Thread Drift

[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.

[Crankin]

That's because of the changes in the new DSM. I have a couple of clients with a PDD-NOS dx, but fortunately, they also have another dx. There is no more PDD dx, just Autism spectrum disorder. However, since all of my clients have one of 3 behavioral health providers that work with Mass Health and the special in home therapy program I work in, they rarely question a dx. In fact, this program has been so successful, that anyone in the state can now access it, through the behavioral health partnership, even if the parents have regular insurance. They can't use it for physical health care, but I now have a couple of clients who are in this category. It's nice that the state realized the benefit of intensive treatment, that it avoids future issues, and not just low income people could benefit.
Of course, it took a lawsuit to get this program.

[Owlie]

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.

That makes me feel all sorts of dirty and I don't know why.

[malkin]

I think it is because of a change in Medicaid rules for our state rather than the DSM change. I know it has generated some controversy, but I think I like the new DSM Autism Spectrum diagnosis because it does away with a perceived (and incorrect) hierarchy of severity.

Anyway, our current online medical record system has this stupid thing where the dx for PDD-NOS shows up as the entire category, so that printed reports state that the child has PDD-NOS, Rhetts Syndrome, and Aspergers.

Owlie- Coding, billing and reimbursement almost never fails to give me a sick feeling. Fortunately I don't have much to do with it at work.

[Dogmama]

((INDY))
I've been estranged from my mother for over twenty years. She was actively alcoholic & abusive which resulted in many adjustment problems for me. I made some major life changes that threatened her. She cut me out of her will - literally - sent me a Fed Ex that I had to sign for where I was deleted & her step son was inserted. Just like a word processing program for her but not so much for me.

It totally sucked, I fell into a deep depression and crawled back out. I am not angry at her because that expends energy and keeps the arrows flying. I do not have any contact nor do I wish to have any. It is self preservation. I had to refocus my life and move on. It wasn't as easy as it sounds now but I'm at peace. When I realize that our estrangement is not against her - but it is for my own basic well being - it feels better. Hope that helps.

Oh and riding my bike really helped move energy that I may have directed towards myself (bad daughter, etc. - the usual crap.) I seem to get a lot of clarity on my bike when it's just me, my bike and nature.

[redrhodie]

I don't know if this is a new thing around here or not, but I just noticed that a lot of kids in my city ride their bikes to school! Little kids, elementary school age. I find that really hopeful for some reason. Do they ride to school where you live?