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Author Topic: What to look for in a therapist (qualifications, other)?  (Read 37775 times)
« 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 »


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.

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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:


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.


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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 ":)ialectical 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 »

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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