Setting Off in Life

The father of Henri Matisse, the great French painter, wanted him to become a lawyer and was disappointed when he took up art. Parenting changes your reactions to this story: young people sympathize instinctively with the young Matisse, but then one day you wake up to realize that now your sympathies all lie with Matisse senior.  Suddenly you find that your young people are on the verge of setting out into the world, and all you want is for them to be safe and happy and successful.  But there’s not much you can do: no matter how good your advice and support, you will probably have to watch while they solemnly set off in what you are quite sure is the wrong direction.  Julie's brother is at this stage, and we have dutifully made all the mistakes that loving parents have made down the ages.

But it’s better to see them set off in the wrong direction than not set off at all, which might be one interpretation of what is happening to Julie at the moment.  She is in a peculiar limbo: she left school long ago, but isn’t well enough to carry on studying, or to work.  She’s living with us, drawing state benefits, receiving specialist therapy, and watching a lot of television.  It feels as if she is slowly being sucked into a life of idle dependency on welfare.  She is not setting off deliberately in any direction at all; she is drifting out to sea.

The specialist BPD therapy, awaited eagerly for so long, has been something of a disappointment.  Budget cuts and budget cuts have reduced what was once a flagship service to a six-month package of “psycho-education”: one class a week, first concentrating on DBT, then mindfulness, then mentalization.  The focus is on learning skills, not on therapy.  The result is poor – a lot of dry theory, but no opportunity to practice it, and critically, no one checking that the skills have been learnt, or providing feedback.  Staff work hard to teach the skills, but they are not trained teachers, there are no publicly available materials to learn from, and their hand-outs and notes are sketchy.  Julie has a care coordinator, but does not see her, so has been unable to form any sort of relationship with her.  Even the psychiatrist running the service privately describes the psycho-education package as “a sticking plaster” on a raw wound.  Personality disorders are, after all, major, life-long and life threatening.  Are they really going to be resolved with a short course of self-help material, delivered so impersonally?  At the end of the six months, ready or not, Julie will be discharged back to the care of her GP - and her family.

Julie is deeply disappointed, but I am determined we make the best of it.  I work through the materials with her each week and try to find ways of making the concepts come alive.  They are very abstract, and it’s difficult, but I’m not worried about explaining the material.  What worries me is that I can’t be her therapist.  I can help her practice these skills but they remain dry exercises; I don’t have the insight to help her break away from old habits and make them part of herself.  Mentalization, in particular, requires a very experienced therapist.  We do our best, talking through situations and conversations from the week, but there is a huge gap.  I ask the service to recommend a private therapist, but they refuse: even though they admit their own service is diminished, they will not cooperate with private practice.

I am, however, determined not to give up.  It may take longer than Julie expected, but I am sure one day we will get through this patch and she will set off into life.  Not necessarily in the right direction, of course, but that is her business.