Does ‘being pd2ot’ make me less competent?

296-1248099726Ti7pThis post is being written at the expense of the ‘Dissociation’ blog post, which still remains a half written draft. There are two reasons for this; 1. the dissociation post is proving very hard to attend to and 2. the topic of this post is one that more urgently warrants personal reflection. I will reflect on the question with consideration of my experience of being the student that is pd2ot, at this, the halfway point in my course.

So, am I less competent as a student that has recovered from Borderline Personality Disorder?

It is possible that you are wondering why I’m even considering this. Especially as I have been fortunate enough to receive quite public feedback about the contribution my experience could make to the Occupational Therapy profession through this blog/Twitter. Well, the reason for this is my own internalised stigma. I am soon to face a practice placement where I will be ‘bare below the elbows’. When I discovered this I was terrified as it will mean that my scarred arms are visible to staff and clients alike. My panicked concerns ranged from ‘What if my educator judges me as incompetent?’ and ‘What if my clients don’t want to work with me as they don’t trust me with their care’ to the slightly more probable ‘What if my performance isn’t as good because I feel self-conscious and can’t hide behind apparent competence?’ I had a very useful meeting with my academic tutor, in which we explored the issue and action-planned how I would manage various scenarios. I know that the reality is likely to be that it will be a complete non-issue and most likely something that is very good for me getting experience of being accepted ‘warts and all’, but it feels good to be prepared. During this meeting my tutor asked me if I feel less competent due to being a person who has experience of self-harm. My short answer was ‘No’, but I am aware that if I 100% believed that we probably wouldn’t have been sitting in a room having the conversation. Like many things I think ‘being pd2ot’ has advantages and disadvantages.

The Challenges

Rest. I still have a pretty horrendous sleep pattern, this means that I find functioning and getting myself to placement/university in the morning to be hard work. Judging by feedback from my previous educator this wasn’t at all evident in my performance on placement. It simply makes placement a pretty big challenge for me. While I am very glad that it doesn’t effect my performance, it can make it all the more challenging to speak up and say ‘I can’t keep doing this’, because to all concerned all they observe is a student managing really well. This is probably the most significant area for making me doubt my competencies, because sometimes just managing is hard work. 

The skills you can’t explain. Fortunately my CV has a lot of experience that would go some way to explaining some of the skills I exhibit. However, I do feel a little sad that the Therapeutic Community (TC) that was so crucial to my recovery never gets any of the credit. It often makes me giggle inside when ‘working in a busy shop at Christmas’ gets the credit for my ability to manage ‘customers’ with high stress levels. The reality is that once you have lived in a TC for a year, with infinite unrelenting crises occurring, there’s really not much left to phase you. Similarly, the Samaritan’s training for volunteers is getting an awful lot of credit for my abilities to listen and relate to people. Now, these things are probably ‘positives’ really, the challenge is simply feeling like it’s best to hide your experience. There’s also the ‘skill’ of having an extensive working knowledge of psychotropic medications that significantly exceeds that expected of an OT student. Unfortunately there’s nothing on my CV to explain why I know that likely side-effects of intra-muscular haloperidol injection, or even have such good understanding of the sections of the Mental Health Act, but I suppose it’s all valuable information to have.

Them and Us. At both university and placement I have experienced a degree of ‘them and us’ type thinking (the university experience was explored here). I do hope that one day I can help challenge some of that thinking by being more open about my experiences. For now, my work is in getting through my training in one piece. As a student it feels difficult to challenge overtly, but I do hope that my discussions and way of working with people who have been ‘written off’ due to being ‘personality disordered’ might prompt other practitioners to reflect.

Am I completely better? I am still in therapy, and have significant work left to do. This can make me wonder if I am ready for a professional career. However, I would not meet the criteria for BPD or any other mental health condition and probably have a much more balanced approach to life the the majority of people. I think there can be a disparity between the way I manage life and the amount of effort it takes to manage in such a way. Compared to some (some, but most definitely not all) people I suspect I have to work harder at the little things. Does that make me a less competent OT? No. I don’t think so. It gives me awareness of how hard life can be.

The Advantages

Skills. As alluded to above, my year in a TC has given me a range of skills: From the teamwork required to live in a TC, to being a co-facilitator of a range of therapeutic groups, from learning to tolerate hearing difficult things and providing support to those in great distress to gaining the ability to reflect and realise when you are absorbing ‘someone else’s stuff’ or projecting ‘your stuff’. These skills are not taught on an OT degree, they may in part be developed on a practice placement but the reality is the experience gained is probably equivalent to that  gained in the first few years of employment. The value is significant, I have only worked with one or two people diagnosed with Personality Disorder so far in my training, yet the skills have been transferable to the people I’ve worked with in both placement settings (older adult mental health and social services).

Interest. I am perhaps not the best student at studying ‘what I am meant to’. Like many people, once reading for an essay, I lose interest. I also struggle a little with the delivery of our lectures, I find it hard to remain engaged when we are not challenged to think. So, having this blog based on my own experience has been a lifeline. I know I have developed my skills in applying occupational theory to my own experience, which has given me the confidence to do the same when out on placement.

Perspective. It sounds a little ‘corny’ to say this, but I will anyway. My life experience puts university into perspective. That does not mean I don’t treat my studies with respect but it does give me an attitude of ‘I’ve come a long way to get to this point, I can certainly manage the stress of a degree’. That doesn’t mean I find it all easy, but it does give me the self-belief to get through it.

Opportunity. I have recently written a service-user commentary for a chapter in a forthcoming edition of an occupational therapy text. This was a privilege as I got to read new material before it was published and it feels quite special to know that I will have my name in a text book before I even graduate. I suppose the next goal is to have my name in print as a student/practitioner/researcher rather than service-user.

The role of this blog. It’s been difficult to write as many posts as I would like. The ‘sleep’ issue above means I often have to prioritise energy levels for university work. However, writing the blog only came about from suggestion of my tutor and what a brilliant suggestion it was. Having this perspective opened up a world of opportunity for my engagement in occupational therapy in the social media domain. I’ve read countless other blogs, had enlightening discussions on twitter, joined in #OTalks and #occhats, met up with some brilliant people, made some valued friends and ‘outed’ my inner OT Geek, all of which wouldn’t have happened if I didn’t have the pd2ot story to tell. The feedback received has also helped me integrate my experience. The support given about my perspective has let me experiment with letting more people in. There are several ‘real life’ friends who have read the blog, and I am much less afraid about sharing (in a boundaried way) parts on my experience with the right people, more confident in the knowledge that I’ll be accepted. So, thank you readers/tweeters/commentators. I also was humbled to receive nominations in two recent social media awards. The thing that struck me was that I was not nominated as a service-user, but rather in categories for ‘academic’ or ‘occupational therapy’ content. This felt quite powerful, and hopefully means I’m getting the balance right. I am primarily an OT student, who is influenced by her experience of having BPD.

So, no, I do not believe being pd2ot makes me less competent. It does mean there are challenges for me that some other students might not face (but I suspect they have their own, unique, challenges) but overall the range of ‘positives’ outweighs the challenges. There is also a significant point to remember, while I am reasonably confident that being a student who has had BPD helps me be a better OT student, I am more certain that without having had BPD I would never have embarked on this career.