“I have a client for you.”
The smile on the office manager’s face did not indicate happiness. It was more like she had a foul surprise in that manila folder.
“Nobody else wanted her,” she said, “but since you work with addiction, she’s yours.”
Yes, that happens in community mental health and substance abuse clinics. This client’s file first went to the psychologist on staff who took a pass, then to the experienced and fully licensed therapists until it made it to me — a second-year grad student intern.
And people do talk like that. Nobody else wanted her. None of the seven other therapists more qualified than I wanted to help a woman in her early 20s with opioid and Xanax addiction caught up in the social services system trying to get her daughter back. She would be complicated. The paperwork for social services would be a nightmare, not to mention the requirements of the grant program funding her suboxone treatment. Plus, collaborating with those agencies takes time. Unpaid time. To add extra sparkle to “complicated,” her referral included a diagnosis: Borderline Personality Disorder.
The labels set my brain reeling. Two addictions. The system took her kid. BPD.
My first session with her occurred behind the lens of my knowledge about all those labels. Everything I saw from her that day went into either the addictions or BPD categories. The young lady in front of me looked younger than her 22 years. She dressed a bit inappropriately for a therapy appointment. She spoke openly about years of abuse and trauma endured at the hands of her father and was clearly high. Despite all of that, one thing was abundantly clear — her daughter meant everything to her.
I worked with this client for almost a year. Over time, I saw less of the labels and more of the young woman. As she disclosed more of her trauma, it also became clear she did not have BPD; she suffered from complex trauma. Both issues involve similar treatment interventions, but a BPD diagnosis carries baggage.
When I told her I did not agree with her BPD diagnosis and explained complex trauma to her, something changed for her. The realization that her behaviors came from a normal reaction to a long history of abnormal events, it was as if she stopped seeing herself as a hopeless case. She kept her appointments. She no longer called for early med refills and complied with recommendations for tapering off of them. She learned emotional regulation skills and self-care. She dressed more appropriately during appointments. She stopped swearing at the social workers.
One day she brought her daughter, who was three years old, to an appointment. Although her daughter was not yet living with her, their chemistry was visible. The child smiled with excited wiggles when her mother played with her, and this young woman attended to her daughter with care, gentleness, and complete attention. Before she left the office that day, I told her what I saw in her. The strength, compassion, and fierce love she showed for her daughter was something she could also show herself.
When I left that internship, I transferred her to another therapist. Except for this time, the BPD diagnosis did not appear under the list of problems in the file. While I do not know what happened to her, but I did find out, she finally got to bring her daughter home.
People who have been through hell see themselves through smoked-over glasses. They believe they are defined by what has happened to them. As helpers, caregivers, caregivers, friends, and family, we have a chance to speak life into others. Verbalize their strengths. Reframe smudges into abstract art. Make known the light you see in them. Give them something positive to think about themselves. Be the person who reminds them of who they are. Shine a light so they can see in the darkness.