Lived Experience Forum

[amber22]

Onto our second question of the night...

@Alex_Spectrum - What treatments are available for Borderline Personality Disorder? 

@BPDSurvivor - What are your experiences with treatment for BPD? 

[BPDSurvivor]

For years I was in and out of emergency departments, went from therapist to therapist, clinic to clinic. I pretty much gave up on looking anymore until I stumbled across Spectrum in Victoria – a specialist service for personality disorders. I didn’t know much about the service, and so after having a referral put in, and Spectrum phoning me many times, I didn’t respond. Eventually, I received a letter which pretty much said that if I didn’t respond, I’d be taken off the wait list. This was the first marked difference between this service and other services. Why did they keep phoning me, and then eventually send me a letter?

I believe it was the underlying BPD Core Principles of Care that meant they recognised the difficulties for some borderlines to trust people and engage in therapeutic relationships.

Long story short, I had the privilege of engaging in Mentalization-Based Therapy. It was lengthy therapy of twice weekly 1-2 hour both group and individual sessions. Group sessions had a maximum of 8 people, and individual sessions were 1:1 with a regular psychologist. It required persistence and commitment to engage in MBT.

For the first year or so, I routinely attended, however, I didn’t see much progress. Or let’s just say, I didn’t really reflect on any progress made because I was often caught up in my own emotional distress.

It wasn’t until towards the end of treatment that I turned and sort of said, “Wow! Something’s different!” At that time, I couldn’t pinpoint what the difference was. It was as though my way of thinking had transformed into a different process. I used to always jump into the negative. But MBT helped slow things down so I became more proactive rather than reactive to environmental triggers.

MBT treatment for my BPD was a life-altering part of my life. It was marked by uncertainty, difficulty and change. Yet it also led to a whole new way of thinking.

It truly was the core principles of care that supported me to continue and press on, especially when it was tough.

[Alex_Spectrum]

To start with many people think that if they have a diagnosis of BPD then they have to do DBT therapy. While many people benefit from DBT therapy this is not the only option and in fact, there are many different treatment modalities specifically focused on treating people with a diagnosis of BPD.

There are several evidence-based treatments for BPD, such as Mentalization-Based Treatment (MBT), Dialectical Behaviour Therapy (DBT), Schema-Focused Therapy (SFT) and Transference-Focused Psychotherapy (TFP). There are also a number of more generalised approaches that have been shown to be effective such as Good Psychiatric Management (GPM).

My sense often is that even more important than what treatment modality is used is that the clinician is experienced and interested in working with BPD and is interested in developing a good therapeutic relationship. It’s vital that clients feel heard, understood and respected by the person they are working with. As mentioned earlier it is also important that the work is collaborative and that client and clinician are able to set goals for treatment. These are all ‘common factors’ that are used across all therapies. In fact, research suggests that these common factors are even more important than the specific ingredients/skills taught in the different therapy modalities when it comes to therapeutic outcomes. All this being said, a consistent treatment framework is also vital.

One other necessary ingredient in therapy is that the client should be able to provide feedback to their clinician and to be able to discuss any issues that may arise. Ideally, the clinician should then be responsive to this feedback to help build collaboration. It may be difficult/daunting to provide feedback to a clinician but a good clinician should be welcoming of feedback and open to discussing concerns. I know for me one of the hardest things to manage is if a client just stops coming without explanation and I want to be able to work through any issues that arise as I know I make mistakes just like everybody does!

[TideisTurning]

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@BPDSurvivor wrote:

For years I was in and out of emergency departments, went from therapist to therapist, clinic to clinic. I pretty much gave up on looking anymore until I stumbled across Spectrum in Victoria – a specialist service for personality disorders. I didn’t know much about the service, and so after having a referral put in, and Spectrum phoning me many times, I didn’t respond. Eventually, I received a letter which pretty much said that if I didn’t respond, I’d be taken off the wait list. This was the first marked difference between this service and other services. Why did they keep phoning me, and then eventually send me a letter?

I believe it was the underlying BPD Core Principles of Care that meant they recognised the difficulties for some borderlines to trust people and engage in therapeutic relationships.

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This in particular about the difference a little persistance and recognition made really stuck out for me @BPDSurvivor. I can sense just how impactful that must have been 💙 

[TideisTurning]

Hi there @EliReardon 😊 Welcome!

[amber22]

There’s a lot of stigma and negative stereotypes about BPD.  

@Alex_Spectrum - How could a clinician or support professional be the difference in terms of challenging stigma?  

 
@BPDSurvivor - What could a clinician or support professional do to help reduce the impact of negative stigma? 

[TideisTurning]

Welcome @round_the_twist 😊

[BPDSurvivor]

I can speak first hand of the many times I was turned away from receiving support. Stigma stinks. One thing that would be a marked difference is if a clinician/support person could really see a borderline as a person, and not a diagnosis. This will then guide their approach. The person-centred, recovery focussed approach is what we need to see more of. Modelling this understanding in the workplace and being ready to challenge negative stigma is one step forward in helping to reduce the impact of negative stigma.

Something else they can do is share stories of hope. Those going through the challenges associated with BPD can quickly lose sight of hope – and so can professionals. If we share that BPD recovery is absolutely possible, then it can reduce the negativity currently associated with a BPD diagnosis.

[Alex_Spectrum]

Well to start with being involved in forums like this are a great way for clinicians like me to help to challenge stigma and to provide evidence based information. I also agree with what @BPDSurvivor has said in that we need to focus on the person rather than the diagnosis. What we know is that no two people with a BPD diagnosis are the same. There are a multitude of different interactions of symptoms that make up a BPD diagnosis and this means it’s important to focus on an individual’s unique story. For me, providing education to clients about BPD and recovery is important. The fact that BPD is highly treatable is not well understood nor is it promoted enough. Finally, expressing a desire to work with people with a diagnosis of BPD and in fact a desire to work with the person in front of them regardless of diagnosis is also crucial in my mind.

[rye]

I have a question for @Alex_Spectrum if there’s time.

When would RO-DBT be used, and is this treatment very available (around AUS) at the moment?
I have done a DBT group, and while it was helpful, I tend to hover more towards what I’ve heard termed ‘overcontrolled’ and ‘internalising’. I’m wondering if RO-DBT is supported for these kinds of BPD traits.

Thanks 🙂