Friends, Family & Carers Forum

[Rp79]

Hi, 

Hopefully I've posted this in the right topic.

I'm just wondering if anyone has any tips on organising a treatment plan for complex mental health issues or who would be in the best position to help with one?

My daughter has been diagnosed with BPD plus CPTSD, general anxiey and depression. She is 22 and was diagnosed with BPD when she was 21 by a psychiatrist that she was assigned to after admissin to a private clinic. He hasn't really been particularly helpful in helping her set an actual treatment plan in place. Although her instances of SH and SI have decreased, overall she is definitely not improving and I feel like I've got the 14/15 year old back.

The clinic has group therapies in place and my daughter wasn't interested in doing more than those originally especially when the psychiatrist didn't suggest them. It wasn't until her 2nd admission to the clinic that he said that she should also be seeing a psychologist for psychotherapy. 

I had done some research on different options with treatment, etc however I'm no expert and my daughter has no real idea on what to do most of the time as she's just struggling to keep it together. When she's in the clinic and in group therapy, she has plans and ideas, but when she comes home they all seem to fly out the window. She gets caught up in her depression and negative thoughts that is all too hard as there aren't the resources in WA to properly deal with personality disorders (unless you're rich and can afford a psychologist for more than 10 times a year).

I am hoping to speak to the psychiatrist but honestly, he just checks her meds and gets her admission in to the clinic and the groups in the clinic when needed. Should we just find a psych who specialises in all of her issues and (if she likes them) see if they can help organise a plan? How do we choose the psych? My issue with using the psych is whether they can actually do all the therapies and will this affect their suggestions? 

My last question is does anyone know the difference between a 12 week dbt group course and the long ones that are run at Spectrum? I know she can't go to Spectrum but they seem to be the only place who still do long term dbt or even mbt in Australia so it's all I can compare to. I do want my daughter to ask about redoing the dbt course at the clinic but as she's already done it once, I was worried they might say no.

Thanks

[tyme]

I've done the MBT long course at Spectrum @Rp79 - it was absolutely the best thing. It's made a huge difference to my life. BPD requires long term therapy. Spectrum has a very lengthy and thorough assessment process. If they do not believe there will be enough commitment from the person e.g. they are not 'ready' to make changes, it is unlikely they will accept them. For example, they want people to have stable accommodation, living arrangements, finances etc. The reason for this (i later found out) is because they know if people do not have life's necessities, they will not be able to focus on therapy. 

I believe @BlueBay has also completed DBT therapy at Spectrum (please correct me if I'm wrong) and @BPDSurvivor has completed MBT too I believe.

You may be interested in reading Topic Tuesday// Borderline Personality Disorder Awareness Week 2022: 'See The Person'// Tues 27th Se... A Spectrum clinician was a guest speaker here.

Topic Tuesday // Supporting loved ones living with BPD // Tuesday 25th January, 7pm-8:30pm AEDT 

LIVE CHAT: BPD for Friends, Family and Carers - This Sunday 3rd October 7:00-8:30pm AEDT 

[BPDSurvivor]

Hi @Rp79 ,

Yes, I have graduated from Spectrum's MBT clinic. I didn't realise it was hard to get into when I first got it. If anything, I was pushing the appointments back, back, back, back. Until I got a letter in the mail which said if I don't respond, I would be taken off the waitlist. 

I was really hesitant and skeptical about the therapy. It was so strange. 

All in all, it was the group therapy component that made the most difference. 

Anyway, in terms of your questions about seeking support... I'm not sure because supports sort of fell into place for me. I was first accepted in to Spectrum, then my acuity and risk meant I was placed under my area mental health team with case management. From there, my spectrum treatment and case management psych sessions complemented each other.... I also had admissions to PARCs.

Oh! PARCs was incredible! It is not restrictive like an inpatient unit. And is 100% voluntary. I connected with people here and learnt to once again trust people.

Another thing I really have to mention is, unless your daughter wants and is ready for therapy, it is very unlikely that even the best therapy will work. Recovery is 2 sided. In all this therapy, I had to work so damn hard to get to where I am now. It was blood, sweat and tears. Recovery was not about passively receiving strategies and head-knowledge. It was actively going out to take measured risks, do things outside my comforts, connect with people I couldn't stand. Therapy was one of the hardest things I have endured. 

Hence, IS YOUR DAUGHTER READY?

[BPDSurvivor]

Oh, @Rp79 , I didn't mention. The LONG MBT course I did consisted of both group and individual therapy. It was weekly sessions - so one group and one individual each week (hence commitment).

There was a preparatory 6-wk course too before the actual MBT. It sort of went through the 'rules' of engaging in therapy e.g. we were not permitted to contact other group members outside therapy. It also gave some theoretical knowledge about the treatment. 

We went joined a rolling group. Each member would talk about what was on their mind etc. Then we picked something we would collaboratively discuss, mentalise and offer difference perspectives on. This went on for another 18 months.

Voila! Then it was discharge/graduation at the end of that.

So that sums up the long course.

The short course is mainly skills based. I believe there are DBT manuals and workbooks people can work through. I don't think I would have received much from this type of 'learning' though.

Also @Rp79 , have you access The Australian BPD Foundation? If you go to their website, click on their newsletter. They have BPD ad mental health groups and resources for each state. You may be able to find supports in WA.

Project Air (NSW) have online peer-led group sessions you can also look at. These are all free-of-charge.

Hope this helps you. People can recover from BPD. It is treatable despite what people say.

[Zoe7]

Hi @Rp79 I have done the longer DBT course - twice plus a bit more. The shorter version is an abridged version of the longer, more thorough course. It required a full day commitment each week - the DBT sessions went for a few hours then I saw my psychiatrist afterwards. It is run so you have group sessions then an individual psych/pdoc session afterwards. This is to be able to talk through anything the session brought up as well as the skills covered. Each session was pretty intensive with follow up activities/homework to do throughout the week. Part of this was completing a daily log charting our emotions, feelings, medication, behaviours, etc. This was a great resource over the course of the program to see where we had been and where we had got to (for many). 

Why 2+ courses - it is suggested that the first time you 'acquire' skills and the second time you can actually take them in and make them part of your everyday living. For me, the first time around I was very hesitant and did not actually take much in - I was also very unwell so although I was reluctant to do the course, I persisted. The second time around the skills became more second nature and that is a major part of being able to carry them on into everyday life ...and especially when life is hard and you really need them. The 'little bit extra' for me was a few more sessions on the skills that I had previously struggled more with - so 3 times is a charm!

What I would add is that you absolutely need to be willing and able to do everything in the course otherwise it just will not stick. In our courses we had several people drop out because they could not commit and/or where not in the right place to make it work. 

I suppose that is the same with any therapy - you have to be ready and willing to do the work but I would absolutely recommend the longer term DBT course if you can find a program available.

[Rp79]

@tyme 

Thanks for the links. I was given these when I first posted and they were an excellent source of information. I learnt so much from the conversations.

It was in the first one was where I found out about Spectrum. My daughter meets all the criteria in Perth but unfortunately wouldn't in Melbourne 🙂 😞

We do have access to MBT therapy in Perth but only as a private individual. I found a clinic in Perth for it but I've not contacted them yet as I'm not sure if it should be done next. With the limited number of private sessions we can do per year, I want to make sure we're doing everything in the right order. I'm also worried that if she only has a limited number of sessions per year, will it be worth it? If she does weekly sessions for 12 weeks, will it matter that she will have to wait another year before starting it again? 

I know this is going to be a long journey and I'm fairly sure that it's going to take longer due to our financial constraints but I am fairly sure that she will get through it. She may never be neurotypical but she is an amazing person and has much potential. She is just so hard on herself and quite often can't see the forest for the trees.

[Rp79]

@BPDSurvivor 

Something went wrong with my reply and it didn't post. Lol, good news for you in that you get the short version.  

Basically while I've seen improvements in my daughter from dbt and then cbt, i think her anxiety and depression are so high that she not ready to be 100% in charge of her recovery. We have looked at schema (we didn't know of mbt then as it looks as if only one practice did it over here) and I believe that is as difficult as mbt and requires the same readiness. She wants to get better but we have so limited resources (both financially and what's actually available in perth) that it's probably not going to be effective at this stage. 

Regarding the team,  I'm so glad that you found something for you. My daughter has been having problems with her mental health since she was 13 (she did go to a counsellor when she was 7 but that was to help with her dad and mine separation). There was a team at the first place we went to (Headspace) but they don't seem to be equipped to deal with anything more than normal child problems so she was referred to cahms. Unfortunately my daughter did not gel with anyone there and she stopped going before a year was even up. A friend (at the time) was forcibly admitted to the same place when they were teens which has/had turned her off there altogether. 

She decided to go back to therapy when she was 19 and was eventually recommended to be admitted in to a private facility. It is here that she did the dbt and cbt as well as getting a psychiatrist. They have psychologists attached to the clinic but they are also separate. There is definitely not a treating team unless you are admitted.

I have looked in to the other private clinics in perth and they are more or less the same. One does extra outpatient groups but she would need to change her psychiatrist to go there. Other than changing her mind about a new one (she hates change), we'd also have to wait 6 plus months to see one. They also only have one psychiatrist who deals with bpd so the wait could be longer.

I do need to find a new psychiatrist to get her tested for adhd and I'm also hoping to get a second opinion. While I'm fairly certain she has bpd (4 of the 9 definitely are applicable to her but there's one where I don't understand it or how it applies to her) I can't help but think that there's more to it. Adhd is a possibility as it matches me and my daughter now and when we were younger but there are also a few other things that don't match up with her current diagnoses.

Um so that was the shorter version although the last paragraph was new.. sorry, I just really struggle to do sort. Haha, you should see what's it's like to have a face to face conversation with me. Very convoluted. 

[Rp79]

@BPDSurvivor 

I'll try and make this one short. Thank you so much for the explanation. The short mbt sounds like the 12 week dbt. All skills based which is good for my daughter as it's what she needs right now. She sort of just needs to be reminded all the time hence why I'd rather she go on a long course of reiterating them but it sounds like that's not really an option. I'm assuming even Spectrum don't do that? Their long course is the mbt? If I could afford weekly sessions with a psychologist, that would be an alternative. I'll keep looking and see if there are any doing sliding scales, etc that are able to deal with bpd. It's possible..

I will look in to the Project Air and suggest it to my daughter. She's not had much success with non face to face though so I'm not sure how it will go down. It's worth the try.

Re the foundation, I've not been able to find the newsletter so have just being relying on my google skills (I'm usually a Google queen) and information from others. I'll take another look later this morning when I'm on a computer. 

Thanks for the final comment. I know it's treatable which is why I keep researching but damn it can get depressing with all the negativity surrounding bpd. 

[Rp79]

@Zoe7 

Thanks heaps for the information. My daughter isn't currently working or studying so time is not an issue and she does want to get better. I don't think there are any long term options available in perth any more so I think private psychologist as often as we can afford plus redoing the short courses she's already done are going to be it until new options become available or her circumstances change (or we win lotto 😉)

Thank you so much. I wasn't sure of the difference and that made it much clearer

[BPDSurvivor]

Hey @Rp79 ,

 For me, I also had depression, anxiety, and insomnia. This is where medication came in handy. Once these conditions were under control, I could then focus on therapy. Didn’t mean these conditions no longer existed - but just meant it was under control.

 Have you seen SANE’s guided service? Both you and your daughter may be able to utilise that service while you are looking for options. From what I know, it is recovery centred. Also, it is free. Depends on your postcode as to whether you are eligible.

Having BPD is tough. It affects relationships at all levels. The pain is real. Yet recovery is also real.

Recovery required me to step in to difficult spaces and work against what I would instinctively do. It’s hard hard work. But for me, the journey was totally worth it.

 Please take care.