearly kills me then I would very much hope they do get blamed and probably fired as well.

[Bonjour Tristesse]

My take is that I would not be able to trust her. The DSM is the tool for diagnosis, not using it and getting creative around it, and then not explaining when you go to her for clarification are irresponsible and unacceptable.

[colorsofthewind12]

I wonder, like others have, why after 6 years you decided to get a second opinion? How do you know the psychiatrists opinion is any more accurate then your therapist? Could the reason you're feeling better now be due to the last 6 years you spent in intensive psychotherapy?

[Ididitmyway]

I would fire her and find a lawyer to explore the option of suing her for malpractice because this is what it looks like to me.

As to the whole DSM thing, while I somewhat understand the necessity to use some kind of labels for insurance purposes and just to point out some behavioral patterns, I completely reject the notion that they have the same validity as other medical diagnoses. I don't want to get started on this subject because to me this entire idea is an Orwellian Newspeak.

[Desklamp]

Originally Posted by Moment

So you have seen this person for years? Presumably you have had a trusting, beneficial relationship with her?

I'll be totally honest and I am wondering if you are engaging in "splitting." You seem to be blaming this therapist for all suffering and bad things that have happened to you since this diagnosis.

You want her to apologize and she goes mute. From her point of view, she has nothing to apologize for. All of these diagnostics are subjective. Even the DSM criteria are subjective. She felt you met the criteria for what she considers to be borderline. And, from her perspective, your intense anger about this and your vilifying her (splitting) feels like further evidence that you indeed have this disorder, since those are some of the criteria.

I guess the question I'd have is, what prompted you to get an independent evaluation at this particular time? What was the motivating trigger? Why trust the independent evaluation over someone who has known you for years? Do you not think it is possible that two therapists could disagree on a diagnosis? And what's more, do you not think that these diagnoses are somewhat subjective in nature? It is not like you get a blood test. I feel like borderline and other disorders exist on a spectrum, with some people meeting the criteria to a T and others tending towards borderline traits.

I also personally think that a diagnosis is not, in the end, all that meaningful. What matters is who you are and how you deal with things and how a therapist can help you achieve your goals, both emotional and otherwise. Does your therapist help you? If she does, I can't understand firing her over this. The two of you do seem to be at an impasse. In my experience in therapy, ruptures can be the most productive part--if they are repaired. Only you can know what your relationship with your therapist was like, but if there were good things about your relationship, and if she was able to help you, maybe really, really try to see if you guys can work through this. If all you are doing is demanding an apology that she will not give, you are not going to get anywhere, and you may lose a relationship that has been valuable. Could you explore with her what an apology would mean to you? What it means to you if she doesn't apologize? Can you envision any way the two of you could go forward without an apology? Can you see it from her perspective at all? Do you think she has any legitimate point of view?

If this has been a valuable relationship to you I can't see why you'd want to lose it.

Thank you for the comment, I will consider it. The indipendenti evaluation came because I was, due to side effects from a medication, hospitalized for a month, so the nurses and doctors there observed me around the clock for a month we can say.

[Desklamp]

Originally Posted by StickyTwig

Im sorry this diagnosis has been so tough on you, it sounds as if it was a lot to go through.

As Moment said, your therapist hasn't been proven to have made a misdiagnosis. Two different professionals have had two different opinions, thats all.

DSM criteria are very broad and loose, and just about anything can be made to fit them or not fit them. It is down to a trained professional to make their own judgement based on experience. I'm guessing what your therapist meant when she says she doesn't really use the DSM criteria is that she uses her own experience which is far more complex and nuanced (but will always still be based on the criteria, just not in a straightforward black and white way). All psychiatrists/psychologists do this, otherwise any person off the street could make a diagnosis. If it was just a case of a simple ticklist, why would you need professional opinions at all? I see it as OK for her to diagnose based on her experience, then use the DSM code for official purposes.

Its also totally fine for you to disagree with her professional option and stop working with her. That is your right. But sorry to say, you wont get her to admit to a mistake because in her view she hasn't made one.

Thank you, maybe I understand her a bit better now. I'd prefer to keep the relationship.

[Erebos]

This is why diagnosing should be left to pdoc, and not T's, psychologists or psychotherapists etc.
This shyt really boils my blood.
If she had concerns she should have referred you for a second opinion (but we all know how much T's despise a someone else overlooking their decisions) instead of boosting her self importance and deciding she knew what was best.
Personally I would be out.
And I would find it almost impossible to trust her as I would suspect her of continuously covering her behind.
Which is probably why she isn't answering your questions or concerns.
To worried about digging herself a deeper hole by admitting what she did was crooked.

Sorry your going through this.
Also psychodynamic twice a week for 6 years?...that's ALOT of therapy.
Afraid I smell financial gain at the centre of this one.
But then I am a solid cynic,so....

All the best whatever you decide.