What to look for in a therapist (qualifications, other)?

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GENERAL ANNOUNCEMENT This board is intended for general questions about BPD and other personality disorders, trait definitions, and related therapies and diagnostics. Topics should be formatted as a question. Please do not host topics related to the specific pwBPD in your life - those discussions should be hosted on an appropraite [L1] - [L4] board. You will find indepth information provided by our senior members in our workshop board discussions (click here).

[leafygreens17]

My BPD husband is searching for a therapist. All the DBT therapists we've found are either full, or not covered by our insurance. Is there an easier way to track one down? His psychiatrist made recommendations, but they're not covered by insurance.  The previous therapist he was seeing was making real headway before we discovered that insurance wouldn't pay for it since she only had a masters degree. (Insurance requires a Psy D, Ed D, or MD.)  She recommended some other therapists, but they're all full.  Getting him to call new therapists is like pulling teeth, so having all of them fall through is really causing a problem.  Please, tell me an easier way!

[Thats priceless]

leafy:

I went to a therapist that came highly recommended by others (but not covered by our insurance) and asked that he recommend a therapist from the list of those covered by my insurance company.

Usually these people are familiar with each other either thru grad school or subsequent professional seminars.  It cost me $65 (half hour consultation which I gladly paid) and he recommended several good ones.

Good luck, T.P.

[Abigail]

It's frustrating when you run into therapists and doctors who are misinformed on BPD.

A friend of mine has a husband who exhibits all of the symptoms for BPD and has deep abandonment issues.  I gave her SWOE and she read some of it and took it to her therapist and asked her if she thought husband might be BPD. The therapist hadn't met him but from the wife's description she told her that he couldn't be BPD because BPD's don't get along with anyone.  And his only problem is deep abandonment issues and substance abuse.  Gee, since when is that criteria in the DSM-IV?

In another case I have a friend whose son-in-law has BPD symptoms and he himself agrees it sounds just like him.  His doctor said he couldn't possibly have BPD because he has a job!  Another new criteria in the DSM-IV that I missed?

Why can't they be honest and say, I really don't know that much about BPD.

Abigail

[GENERAL ANNOUNCEMENT]

GENERAL ANNOUNCEMENT This board is intended for general questions about BPD and other personality disorders, trait definitions, and related therapies and diagnostics. Topics should be formatted as a question. Please do not host topics related to the specific pwBPD in your life - those discussions should be hosted on an appropraite [L1] - [L4] board. You will find indepth information provided by our senior members in our workshop board discussions (click here).

[Theireyeswerewatching]

It is true that a great number of mental health experts who are not specially trained in personality disorders such as BPd do not have an indepth understanding (workable knowledge) about how to treat this mental illness and the seriousness of it. It is also true that borderline personality disorder does not stand alone as a mental illness, it is accompanied with other issues making it a very difficult and life long process of treatment and recovery.

I'd also like to say, remember that some of these so-called experts in mental health (some posters on here have stated their spouse or SO with BPD and other personality disorders either work or have degrees in mental health) are simply people who usually come from problematic dsyfucntional and abusive backgrounds; it is not uncommon to find survivors of abuse or those still in the process of learning survival skills employed in the field of psychology and other helping professions.

[cult]

From tara4bpd.org:

WHY IS IT IMPORTANT TO SEE A TRAINED DBT THERAPIST?

DBT may be the most hopeful and helpful of any new therapy available for people with BPD. Many people with BPD have problems trusting others, have “failed in treatment” or have been dropped by former therapists. When DBT is not done as designed, the results may not be the same, causing the person with BPD to lose hope and trust and then be reluctant to ever try DBT again. If DBT is not practiced according to the research model that produces effective change but is practiced “my way” by a therapist without adequate training, it probably won’t produce the same kind of results as the research programs. Outcomes from this kind of DBT will not justify additional DBT training or new DBT programs in the community. Currently. Dr. Linehan is working on a way to certify therapists who practice DBT so that people can determine if a therapist is truly qualified to practice DBT.

[Unreal]

The  mental health is a complicated field that requires a good bit of knowledge for ethical/competent practice.  My opinion is that the letters are more likely to result in competence than trusting in a shoot-from-the hip person without the letters.  Yes, there are gifted, empathic counselors (masters level) out there.  I am not saying that not having a PhD or MD necessarily makes you an ineffective therapist or inferior to the doctoral level folks.  I am also not saying that having a PhD or MD guarantees competence.  What I am saying, once again, is that mental illness is complicated. I think in a lot of cases, a social work degree is fine.  Often, people just need to talk to an empathetic ear.  There's no real expertise needed with that.  It's about being a caring person.  But, on this site, we are talking about serious mental illness.  I wouldn't in good conscience rec a masters level person for this.  Ill-equipped. 

If I were recommending therapy to a friend, I'd recommend a PhD, ABPP psychologist because that is the clearest credential representing competence in the field.  It doesn't guarantee anything.  It's about probabilities.  A nurse might be able to function as a competent primary care physician if they've spent enough time in a hospital, but that doesn't mean that would always or even mostly be the case.  Experience is important.  But so is education, so are admission standards (better and brighter students), etc. . . If I was worried about a friend, I'm sending her to a board certified physician, not a nurse practitioner. 

[Skip]

This is a really interesting discussion.   I think a lot of people don't have a very good road map for seeking mental health care. I often think people pick a resource based on cost or ease.

My experience, which qualifies as "one rat study", is that there is a huge range of competency continuum among mental-health providers.

I personally look at a DBT provider the same way I look at a surgeon -  their are a lot of general surgeons that can do the job, but picking a specialist, someone that does the same type of surgery day in and day out, really improves the odds that you'll get competent care. Especially if you have no other barometer to access someones skills.  DBT is pretty specialized.

A long the same lines,  I believe that a practitioner with active ties at the University, all things being equal, is also a good bet. It seems that the treatment of BPD is in an embryonic stage and there are still debates about which is best:

Cognitive-behavioral therapy (CBT)
Transference-focused therapy (TFP)
Dialectical-behavioral therapy (DBT)
Schema-focused Therapy (SFT) and
Mentalization-based therapy (MBT)

Although I understand that it is DBT that has the huge studies behind it now.

A few people I've talked to have recommended that DBT be done in conjunction with other methods - talk therapy being one, STEPPS being another, and, of course, the prescribing psychiatrist.   So a competent care plan probably has several mental health professionals involved each working out component of the care.

It's interesting discussion, guys.

Skippy

[Forward]

Just to the comment of DBT being commercialized - I just perused "Dialectical Behavior Therapy in Private Practice" by Dr. Thomas Marra, and the two things that jumped right out is how Dr. Linehan wants to "certify" DBT practicioners, and how DBT is now for all kinds of other PDs.

My limited experience with certificate of counseling from a divinity school is not positive. In general, the focus is spiritual verses mental, and the direction is that most mental disorders are manifestation of spiritual issues.

I am a firm believer of physical, mental and spiritual areas but with no hard boundaries, even major overlaps and influences.

[Unreal]

A few people I've talked to have recommended that DBT be done in conjunction with other methods - talk therapy being one, STEPPS being another, and, of course, the prescribing psychiatrist.   So a competent care plan probably has several mental health professionals involved each working out component of the care.

This should be reinforced.  A competent care plan might include a psychologist, psychiatrist, primary care physician, and social worker.  This may seem like a lot, but in concert, it can be effective.  The primary care physician is necessary to monitor general health factors.  There are many conditions that can affect mental health presentation.  Communication is key.  The mental health practitioners need to have access to medical records to stay on top of this.  The psychiatrist is necessary for any pharmacotherapy.  Though primary care physicians often handle psychoactive medications, they are underqualified for this.  A psychiatrist is the right specialist for this work.  The psychologist can be used for assessment, initially.  They are the most qualified for accurately diagnosing mental illness.  Then, the psychologist can be used for therapy.  The social worker can be used as a case manager and also to facilitate contact with needed services.  People with mental illness are often in need of multiple levels of intervention. 

[william3]

This is a good thread.  It seems to center on selecting an ideal therapist though.

I live in San Antonio, the 7th largest city in the US.  I have searched extensively, and have only found one therapist here that specifically mentions treatment of borderline, he is not trained in DBT though.

The only place in town I've found offering DBT is a center that specializes in treatment of eating disorders.

[Skip]

This is a good thread.  It seems to center on selecting an ideal therapist though.

I live in San Antonio, the 7th largest city in the US... The only place in town I've found offering DBT is a center that specializes in treatment of eating disorders.

Your point is probably one of the most important - for any number of reasons, people often do not have the insight, the resources, the access, or all three to get into an optimal care plan. And of course, we don't want to forget the human elements, interests, compatibilities that also plays a significant role in the outcome. If the working relationship between the client and caregivers is not sound...   

Possibly the most pragmatic thing this thread can accomplish is to outline 1) ideal care models (which have been discussed), 2) outline models that would likely do more harm than good,  and then move on to discuss 3) the practical alternatives between. 

I'll start by saying that if you random or loosely recommended resource - you have as significant risk of "fouling" the person with the disorders acceptance of their illness and disorder.  I, personally, would research the field (both the type of care plans and referrals to specific providers) possibly starting with the nearest university, speaking to people at the best psych facilities in town, and if you can find a support group - inquire there too.

Skippy


PS: You may find these resources help in your search --

UTSW at Austin, has an active mood disorder program run by Robin B. Jarrett, Ph.D., Professor of Psychiatry, and Elizabeth H. Penn, Professorship in Clinical Psychology.  They may be able to direct to to resources a close to your home.

This is a self help group - they may be able to direct you to some resources:
Scarred Souls
San Antonio, TX
Contact: Laura (210) 349-7190 (*not* the church where meetings are held)
scarredsoul@hotmail.com

[Bitzee]

william3,

I live in a major U.S. city, and our County Mental Health agency has DBT therapists and programs (with waiting lists).  Not that I recommend county agencies (I don't), but I just wonder if you have looked in the right places.

I found a referral for a private DBT therapist by calling my local county mental health agency.

[william3]

Skip & Bitzee -

Turns out the eating disorder clinic also treats BPD, but doesn't advertise it.  This is good - if they advertised BPD treatment, I doubt my uBPDw would be willing to attend.  In the past, telling her she has BPD and should seek BPD treatment has been counterproductive.  I guess I really don't care what her diagnosis is, as long as she can get the symptoms under control.  Now I just need to pick the right way to frame my suggestion for an appointment with the DBT therapist. 

Thanks for the other suggestions - I will check into those too if this doesn't pan out.

[Mollyd]

 ... well, this probably goes without saying, but ...

ir'a not a non's job to select a therapist for someone with bpd, and that seems to be most of the content of this thread (and this conversation has been interesting!)

This is a non board, right?

So, selection of a therapist who really understands dynamics related to being in relationship with someone who has bpd ...

how does one find that?

thoughts?

Molly

[Bitzee]

Mollyd,

I think Domestic Violence therapists understand these dynamics... they may tend to be a little low end, though, working for shelters, etc.  A private therapist with a background in Domestic Violence might be good.

I chose a DBT therapist for myself, thinking she would be knowledgeable about both the relationship dynamics and BPD.  I ended up being very disappointed with her, however.  Perhaps this was just a fluke.

[Ibenhad]

  My dBPDF is going to change Therapist's next week and has called a new one that I recommended that specializes in DBT and other BPD issues. Are there any specific questions  my F should ask the T before signing up or should she just give this new one a try? TIA

[Ibenhad]

 Maybe this could be made a sticky in case others ask :

From BPD Demystified , Robert O. Friedel, MD -

"John Gunderson described well the responsibilities of the primary clinician"

 - Educate the patient about the nature and causes of Borderline Disorder
 - Ensure that all appropriate evaluations are performed in order to determine the patients specific needs
 - Develop with the patient a comprehensive treatment plan that best meets these needs
 - Ensure the plan is implemented
 - Routinely determine the patients safety and progress in treatment
 - Implement changes in the treatment plan when indicated 
 - Ensure communication among other therapists, if any , who are involved in the patient's treatment


 And from Stop Walking on Eggshells by Randi Kreger and Paul T. Mason, MS  -

    Asking the clinician questions designed to evaluate the persons competence at treating patients with BPD -

1. Do you treat people with BPD? If so how many have you treated? Watch the therapist's body language and tone of voice to determine their attitude about BPD clients. We suggest you avoid therapist's who do not hav a lot of experience with borderline problems.

2. How do you define BPD? If the therapist knows less than you do keep looking. If the therapist thinks BPD is part of another disorder that you do not have, move on.  ( for example they may believe that BPD is really a form of Post-Traumatic-Stress-Disorder, yet you have no history of trauma.)

3. What do you believe causes BPD? If you are a non-abusive parent of a BP and the therapist believes all BPD is caused by parental abuse, we urge you to find a more compatible therapist. Also if the clinician does not mention possible biological causes, they are probably not up to date on the latest research.

4. What is your treatment plan for clients with BPD? Look for someone who can give you a clear overview of the treatment they provide, but who also says that treatment is modified for each individual. Therapist's who do not have a treatment plan tend to be diverted by BP's crises and never seem to get around to addressing long-standing issues.

5. Do you provide a specific treatment for self-injury? Substance abuse? Eating disorders? Loved ones of those with BPD? Substitute or add your own concerns here.

6. Do you believe that borderlines can get better? If so have you personally treated BP's who improved? According to Santoro and Cohen (1997), " what you want to hear is reasonable optimisim. No one can give you a guarantee( if they do, skip them). If they hedge their bets too much, it is probably better to move on to someone else." Make sure that you and the therapist share the same goals.

7. What are your views on medications? If the therapist is not a psychiatrist , ask who would prescribe them, if any are needed.

  Hope this helps others. I am going to give this to my dBPDF if she doesn't have me go with her.

[Skip]

Good post - thanks!

[mwbpd]

Hello,

I am looking for a T in my area, but when I get a list there are psychologists, psychiatrists, counselors, therapists, LCPC, LCSW etc etc.  I didn't realize it would be that hard.  I need someone that has a clue about BPD and can help me with PTSD.  So what do I pick?

Thank you for your feedback

[Skip]

This might be a good source for help or recommendations in your area:
http://www.emp-dbt.com/index.htm