Interview questions for P/T's

[Think About It...]

I always felt behind the ball and intimidated by Ps and T's because I look at the world half full and that's the way I like to live it. I have friends like that too. I don't like complainers, moaner groaners, and blamers. I like people who see ironies in life and don't take themselves too seriously, but they work hard and enjoy life. So people who look for the weaknesses in others are not my cup of tea.

That's the job of a Pdoc or a T. So we are usually not destined to be BFFs.

So my way of presenting the world is generally thought of by these pros as...lightweight. Not enough self introspection (yikes) and definitely too quick to judge a situation, try to fix it, and move on. Most of these folks LOVE deep discussions, deep looks, deep emotions.

However we always thought the next one was going to be great ( that half full thing again) and each time we were so full of hope that they would just tell us that our dd18 was just going through some rough spots and she would be ok. And the amazing thing was that she had every one of them convinced of that too...until the very last one.

By the time we got her into DBT at 17, it was our last hope, and we had to fight our insurance company to pay for it. But even there she snowed them, and us...now a year later she says it was all bs and the T's were all fake..how could they not be, because they "pretended to care about me, but they were paid to".

So here is a beginning list of questions I never asked, but realized I should have...but we are so lost and desparate as parents of pwBPD.. We just want someone to help. To do whatever it takes. Please fix them?

How long have you been treating pwBPD's?
What is the age range of people you generally treat?
What is your success rate?
Are you reachable for emergencies? (ours you had to wait 24 hours, and if they were dead so be it...)
What do you think of RTC?
When would you use RTC?
What kind of drugs have you found successful or not and why?
Do you recommend any kind of educational modifications?
Do you use any kind of contracts or consequence/reward therapy? (RED FLAG)
Do you have a family member with BPD?
Do you have BPD?
Do you have children?

Do you LIKE YOUR PARENTS? 

[frustratedmom]

I always felt behind the ball and intimidated by Ps and T's because I look at the world half full and that's the way I like to live it. I have friends like that too. I don't like complainers, moaner groaners, and blamers. I like people who see ironies in life and don't take themselves too seriously, but they work hard and enjoy life. So people who look for the weaknesses in others are not my cup of tea.

That's the job of a Pdoc or a T. So we are usually not destined to be BFFs.

So my way of presenting the world is generally thought of by these pros as...lightweight. Not enough self introspection (yikes) and definitely too quick to judge a situation, try to fix it, and move on. Most of these folks LOVE deep discussions, deep looks, deep emotions.

However we always thought the next one was going to be great ( that half full thing again) and each time we were so full of hope that they would just tell us that our dd18 was just going through some rough spots and she would be ok. And the amazing thing was that she had every one of them convinced of that too...until the very last one.

By the time we got her into DBT at 17, it was our last hope, and we had to fight our insurance company to pay for it. But even there she snowed them, and us...now a year later she says it was all bs and the T's were all fake..how could they not be, because they "pretended to care about me, but they were paid to".

So here is a beginning list of questions I never asked, but realized I should have...but we are so lost and desparate as parents of pwBPD.. We just want someone to help. To do whatever it takes. Please fix them?

How long have you been treating pwBPD's?
What is the age range of people you generally treat?
What is your success rate?
Are you reachable for emergencies? (ours you had to wait 24 hours, and if they were dead so be it...)
What do you think of RTC?
When would you use RTC?
What kind of drugs have you found successful or not and why?
Do you recommend any kind of educational modifications?
Do you use any kind of contracts or consequence/reward therapy? (RED FLAG)
Do you have a family member with BPD?
Do you have BPD?
Do you have children?

Do you LIKE YOUR PARENTS? 

[frustratedmom]

BTW, I just counted.
Including one she saw just once...starting at age 13...my dd18 has seen 11 psychiatrists and therapists. Longest one was 18 months.
Our HMO has a stupid system where you are assigned both a P and a T, because the T cannot prescribe anything, and the Ps are too expensive to spend time in treatment. The Ps are supposed to meet with you for 15 min on e a month max to update prescriptions. But kids get overwhelmed with this process ( not to mention parents!)

This total does not include the ones in the hospital and RTC. No wonder she has no faith in therapy? No one could crack her open.

[mikmik]

With the great interview questions Frustratedmom posted, maybe this will help in the search for the right fit!  I think we all need to have our critical questions written down, and respectfully ask for the potential T and P's time to address these.  Also, I think we should feel safe in going back to our current professionals and ask the questions we don't know the answers to,

I would add:

Does the Pdoc have a good working and philosophical relationship with the T
Does the T have a good working and philosophical realationship with the Pdoc
Who is considered part of the treatment team by the T and Pdoc (family, school, coaches?  if family is not included or kept at a distance, run)
How do the T and Pdoc care for themselves to prevent burnout?
If the therapy or meds are not working, do the P and T blame the patient?
What is the ongoing education of P and T with respect to BPD?

mik

[Vivgood]

The thing I ask about is their current thinking/philosophy about BPD treatment, do they stay updated on the latest research in this field? Because its changing rapidly and makes a big difference in how they treat and interact with the BPD. I also talk to them about their understanding of Linehan's work (I also choose only people who have had the full training). Personally, I am not interested in someone who takes an either /or approach- "BPD is caused by abuse" vs. "BPD is purely biological". I want someone who has at least a basic understanding of how complex the disorder is and how biology and environment interact in the context of BPD.

I don't wanna hear either "She can't help it, its a disease like cancer" OR "She can control herself if she wants to, she just needs discipline."

vivgood

[heronbird]

It is very important that DBT Ts be qualified to provide DBT, otherwise, the treatment may very well fail and hoplessness will be reinforced within your loved one. This will then lead to continued distrust of DBT and all other therapies. These are the questions to ask potential DBT Ts.

Have you completed a 10 day intensive DBT training? are you a member of a DBT consultation team?
Have you been supervised by a expert DBT therapist? Are you familiar with the main set of DBT stratagies?
(behaviour therapy, validation, dialectics)?
Do you teach skills, practice behaviour analysis, review diary cards?
Do you do phone coaching?
How many clients have you treated using DBT?
How many patients with BPD do you now have in your practice?
Do you believe you have been successful in helping your patients with BPD lead better lives?

the answer to most of these questions should be yes, You have a right to check on the therapists credentials; to know if the t is licensed in his or her state, to know the extent and nature of the ts education and training; the extent of the ts experience in treating clients with similar problems and the ts arrangements for coverage and/or emergency contacts.

What do you think of that, by Valerie Porr

[twojaybirds]

I have to play devils advocate with some disagreeing.

DBT therapy is fairly new and is the pop answer to lots of things right now.
A good therapist, while grounded in one theory, may call on more than one to meet individual needs.
A well schooled, experienced p does not have to go thru a 10 day training to understand DBT.
Actually it is a fairly simple theory - classic behavior therapy which has been around forever with some Buddha mindfulness which has been around even longer.

Our p has not done any intensive DBT but knows it very well.
He's about 60 and has sen many years of p.
He limits himself to 1 pwBPD, his partner right now has 10.
He says one is all he can manage but his partner  has great effects and can manage multiple pwBPD.

Why do I say this.  I am a Special Ed teacher.  I can manage lots of behavioral kids like a charm, other SPED teacher want nothing to do with them.  Give me a kiddo and some family history and I can usually tell you their diagnosis if they have been in the system.  There are trends the medical profession uses. Trends in diagnosis and therapies.

The more I read about DBT the more it sounds like Teaching or Parenting with Love and Logic.  A fairly simple practice to use and highly effective with kids with behavioral issues. 

DBT is not a silver bullet and has been testified on this board been unsuccessful and has been manipulated by some.

I dont meant to be a downer, just wanted to add another demension to consider.  If you limit yourself to just BPD and its not the therapy for your kiddo and that is all the p or t uses , it wont work.   


Just my opinions

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[jbmom]

I would also ask about how they see the role of the family in therapy? How will you two communicate about important issues? Will there be points to check in? How many BPD patients he has seen/treated? What chance of success with DBT therapy? (get their opinion on DBT -- if they are committed).

[mikmik]

Here is one more,

If you actully find a T who is wonderful, who get BPD and understand DBT, and is willing to take on just one more client...does she know anyone just like her to fill her shoes if, god forbid, anything happens to her practice?  Who else does what she does with the level of success?  How do you transition trust and deal with abandonment issues if you do have to transition?  Or, are you the only T who does this?  It is scary to have just one resource.

mikmik

[heronbird]

what do you think about the fact my dd wont tell the P anything relevant.  I could tell them the whole truth so that they could work better with my dd but do they want to listen to me?

Last week the P asked my dd is your bf a stable influence in your life, dd said yes. Rubbish.  I was there, it was so hard to say nothing. Then she says to dd, will you come and see me next week, dd says yes course. Then when we get outside dd says, Im never going there again. Talk about frustrating. Dd had anxiety attack all weekend ended up self harming, I want to tell P, should I? Iknow dd wont tell her.

When I ask dd why wont she tell them, dd says whats the point, they cant do anything.

When dd has panic attack or wants to self harm, then she gets angry that no one has ever told her what to do or given her alternatives, but how can they if she wont talk about these issues.

Do you relate, what do you do?

Sorry, its kind of off the subject, but its not really, because they could be questions for a P.

[happygolucky]

Over the years my DD has played counsellors, therapists and specialists...
DD would tell them one thing... and they would believe her...
In reality... it was totally different...
The last psychiatrist finally admitted to me after many sessions that he was taken for a ride.
This specialist had over 30 years experience!

I am very cynical about the mental health system in my small part of australia... and feel that we have been let down.
We need people who firstly... care!
We need people who will work with the family...
We need people who will listen to all members of the family...
We need people who can offer support for siblings...

So... in my case it wasn't a specialist... it was health care nurse... who volunteered her time... but worked at the grass roots level with BPD in hospital situations...
She was fantastic! Even though she did not work with my DD... she helped my family turn our existence around.
We can get off the roller coaster ride for a while... take a deep breath... and get back on when we need to!

That is why I feel comfortable posting on this board...
We are all in this together... but have different daily situations...
Ultimately we are all going through the same thing... but in different ways!
We are not alone...

Cheers
HappyGoLucky

[mikmik]

Heron,

This is just what this topic is about.  Go back, demand or schedule time with the P, any P and interview them.  Have your list of BPD questions, take some from Porr, some from others who posted and go ask them.  Tell them you are either, #1, determining if they will continued to be employed by you, or determining if this person is the correct fit to help your dd recover.  #2.  That you are looking at other potential care givers, because of how important the right fit is with this disorder.

I would, and I mean it (because I did w/dd's Ts practice), ask for some of the P's time.  Fill them in (I did this with dd's current T, so she knew my state of mind, as dd lives with me), and ask how you can give information to them as a team approach.

You are spot on with your post.

mikmik

[heronbird]

Oh Mikmik

Im in UK, it shouldnt make  a difference but it seems to, If I was paying, it would feel different maybe. I am paying really.

I found our new P a bit strange to me, it was like she was saying to me back off but she didnt say it. In V Porrs book at the end there is a note for clinicians, I photocopied it and gave it to her at the end, she seemed very strange about it, its like, she is there for dd, and not me. Now dd is over 18. Uh, Im too soft too, dont want to upset anyone, pushover.

I will be strong. Btw, she was amazing with my dd though, seemed to know where she was coming from and understood he a lot. We only met her last week for first time. Its hard getting used to a new one. I did tell her though that if she keeps dd waiting for more than 5 mins dd will leave, that was becasue shed kept us waiting for 15 mins and dd wanted to walk out and started getting anxiety over it.