Thread Drift

[jobob]

A couple of years ago, I deliberately disengaged and eliminated all contact with my birth family. I thought I was very unusual in that respect, but perhaps I'm not.

Hugs to you, Indy.

[shootingstar]

I slept like a log. I haven't slept deeply and through the night for last few months. But when it happens it's like drinking a deep long glass of water after a long hard bike ride. I didn't ride far yesterday since it started to snow. But did some art while playing some classical music.

[goldfinch]

It is unsettling to me that there are therapists that avoid BPD or diagnose it as something else to avoid the issues the diagnoses brings. It feels like an oncologist who doesn't want to help people who have pancreatic cancer because it is too hard. I suppose if they are referring people to therapists that are better equipped that would be fine.

My niece has BPD. She is tough to deal with and I take breaks. She also is bipolar. Her social worker believes that the BPD diagnosis is wrong. I think she believes that simply because of the baggage the diagnosis brings. We have had a few discussions and I think her social worker spends too much time trying to be my niece's friend rather than being a social worker. She wants to be on my niece's side and I think that colors her view of reality. The SW is very inexperienced. Once a week the SW picks up my niece and takes her out for coffee. I She doesn't go inside my niece's apartment. You can tell a lot just by seeing the current state of her apartment. She needs to see that to know that my niece's son is safe and being taken care of. I am blabbing about this because I think I need to talk to someone in charge. Her old social worker was excellent but she retired. Ah well.

At least she has others on her mental health team.

[indysteel]

My own therapist gave up treating BPDs because she found that CBT did not tend to help them. They also tended to exact a huge emotional toll on her, by the very nature of the disorder. A pancreatic cancer patient may be difficult for an oncologist to treat, but not in the same way as a BPD. The extreme love/hate poles that BPDs tend to fluctuate between can be extremely taxing, especially when combined with self injury.

But it's really the first point that's worth emphasizing. CBT may not be the right treatment for BPDs. From what I've read, dialectical behavior therapy may be more effective, but not every therapist offers that type of therapy.

[Crankin]

You are correct, Indy. CBT does not generally help BPD/O. The standard treatment is dialectical behavior therapy, which is a combination of mindfulness training and some cognitive behavior therapy. However, to bill yourself as a DBT specialist, you really need to have taken the special training and not everyone can do that. I, would love to do it. I have found that I am good at keeping boundaries and I expect BPD/O people to test me, as well as some with Bipolar D/O. But, not everyone is like me.
It is very hard to to deal with someone who is continually self-injuring. My client told me she "loves doing it." (cutting). I bought a book for teens that uses some DBT to decrease mood swings and enhance emotional regulation. I'm not certified in DBT, but I can use this. I do have the training in Mindfulness, as I took the official U Mass course at my local hospital.
Goldfinch, it's hard to treat someone who "tests" you consistently and shows little hope of improvement. I just look for stability and functionality. However, your niece's clinician sounds totally off the mark. Taking her out for coffee? This is what a therapeutic mentor does, not a therapist.

[OakLeaf]

The other thing is that in some states, insurance coverage is much more favorable for certain diagnoses than others. Depending on where you are, a therapist might tailor a diagnosis to allow the client the maximum insurance coverage, and choosing a mood disorder over a personality disorder is a prime example of that.

[malkin]

The other thing is that in some states, insurance coverage is much more favorable for certain diagnoses than others. Depending on where you are, a therapist might tailor a diagnosis to allow the client the maximum insurance coverage, and choosing a mood disorder over a personality disorder is a prime example of that.

Right now, the center where I work is in the process of 'diagnosing' every one of our clients with a dx in addition to autism for this reason. So now in addition to 'autistic disorder' every client will have ADD or OCD or anxiety or mood disorder or some other more reimbursable diagnosis.