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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 34907 times)
Skip
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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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Mollyd
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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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Skip
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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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Skip
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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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