Dialectical Behavioural Therapy, BPD and diagnosis

[Monarcmarc]

Hi there,

I'm posting because I am a bit isolated, and had been referred to this forum through services previously.

I have Borderline, and it's something that I've had a lot of trouble getting someone to diagnose me with, there's a lot of resistance to labelling. While I understand that, I've found it really patronising because I'm also living with HIV, so I already have lived experience with highly stigmatised health condition. I'm pretty highly functioning externally, and suicidal attempts and self injury are not a part of my experience with the condition, but there's a lot of emotional dysregulation and interpersonal difficulties in friendships, that have contributed to me being quite isolated as a a managing tactic. 

I'm currently doing a DBT program, and they did a run down of the DSM5 criterion during that, and said that the therapy might be beneficial, but stopped short of saying to me it might be BPD. I understand that it is probably a diagnostic exercise over time, but having done 6 weekly sessions, and revealed myself to be a bit symptomatic, I would have thought, there's still great reluctance.

Everytime you talk about diagnosis, they are avoidant. Previously, I have paid to have a psychiatrist do an assessment, and then when it went to the GP they wouldn't give me the report, spoke about it in general terms. He told me he'd sent it to the psychologist, she told me she never received a copy. So I've paid $500 for a report to try to get some clarity around what goes on for me sometimes, and my own information was withheld from me. For that reason, and some reference to narcissistic defense mechanisms, I worry I'm narcissistic PD, and they're avoiding telling me because I read that it's probably not an ideal way to support people to be treated around the same.

The thing that's most frustrating now, is that because I've been banging on about diagnosis with the current psychologist, who is treating me fortnightly while I'm doing a weekly BPD program for 6 months, they've written to the doctor about it and made that diagnosis. Meanwhile, they've not had that discussion with me directly. 

I'm really frustrated by that. I can understand how they might have thought that was what I was seeking, but the reality is I was looking for them to say it to me, not to write to the doctor for the sake of satisfying what I was saying, however it's continuing on that tendency to talk professionally between themselves about the people they're treating, without providing what I think is important information to the people they are treating.

I don't think it's malintent, but I'm really frustrated because it's a continuation of the experience I have complained about. 

It's also quite upsetting, because sometimes I think being able to negotiate your own needs, is something you might have difficulty with as someone with BPD, but I feel like I have explained all of this, and it still happened.

In terms of the DBT, I am quite struggling with that. I think I also have depression, and that makes it quite a battle to be able to do the diary card, and then also practice the exercises.

At the moment I'm feeling worse for having started the DBT sessions, even though I recognise it's probably something that might be beneficial in the long term. There's lots of mindfulness around what's going on, but because of the reluctance with diagnosis, committing to a full DBT program has been challenging - it's a big investment in terms of time and money, and without a diagnosis, it's hard to pursue that. I recognise it might be beneficial regardless, but as I understood it it's primary efficacy has been shown in managing BPD, and in particular suicidal ideation and self harm. 

Anyway, that was a lot, and I just wanted to ask if anybody has given DBT group therapy a go, and whether they have ended up feeling like they are worse off for having done it, rather than better. A lot of it I'm finding at the moment is focused on seeing the pain, and I already have some insight into that, and it's drawing our attention to it, but not yet giving the skills to change the behaviour, which I accept are likely to come later. 

I would be keen to hear people's experiences.

[fluffylight]

Hi @Monarcmarc
Thank you for sharing about what you're going through. A very warm welcome awaits you in these forums.

I acknowledge that you are holding a lot and DBT sounds like something you are navigating through right now.

Please know that you are not alone, you will find that many other forum members have shared experience with you, I hope that it serves as a reminder that you are not alone 💗

I haven't tried DBT so I just wanted to share lots of light with you and sit with whats coming up for you 💛 

I am offering someone else's story that they have shared to remind you that you can get through this 💛

fluffylight x

[NatureLover]

Welcome, @Monarcmarc . That is terrible that you pursued the report to get a diagnosis, and the report and the diagnosis have been withheld from you! I'm very sorry to hear. Surely you as the patient should have that information in the report, especially having paid $500 for it! 

I don't know if there are any advocacy services that could maybe help you to get that report? 

I am going to tag @tyme  and @BPDSurvivor  to see if they have any insight. 

[balance37]

@Monarcmarc I'm sorry to hear you are going through this. Thank you for being brave and sharing this with us.

As it happens, I have completed DBT group therapy last year, which went for 1 year, and the modules were repeated twice. When I first began I found the work very difficult, too, as there is a lot to learn and I wasn't 100% convinced this whole DBT thing would even work. But as the program progressed, I started to lean into it a lot more, and was able to find the skills that worked for me, such as mindfulness.

You have mentioned it is a struggle to complete the diary card as well as practice the exercises, but what I also see in your post is how much you are trying and you are committed to seeking help and creating a better life for yourself, one that you deserve. It's okay to struggle and know you are doing the best you can. 

Are there any particular exercises in the book (presuming you have it? it's a white book with a blue border) that you really like and could implement in your life? Not all of the exercises will work for you, but it's good to keep track of the ones that you find really helpful for you. 🙂

[Monarcmarc]

Thanks for that, appreciate your response.

Our is a 6 month stint, we're into week 8. 

I'm really struggling to get any value out of the skills. When I'm really struggling, it's hard to get my head around them, and ultimately what I'm seeking is resolution or elimination fo the pain, and that doesn't happen, so I have difficulty in seeing their utility.

When I'm really impacted, and there have been a series of internal crises over the last week or so, I kind of recognise that this is probably symptomatic, but it's very hard to try and figure out what I should be using when.

They say to use what's effective, but I don't find any of them effective.

I know that's a pretty dim view, but that's kind of where I'm at.

I'm also struggling in the group therapy because I have perceived some direct slights in the therapy, and when I've raised them, they've directed me back to the skills. 

I accept the skills need to be used and are potentially useful in managing the distress, however it's also the case that directing me back to the skills avoids any accountability to me if an error has been made. 

[BPDSurvivor]

Hi @Monarcmarc ,

Some great questions you've raised as well as some very valid points.

I wanted to share that I went through 18 months of Mentalisation based therapy for BPD. I didn't see any point in it for over a year. Only in the last few weeks/months was I able to reflect on my journey and see there was a difference.

Consider your age - this is how many years it has taken you to develop the unhelpful thinking patterns you have (in amongst the helpful thinking processes of course). It takes more than a few weeks for you to 'unlearn' the unhelpful and learn new skills. 

My suggestion is to just keep pushing through. What you go through will be invaluable to you in the future. In DBT, at least you have tangible 'skills' to learn. MBT is different - we didn't have those skills to learn. Rather, within group therapy, for 18 months, we:

1) Recalled a situation

2) Considered the emotions/feelings that came up during that time

3) Considered the emotions/feelings in the present that now come up about that particular situation

4) Consider a different perspective

Here's a better way of putting it:

None of the above processes were clear to me at that time. After 6 years or so, when I look back at this flowchart, only now I have more clarity.

@Monarcmarc , sometimes, the journey may not be clear. However, as you progress, it will become clearer. 

I'd encourage you to just keep going. In actual fact, my real recovery didn't really begin until AFTER my MBT treatment. 

I look forward to hearing from you! Feel free to visit Raising Awareness of BPD - Flipping the Script and tonight's Topic Tuesday Topic Tuesday// Borderline Personality Disorder Awareness Week 2023: Be the Difference // Tuesday 26... 

See you around.

Hi @balance37 @NatureLover @fluffylight