u/Cheetolite

I'm very curious about what is happening clinically during a misdiagnosis, especially for serious and potentially consequential diagnosis like a PD; both in cases where it's done consciously and unconsciously by the therapist. I'm assuming the vast majority of therapists are well meaning and so arrive at a misdiagnosis in good faith, but I also want to know what would cause a therapist to intentionally misdiagnose. I have a few working theories, but I really welcome the input of people who are actually familiar with the process of diagnosis and personal anecdotes.

How do clinicians work with their own biases and countertransference to ensure that the way they are seeing the presenting issue is not in fact distorted and how might this process go awry? There is just so much room for interpretation in the way people show up and behave.

I’m curious, maybe it’s different for others, but I feel most Self like and most resourced when I am alone. I feel like I would be perfectly content and satisfied on my own doing my own thing. Although I love people and deeply enjoy connecting with them. I’m not sure how to integrate this defensive split which I’m more aware of now as I get deeper into IFS.

What I’ve realized is that most, if not all, of my manager and firefighter parts are active only in relation to other people. They originated from interactions with people in the past, are reacting to people in the moment, or are anticipating people’s likely behavior in the future.

There is a deep, maybe childlike, part of me that would be so happy to run off and be a hermit somewhere beautiful and dilly dally. However, I also adore people.

Staying in Self energy while also being in relationship to others is my goal in doing this work. But this presents a problem. I’m so much more relaxed when alone, at the same time it’s also more difficult for me to work with parts when I’m alone because they’re just not activated.

This split I believe reflects the good/bad split of my high functioning and untreated BPD mom. I was an only child to her and she an only parent. I bore the brunt of her illness at a time when she had minimal external support and was under stress. I intuitively sensed that she was subtly undermining to my selfhood, sense of goodness, and subjective truth. She was in denial of her own shadow, but I could see it, which only added to my feelings of confusion about her and her irreconcilable behavior. She needed rescuing and emotional regulation from me. I learned early on to basically compartmentalize aspects of my Self because I felt vulnerable to her invalidation when being self-focused and autonomous. I sealed off aspects of myself to keep them safe. I feared she would try to corrupt them, invalidate them or extract them to meet her needs (which felt overwhelming to me as a kid).

I think this may be a fear I need to unburden related to enmeshment. A fear that if I share myself fully that my good qualities will be erased.

I wonder if anyone else here is processing a similar dynamic in their parts and has a helpful perspective.