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THE PSYCHOLOGY OF PERSONALITY DISORDERS
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Author Topic: What to look for in a therapist (qualifications, other)?  (Read 34985 times)
leafygreens17
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« on: November 15, 2005, 12:18:27 PM »

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!
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« Reply #1 on: November 15, 2005, 01:03:44 PM »

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.
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« Reply #2 on: March 23, 2007, 03:05:28 PM »

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
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Theireyeswerewatching
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« Reply #3 on: March 24, 2007, 12:13:55 AM »

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.
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« Reply #4 on: December 31, 2008, 08:30:45 PM »

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.
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« Reply #5 on: January 01, 2009, 08:10:19 PM »

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. 
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« Reply #6 on: January 01, 2009, 09:14:11 PM »

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
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« Reply #7 on: January 02, 2009, 09:47:57 AM »

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.
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« Reply #8 on: January 05, 2009, 10:53:09 AM »

Quote
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. 


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« Reply #9 on: January 05, 2009, 12:18:24 PM »

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.
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« Reply #10 on: January 05, 2009, 01:33:12 PM »

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
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« Reply #11 on: January 05, 2009, 03:23:08 PM »

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.
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« Reply #12 on: January 06, 2009, 01:41:11 PM »

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.
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« Reply #13 on: January 06, 2009, 11:16:03 PM »

 ... 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
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« Reply #14 on: January 07, 2009, 08:58:01 AM »



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.
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« Reply #15 on: July 08, 2009, 10:10:30 PM »

  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
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« Reply #16 on: July 09, 2009, 08:54:17 AM »

 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.
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« Reply #17 on: July 09, 2009, 10:04:05 AM »

Good post - thanks!
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« Reply #18 on: September 08, 2009, 02:40:22 PM »

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
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« Reply #19 on: September 08, 2009, 03:10:38 PM »

This might be a good source for help or recommendations in your area:

www.emp-dbt.com/index.htm
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« Reply #20 on: April 09, 2010, 08:01:58 PM »

Staff only

This thread about what we're looking for in a therapist is split off from another started by Randi Kreger about how therapists have helped/hurt: https://bpdfamily.com/message_board/index.php?topic=115997.40.

Without getting into details ( sorry I have not read all of the posts but some of them) I had the opportunity to speak to two T's recently that were my daughter's T's.  So the first one was phenomenal.  He was brilliant and perceptive and thought outside the box and was able to HEAR  and synthesize what H and I were telling him and he was able to see the possibility of BPD  in our D and then after talking to us ( h and me) HE felt validated by what we had told him.  He would have been the best T for our D.  But our D did not like that anyone was finding out what she was really like- being challenged so that was the end of him.  

Now- presently there is one who is exactly what I was afraid of- she is an enabler and to my D she is a keeper.  This is always the case- anyone who agrees is IN and if you see though her- and start to challenge you are out.  So I was telling T#2  the exact same things I told T # 1 (above) and #2  took it all differently and seemed to have a ONE TRACT MIND- and she used all of my very important information differently than #1 and kept defending our D as if I was TRYING  to use the information AGAINST  our D instead of informing the #2  of another side that my D is so good at hiding.  This T wasn't hearing a word I was saying.  She was like a broken record no matter what I said.  My aim was to help my D.  

It is about skills.  The ability to HEAR WITHOUT BIAS, SYNTHESIZE INFORMATION, THINK OUTSIDE THE BOX, UNDERSTANDING THAT THERE IS A GLOBAL PICTURE AND NOT JUST ONE SIDE...AND MORE!

Bleccchhh.  Speaking to this T#2 keeps me feeling so hopeless and my H too about our D.  I know it IS our D's own choice who she picked and I know what her schtick is all of the time- but besides what this thread is about I also wish there was a law that prevented BPD's to pick their own T's too.  That would be a miracle, eh?  Of course you need to have the diagnosis of BPD for that kind of magical thinking.  So many on these boards say uBPD...or they are too young for the psyche to "name" as BPD.  

Thanks

wtsp

oops- just saw that Randi had all of her answers necessary.  Well it felt good to vent anyway.  

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« Reply #21 on: April 10, 2010, 11:09:19 PM »

Quote
Experience is not enough.  There is a way of thinking that's important. . . the science of mental health

?

there are therapists/psychologists/psychiatrsits that are skilled and talented and there are those who are not ...

the point I was trying to make, which I don't feel is especially unique or controversial, is that a clinician who has a lot of expeience with a particular type of problem or disorder, like BPD, will possess more  knowledge and more expertise concerning that disorder, and therefore will likely be able to offer more help or assistance to someone suffering from that disorder, ... than would another equally skilled clinician that has little or no knowledge or experience of that particular disorder or ailment.   

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« Reply #22 on: April 12, 2010, 01:33:00 PM »

"there are therapists/psychologists/psychiatrsits that are skilled and talented and there are those who are not ... "

agree. . . but, they aren't equivalent levels of care therapist does not equal psychologist does not equal psychiatrist.  They are supposed to target different things.  Granted, there is significant overlap these days with the expansion of scope of practice of midlevels, but, even when performing similar tasks, you're dealing with very different experience/training/thought process among professions. 

"the point I was trying to make, which I don't feel is especially unique or controversial, is that a clinician who has a lot of expeience with a particular type of problem or disorder, like BPD, will possess more  knowledge and more expertise concerning that disorder, and therefore will likely be able to offer more help or assistance to someone suffering from that disorder, ... than would another equally skilled clinician that has little or no knowledge or experience of that particular disorder or ailment.   

"

I agree, with the caveat that experience without proper frame of reference is nearly useless.  Meaning, I would tend to prefer a less experienced (with BPD) doctoral level practitioner than a masters practitioner who has lots of exposure to BPD because in my view treating BPD should be outside of the scope of practice of a masters level therapist. 


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« Reply #23 on: April 12, 2010, 10:11:13 PM »

Quote
I agree, with the caveat that experience without proper frame of reference is nearly useless.  Meaning, I would tend to prefer a less experienced (with BPD) doctoral level practitioner than a masters practitioner who has lots of exposure to BPD because in my view treating BPD should be outside of the scope of practice of a masters level therapist.

 

I see it differently.  I would rather work with a skilled and talented cinician(s) who has expertise in a specialized area if I were dealing with a difficult and specialized disorder such as BPD, regardless of the PhD v. Masters level of education. I've seen way too many genuinely talent people from the 'lower eschelons' of life work wonders and way way too much inflated pseudo brilliance from supposedly 'higher degreed' individuals... to assume or expect the degree or even the school (Harvard v. a State School) necessarily means squat

A psychiatrist is of course a medical doctor and therefore can treat medical issues and perscribe medication, whereas a psychologist and MFT or other master's level clinican cannot.   A psychologist can administer and interpret a variety of psych tests.  Someone w/ a PhD level education may also be invovled in teaching/research endeavors.  While perscribing drugs and administering (certain) psych tests are beyond the scope of practice of a master's level clinican...Neither of those targeted skills, nor teaching or research endeavors, necessarily make an individual a better therapist.  I've worked with way too many physicians and other 'supremely degreed' individuals whose people skills and common sense were absolutly atrocious and whom caused many more problems than they ever helped.  I am not personally automatically enamoured of  or even trusting of a professional based on the degree.

I would never personally choose to do ‘therapy’ with a psychiatrist.  This is an individual who has focused most his/her adult life on the study and application of a classic medical model, and gaining expertise in prescribing drugs for specific mental health issues.  They are usually over extended and stressed-out and typically  have way too large a patient load.   They can barely keep up with seeing their patients 1x every 2 weeks to check on how the medication is doing and are of course immersed in all sorts of insurance issues and hospital paperwork.  This is the person I want to see for medication, this is  NOT the person I want to see for ongoing  ‘therapy’.   

In any event, what I've seen in practice are 'treatment teams' with a psychiatrist taking the lead on dx and medication even though they have the least 'face time' with the patient...and maybe a psychologist for testing...but the people working daily in the trenches in group and individual therapy, including DBT therapy targeted for BPD symptoms, are mft's and/or lcsw's.  Further rounding out the team are psych. nurses and in some cases even case managers.   

I don't see too many psychiatrist's or psychologists leading dbt therapy groups or any kind of therapy groups w/ significantly mentally ill individuals. In fact I've never seen that.  Ever.  At least not in out-patient or partial hospitalization programs and / clinic programs that I've been exposed to. Not even once.  Maybe that's just the case in  my state or my area, but that's what I see.  In support of family members of those who suffer w/ BPD, it is my understanding that some Family Connections type support groups are led by lay people; family members who have lived with this disorder and gone through their own skills training and are trained to help lead groups of family members who are eager to learn similar skills, with positive results.

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« Reply #24 on: April 12, 2010, 11:25:39 PM »

continued...

The overlap is that all three are involved in psychiatric patient care to one degree or another.  But there is less and less overlap, and more specialization in each role, specifically…

Psychiatrists are medical doctors and their expertise usually lies in hospitalization and medication issues of patients with acute mental health problems.

Psychologists are relied on by schools, hospitals and other social institutions to administer and interpret psychological tests, and some also perform  therapy.  Many psychologist programs can be entered from directly after the undergrad level of study has been completed…meaning you do not have to move from undergrad to masters to PhD level study.  Indeed,  if you want to ultimately become a psychologist, it is recommended that you not take a  masters course of study such as an MFT undergoes, because you will have to start from scratch and go through many of the same hours of onsite training that you did while getting your MFT.  

MFTs are Marriage and Family Therapists, they are trained and licensed exclusively for the purpose of performing therapy with men, women, children and families regardless of the diagnosis.  They work either in private practice or in mental health agency’s and clinics and/or hospitals in tandem with a ‘treatment team’ that will include consultation with and referral to a psychiatrist if medication or medical issues are assessed.  They undergo a total of 7 years of total undergrad/post grad schooling and another 3000 hours of supervised onsite training as a therapist intern doing one on one, group, family and couples therapy supervised by a licensed MFT or clinical psychologist before they can sit for the state board and become a licensed therapist in private practice.  MFT’s along with LCSWs are relied upon almost exclusively in hospital settings by psychiatrists to perform hours of client individual and group ‘therapy’ , they are relied upon to peform assessment, diagnosis and treatment planning, and their scope of practice is NOT limited by law or ethics to any particular type of client or diagnosis.  Meaning…it is fully within the scope of practice for MFT’s to be working with individuals with BPD or any other diagnosis.  As with any clinician, if they feel they do not possess the knowledge or expertise to address a client’s presenting problem, they are legally and ethically mandated to refer the client to a practitioner who can and they most cetainly cannot perscribe medicine though they monitor and consult with a psychiatrist and other team members regarding medication issues.

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« Reply #25 on: April 13, 2010, 06:48:08 AM »

Quote
I see it differently.  I would rather work with a skilled and talented cinician(s) who has expertise in a specialized area if I were dealing with a difficult and specialized disorder such as BPD, regardless of the PhD v. Masters level of education. I've seen way too many genuinely talent people from the 'lower eschelons' of life work wonders and way way too much inflated pseudo brilliance from supposedly 'higher degreed' individuals... to assume or expect the degree or even the school (Harvard v. a State School) necessarily means squat. 



Beyond the scope of this thread, though I suppose it's tenuously relevant.  While I agree there are talented people in the "lower echelons" (though, I don't see them as lower echelons, I see them as designed for different purposes), part of skill and "talent" with respect to being a clinician, part of "expertise" is the training form.  Mental health is a strange field.  You wouldn't see a nurse as a "clinician" and talk about their talent, while arguing that the MD/DO doesn't mean squat.  The gulf between masters level and doctoral level in mental health is as wide.  It's not about talent per se, it's about roles.  It's just been blurred by politics and a lack of understanding. 
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« Reply #26 on: April 13, 2010, 06:55:13 AM »

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A psychologist can administer and interpret a variety of psych tests.  Someone w/ a PhD level education may also be invovled in teaching/research endeavors.  While perscribing drugs and administering (certain) psych tests are beyond the scope of practice of a master's level clinican...Neither of those targeted skills, nor teaching or research endeavors, necessarily make an individual a better therapist. 



That isn't the only difference between the fields (psychiatry, social work, psychology).  A PhD/PsyD cannot be looked at as teaching/research/assessment added on to therapy training (masters).  This is partially why you see so much pseudoscience in the field (e.g., EMDR, shaman healing, etc...).  Most doctoral level practitioners do zero research or teaching.   

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I've worked with way too many physicians and other 'supremely degreed' individuals whose people skills and common sense were absolutly atrocious and whom caused many more problems than they ever helped.  I am not personally automatically enamoured of  or even trusting of a professional based on the degree.

Okay, but these are not correlated, and the answer isn't go to someone who is inadequately/inappropriately trained for the task; the answer is to find another physician or doctoral level provider with appropriate background that has good people skills.  It's not about being "supremely degreed," it's about meeting a minimum bar of entry.  I understand that legally LCSWs can do therapy.  But, that's more of a failure of the APA than a stamp of approval of social work for these roles.   

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« Reply #27 on: April 13, 2010, 07:00:06 AM »

  

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I would never personally choose to do ‘therapy’ with a psychiatrist.  



Depends on the psychiatrist and the problem at hand.  

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They are usually over extended and stressed-out and typically  have way too large a patient load.   They can barely keep up with seeing their patients 1x every 2 weeks to check on how the medication is doing and are of course immersed in all sorts of insurance issues and hospital paperwork.  This is the person I want to see for medication, this is  NOT the person I want to see for ongoing  ‘therapy’.    



Too much of a generalization.  

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In any event, what I've seen in practice are 'treatment teams' with a psychiatrist taking the lead on dx and medication even though they have the least 'face time' with the patient...and maybe a psychologist for testing...but the people working daily in the trenches in group and individual therapy, including DBT therapy targeted for BPD symptoms, are mft's and/or lcsw's.  Further rounding out the team are psych. nurses and in some cases even case managers.  I don't see too many psychiatrist's or psychologists leading dbt therapy groups or any kind of therapy groups w/ significantly mentally ill individuals.  



It depends on where you are.  Regarding Dx, psychology is generally the gold standard (assessment and Dx is how clinical psychology started), not psychiatry.  Masters level practioners are out there in large numbers, no doubt.  But, I'd use them differently.  I'd setup my team like this:

psychiatrist - med management

internist - rule out other conditions affecting emotional regulation (e.g., thyroid disease)

psychologist - dx and psychotherapy

social worker - supportive therapy and case management (visiting home, checking on children).  (your lay people role is traditional social work)            
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« Reply #28 on: April 13, 2010, 07:09:30 AM »

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Psychologists are relied on by schools, hospitals and other social institutions to administer and interpret psychological tests, and some also perform  therapy.  Many psychologist programs can be entered from directly after the undergrad level of study has been completed…meaning you do not have to move from undergrad to masters to PhD level study.  Indeed,  if you want to ultimately become a psychologist, it is recommended that you not take a  masters course of study such as an MFT undergoes, because you will have to start from scratch and go through many of the same hours of onsite training that you did while getting your MFT.  



Every doctoral level psychology program that I'm aware of awards a masters degree in the course of completing the doctorate.  What you're touching upon here is exactly the point I was making earlier.  There is a substantial difference in the masters degree that is completed on route to the phd/psyd and that that is completed as an MFT.  They are not the same course of study.  Further, psychology is an extremely vast field.  There are psychologists that never do any clinic work at all and there are psychologist who do therapy all day long.  I know psychologists that work for the NSA, for banks, in psychiatry depts, in neurology depts, in psychology depts, in private practice, for the department of corrections, for NFL teams, etc. . .   There are even psychologists, in a few states, that do med management along with providing assessment and therapy services (though I don't agree with the expansion of psychology into medication prescription; it is the same issue I have with the expansion of MFT and LCSW into doing psychotherapy, Dx, assessment). 

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« Reply #29 on: April 13, 2010, 07:17:49 AM »

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MFTs are Marriage and Family Therapists, they are trained and licensed exclusively for the purpose of performing therapy with men, women, children and families regardless of the diagnosis. 



MFT was never intended to be a generalist psychotherapy degree (nor was social work).  This is the scope of practice expansion that I'm talking about.  The MFT, as named, was designed to train people to do couples therapy, deal with child rearing issues, not deal with significant mental health issues. 


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They undergo a total of 7 years of total undergrad/post grad schooling



Shouldn't be counting undergrad.  They are 2 - 3 year programs.  Otherwise, you're looking at 12-13 years of training for physicians and psychologists.  I don't think anyone looks at it that way.   

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As with any clinician, if they feel they do not possess the knowledge or expertise to address a client’s presenting problem, they are legally and ethically mandated to refer the client to a practitioner who can and they most cetainly cannot perscribe medicine though they monitor and consult with a psychiatrist and other team members regarding medication issues.




Knowing what you don't know is a difficult thing. 

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« Reply #30 on: April 13, 2010, 08:35:02 AM »

You wouldn't see a nurse as a "clinician" and talk about their talent, while arguing that the MD/DO doesn't mean squat. 

No ... on the other hand, I've been a patient of nurse practitioners - an even nurses - who seemed to know much more what they were doing than some MDs. At least in some areas.

And I know for sure who I'd rather have give me a shot or draw blood ...

Interesting discussion - I think there are some good points all around.
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« Reply #31 on: April 13, 2010, 12:47:40 PM »

No ... on the other hand, I've been a patient of nurse practitioners - an even nurses - who seemed to know much more what they were doing than some MDs. At least in some areas.

And I know for sure who I'd rather have give me a shot or draw blood ...

As long as we seek THE ONE solution we are bound to fail. The question is not who is the best but who is the best for what task? So what are the basic tasks. I really don't know but since I'm not a trained professional I don't have to stop  wink and refer you to one. So here we go:

1) diagnosis

2) individual therapy

3) DBT therapy in a structured format

4) medication

5) clinical treatment of severe episodes

I suspect the questions one would need to ask are very different in each case. For e.g. diagnosis the ability to form a relationship quickly, emotional self awareness and a very good clue about BPD vs. bipolar and other stuff. Plus a good idea about the possible courses of action. But while analytical capabilities are helpful a lot more important later is the ability to lead the BPD sufferer through change and sustain the relationship. Whether you find both capabilities in the same person expressed to a greater extent is not so clear.

When it comes to Ph.D.'s in psychology it is at least in my country a good indicator that the person has a grasp on basic statistics. Whether that is relevant or not for treatment - I doubt it. But is may be an indication of abstract thinking and that is useful considering the games that are played with us by our SOs.
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« Reply #32 on: January 23, 2011, 04:15:32 PM »

I have a therapist that I have been talking to, but have decided that she is not what I need.  She listens well, but I know that she does not understand the hell my family is going through.   She insists that to "fix" this, that I need to sit down with the unBPD and tell her that I would like us to "fix" this, so that the family can be whole again.  My DS has tried talking his unBPD wife into going to therapy, or couples therapy or group therapy and her answer is, ALL of you are crazy and ALL of you need to go.  I am the only sane person.   Well, folks, NO SHE IS NOT!  She is the one that has brought all this hell into our lives.  So, back to my question.  I need to find a therapist who is familiar with BPD.   I live in North Carolina.  Any suggestions?
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« Reply #33 on: April 21, 2011, 07:12:42 AM »

Is there a good reference site for therapists who specialize in BPD and the people that care about them?
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« Reply #34 on: September 24, 2011, 10:18:08 PM »

Hi

  I am a long term member but I wanted to post something I think is important for everyone so Im posting it here. I recently read a post from a non having issues with their BPD's current Therapist. For those of you who have followed my story my exBPD ended up a disaster because of his own T.But here is the substance of what I want to get out there. I also don't want to make any sweeping generalizations so read carefully- this applies to Many but not ALL therapists. The goal of this post is to help people CHoose wisely.

  Many  therapists, including but not limited to MSWs. PsycD, PHds, Addiction counselors etc.. DO NOT have training in extreme psychopathology especially BPD. However I suspect that many of these same people are reluctant to turn away a patient let alone a BPD who is easily develope a dependency on them. More importantly BPDs are absolute masters at both perceiving and portraying themselves as victims inducing rescue fantasies in their therapists. The result is that some T's will fail to properly dx the BPD and in many many instances will only re-inforce the BPDs persecution complex. Its becomes a seriously maladaptive cycle wherein the BPD traingulates using the T to get whatever they want; whether its antipathy towards the Non or med changes or just validation that nothing is wrong with them. Herein the real problem- what use is a T who is just taking money in exchange for ratifying a mentally ill person's denial. If anything these serious countertransferance abuses lead to only more difficult. In my own case- it was a disaster and my ex BPD is probably a whole lot worse for his T.

  I dont know how many people will read this but... someone posted that while a non has little rights talking about the BPD with their T, we are completely within our own rights to ask the T exactly what was his/her training, education and precise experience working with BPDs. If they don't answer- you got a huge red flag that the person your BPD is seeing to help - may in fact only be hurting them. So here are some suggestions

a) Find out about credentials, training and education regarding the types of mental health issues they deal with

b) You have an absolute right to know how much experience the T has with BPDs.

c) Check with the local dept of ed to make sure their licenses are real and up to date

d) A great resource is the National Degree Clearinghouse data base which keeps diploma records

e) Ask about the experience the T has with CBT, DBT, Transferance Based therapy and anything else that applies

SSD
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« Reply #35 on: September 25, 2011, 11:16:26 AM »

Some therapists are versed in DBT but don't necessarily sponsor the skills workshops required to be a 'certified' dbt therapist.  The other day, I found a DBT teacher who is not certified to teach due to this workshop limitation.  He mentioned that therapists who do 'trauma' work are often trained in DBT.  Perhaps you can google 'trauma' therapist.  Hope this helps. 
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« Reply #36 on: September 25, 2011, 08:04:21 PM »

I dont want to generalize but really "trauma therapy". Sounds like PTSD psychobabble to me

I wonder if Linehan keeps a list of approved Ts/

That would seem the only way to go

Otherwise a BPD is a T's wet dream; someone willing to come as often as possible keep paying just dont ever tell them the truth

A psych I dated once joked; First I tell pts they wont get better until my youngest graduates prof school

And those are the good ones

Caveat EMptor
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« Reply #37 on: November 07, 2011, 04:52:20 PM »

How do you find a Dialectical Behavior Therapist? We are in Arkansas - I can't seem to find any information.

We are also only an hour to an hour and a half from Tulsa Oklahoma.

Thanks.
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« Reply #38 on: November 11, 2011, 10:21:16 AM »

It isn't always easy to find a provider, so here are some places to look:

Psychology Today has a good therapist look up: www.therapists.psychologytoday.com/rms/prof_search.php

Insurance companies often have lists of providers, with specialties and profiles listed, that you can access online (if you are a member of that insurance group).

DBT Self Help has announced it is partnering with another group to provide a comprehensive list of DBT therapists (still pending as of the time of this post but apparently coming soon):

Quote
A Worldwide DBT Database will be available for anyone who is looking for a DBT therapist or group in their area. This database will be provided in partnership with GoodTherapy.org. The actual database and search engine will be available on this website. DBT therapists and Centers offering DBT groups will find a coupon for 2 months free listing which they can use to sign up via GoodTherapy.org.

The current list of resources (soon to be replaced) is here: www.dbtselfhelp.com/html/resources.html

Your local NAMI affiliate may have resources for referrals.
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« Reply #39 on: November 18, 2011, 09:50:03 PM »

I came across a therapist who was very astute with a BPD/NPD comorbid diagnosis and I asked her her advice to find more like her.She said that private therapists screen out axis ll patients and are inexperienced, so your best bet to find someone with a great deal of experience (which is what you want most of all) is to find people who have experience at places where:1) they did not have a choice as to clients 2) they were most likely to get clients with axis ll (PD) disorders.So where?1) Free or low cost clinics2) People with experience in prisons or domestic abuse and things like that. Some 30% of people in prisons have BPD and I am sure they are crawling with narcissists and antisocials as well. Look at Brandon Marshall, the new face of BPD.
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« Reply #40 on: November 22, 2011, 07:46:43 AM »

Another search engine resource (for the U.S.): www.findacounselor.org/. Listings are not comprehensive but the site is easy to use and information is good.

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« Reply #41 on: November 22, 2011, 07:53:36 AM »

DBT Self Help has announced it is partnering with another group to provide a comprehensive list of DBT therapists (still pending as of the time of this post but apparently coming soon):

Quote
A Worldwide DBT Database will be available for anyone who is looking for a DBT therapist or group in their area. This database will be provided in partnership with GoodTherapy.org. The actual database and search engine will be available on this website. DBT therapists and Centers offering DBT groups will find a coupon for 2 months free listing which they can use to sign up via GoodTherapy.org.


GoodTherapy.org has a searachable database that includes "dialectical behavioral therapy" (as well as "schema therapy" and other relevant therapy types for our members) under "Type of Therapy." Database is international, though I cannot speak to how comprehensive the listings are.
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« Reply #42 on: May 23, 2012, 07:20:40 PM »

Hi,

I'm not sure if this is appropriate here on this board - or site in general.  Please move -or even delete I suppose- if necessary.  

I am relocating to the St Louis area and am terrified I will not find a good therapist there.  Can anyone recommend someone who has BPD experience?  

Thank you!  
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« Reply #43 on: May 23, 2012, 09:50:54 PM »

You can start by taking a look at the Resources and Download tab on the Home page.

https://bpdfamily.com/discussions/family-resources.htm

Let us know if that helps.
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« Reply #44 on: June 02, 2012, 07:34:51 PM »

This might be a good source for help or recommendations in your area:

www.emp-dbt.com/index.htm

I am also looking for a therapist that does DBT.  I live in Southern California.  Are there resources for finding a qualified person.
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« Reply #45 on: June 03, 2012, 01:35:09 AM »

This might be a good source for help or recommendations in your area:

www.emp-dbt.com/index.htm

I am also looking for a therapist that does DBT.  I live in Southern California.  Are there resources for finding a qualified person.

Jim,

Have you checked out any of these sites for referrals?

It isn't always easy to find a provider, so here are some places to look:

Psychology Today has a good therapist look up: www.therapists.psychologytoday.com/rms/prof_search.php

Insurance companies often have lists of providers, with specialties and profiles listed, that you can access online (if you are a member of that insurance group).

DBT Self Help has announced it is partnering with another group to provide a comprehensive list of DBT therapists (still pending as of the time of this post but apparently coming soon):

Quote
A Worldwide DBT Database will be available for anyone who is looking for a DBT therapist or group in their area. This database will be provided in partnership with GoodTherapy.org. The actual database and search engine will be available on this website. DBT therapists and Centers offering DBT groups will find a coupon for 2 months free listing which they can use to sign up via GoodTherapy.org.

The current list of resources (soon to be replaced) is here: www.dbtselfhelp.com/html/resources.html

Your local NAMI affiliate may have resources for referrals.

-GM
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« Reply #46 on: June 04, 2012, 03:06:12 PM »

Thank you GreenMango

But how do I get the search to only look for people who offer DBT?
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« Reply #47 on: June 05, 2012, 12:10:44 AM »

Thank you GreenMango

But how do I get the search to only look for people who offer DBT?

JimNelson

It's going to take some legwork on your end.  To my knowledge there is not a BPD/DBT specialty referrals website for clinicians (If anyone knows of one please let the staff here know)

If you go into the either the Psychology Today link www.therapists.psychologytoday.com/rms/prof_search.php

you need to select "borderline personality disorder" under the issues menu.  It does not have a DBT specific option.  But therapists who have "experience" with BPD come up.  Some use DBT, some don't.  You need to check their individual profiles for a DBT specialty.

Through the dbt-self help link to www.goodtherapy.org under the advanced search options you can select both your region and type of therapy dialectical behaviorial therapy.  You will need to check if they are experienced with people with BPD.

Now both of these will pop up a variety of clinicians with varying degrees of experience, education, and philosophies.  It is important to ask questions and interview the potential therapists.

This post from page one of this thread may be helpful as a starting point:

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.

-GM
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« Reply #48 on: December 21, 2012, 06:44:13 AM »

I tried searching and didn't find anything...

I am starting to look for a therapist to help me get rid of my  PD traits  PD traits, and I would like some guidance.  I would prefer someone with experience with helping adult children of a uBPDm, but I also want to make sure the person can actually help and not just look good on paper.

What questions have you found helpful/did you wish you asked a therapist before you started therapy with him/her? What qualities did you appreciate in a therapist that help you deal with your  PD traits  PD traits?  Thanks for your help!
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« Reply #49 on: March 01, 2013, 11:15:55 PM »

Looking for a therapist when you have a parent with BPD could involve narrowing your search for therapists that were familiar with PDs.  Then calling the therapist's office and asking the therapist some questions about their focus, therapy style, years as a therapist, etc.

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« Reply #50 on: July 12, 2013, 09:51:15 AM »

Yesterday was my first personal/individual session with a new therapist. It was just me, and I found him by asking our MC (who includes BPD as her specialties) who she recommended. (This was a 1:1 call between me and the MC)

I have to say, and couldn't recommend more to all of you here on this board: Find a T that is trained in/experienced with BPD. Wow oh wow does it make a difference. In 20 minutes, he understand my needs and situation and next steps better than 6 sessions with my last non-BPD trained T.

May seem obvious, but if it wasn't to me, maybe it's not to others.
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« Reply #51 on: July 13, 2013, 06:11:52 AM »

 Doing the right thing

ya i went to a therapist also who knew about BPD most counselors do not you have to attend a therapist one who would know about BPD it helps a great deal...  they help you learn the skills and tools to live with a BPD...  
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« Reply #52 on: August 05, 2013, 04:06:32 AM »

Hi all,

Does anyone happen to know of a good psychologist/therapist around Amsterdam (Netherlands) who can work with me in diagnosing my wife's possible BPD?

Kind regards
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« Reply #53 on: August 14, 2013, 12:09:18 PM »

I think that this site can help you further on this matter :

https://www.stichtingborderline.nl/site/Voorlichting/Activiteitenagenda
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« Reply #54 on: August 15, 2013, 06:41:24 AM »

Graag gedaan ! Succes !

I think they may put you on the right track towards experienced people on the matter.
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« Reply #55 on: September 08, 2013, 05:58:03 AM »

Hi all -

I'm currently living in Beijing, and my partner has a number of symptoms of BPD if not a formal diagnosis.  The options for english-speaking therapists here are pretty limited, so I'm wondering if anyone knows a good therapist who is willing to work over skype?  I know it's far short of ideal, but we desperately need help and I want to find someone who gets the BPD behavior pattern and ideally practices DBT.  My partner has already been through a number of therapists with little success.

Any leads welcome, thank you!

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