DBT = dialectical behavior therapy. The so-called gold standard for treatment of BPD, borderline personality disorder since it's effective for 77% of patients. But what about the remaining 23%?...
DBT = dialectical behavior therapy. The so-called gold standard for treatment of BPD, borderline personality disorder since it's effective for 77% of patients. But what about the remaining 23%?
Posting as I felt very seen by what Rebecca writes here. And I just want to vent a little bit.
Some of the language and the examples so far have really hurt me, and it’s upsetting that questioning this is somehow viewed as possibly not being open-minded. I do not believe we should be open-minded about harmful language being used to describe people and their experiences. We aren’t working with pigeons. Rather, in DBT, we are most often working with trauma survivors.
My own experience mirrored this. A lot of the language was really quite patronizing and it often felt like I was being gaslit into believing I am a bad person in need of fixing instead of a good person - and I am a good person - in need of healing.
Some of your words have honestly had me going home crying. I know it is not your intention and that you are only teaching a program that was taught to you, but phrases and sentences like “problem behaviors, therapy-interfering behaviors, swallowing the Kool-Aid” and saying a child crying about Bambi’s mom dying was what caused a negative reaction from the parents rather than acknowledging the parents responded poorly, are difficult to hear.
Again, mirrors my experience. There were several times where during a session I could not think of anything else but to go home and self-harm and most of those times I would end up going through with it. The time I was in DBT was the worst time in my life for how often I self-harmed. Even bringing it up in the 1-on-1 sessions was unhelpful and largely dismissive: "you have to use your distress tolerance skills" which I had already brought up as something I had problems with.. it was infuriating.
Yes, drinking hot things, taking a cold shower, and practicing mindfulness have all been wonderfully helpful. What hasn’t been helpful to me is this silencing of my own lived experiences that goes on in DBT because you label it as “therapy-interfering behaviors.” It’s traumatic. It feels as if you are taping my mouth shut, and I do not like it. I do not know all the stories of those given this label, but I can tell you every person I have ever met with this label was seriously abused.
It really felt this way really often. Most sessions, the things being taught was only aimed at the symptoms and not the underlying cause for my disorder.
Therapists are only human, and maybe Rebecca and I both had grave mismatches of providers with whom we had no chemistry. I took maybe 5% of the teachings with me. The rest was a waste of time and even detrimental to my well-being.
Wouldn't mind hearing from others on tildes, if anyone else has had experience with DBT.
I don't think a patient can reliably count on good results with any kind of therapy, especially behavioral therapy, if they have doubts about the therapist or doctor or whoever's involved in it....
Exemplary
I don't think a patient can reliably count on good results with any kind of therapy, especially behavioral therapy, if they have doubts about the therapist or doctor or whoever's involved in it. Maybe someone does or doesn't agree on the general state of MHPs, but if you don't feel trust and like yours is truly invested in helping you, I don't think that MHP is the right fit to be able to help.
Doctors, Mental Health Providers, are people. And people don't often like complicated things. They especially don't like having to get their hands dirty, to get up out of their chairs and need to work and dig and think. That's so annoying, when they have a whole book of explanations, an education full of obvious answers, and have been to conferences and training that tells them what's happening and how it should be handled. How easy it's supposed to be, because they know everything.
Outliers irritate them. For all the above reasons. They want neat cases and neat, easy answers. Same as everyone wants with everything. It's irritating when people have to get out of their chairs and work.
MHPs can be especially guilty of it. Maybe it's one thing, if a physician misdiagnoses high blood pressure or something. Sure it can be very serious, even cause deaths, but with physical injury or infirmity there are usually physical symptoms. Most of the fight those patients have is trying to get some physician to look at what's there. Maybe it's buried and needs some expensive test to confirm, but it's still probably there because physical aliments usually have physical symptoms.
Any kind of mental issue though? So much of it is opinion, because a lot of "conditions" are up to interpretation. It's why those MHPs can get up in court, and in full good faith without any intent to lie or deceive, disagree very strenuously with each other about some case or another that's come before the court.
When they decide to not really engage, when they sit back and assume they've got everything figured out and that it's the patient who isn't cooperating or trying or obeying ... very damaging for the patient. Especially since you can't always know they're not dealing with you in good faith to the extent of their supposed abilities. Are they truly trying to help you, or are they just taking the easy path because lunch is soon or they have a vacation coming up?
Totally sucks. Especially since, sometimes, a patient's condition might make them question reality or intentions more than others might. Is it you, or is it them just being unhelpful? Should you try to switch MHPs again? Sometimes that's not even possible. Not like there's a surplus of doctors and therapists and psychologists and psychiatrists just laying around begging for new patients. It can take a long time to find someone, longer to figure out payment, and if they're hostile or uninvolved in you and the help you're hoping for, back to square one.
Lots of fun. It's a mystery why some people aren't being helped.
With the caveat that I don't have BPD- I've gone though a good half-dozen therapists over the years, and the quality of the care I have received has ranged from horrific to phenomenal, and helpful...
With the caveat that I don't have BPD- I've gone though a good half-dozen therapists over the years, and the quality of the care I have received has ranged from horrific to phenomenal, and helpful in ways I could never have imagined beforehand. And I never knew what I was going to get until after a few sessions.
Which is kind of scary, in addition to frustrating. The one takeaway that I can share is that DBT, CBT, whatever, all seems to matter a lot less than the therapist themselves, and how well you click in those million amorphous ways that are difficult to put in to words. Now, when I'm seeing someone new, I focus on the interpersonal connection first. If I feel we can talk freely, fantastic! If not, I move on rapidly, and without ruminating further on the whys, as I have found doing so unproductive.
I guess I've never really had a truly good or great therapist. They have only ever ranged from a few that were somewhat fine at best, a couple that were absolutely awful to the point of furthering...
I guess I've never really had a truly good or great therapist. They have only ever ranged from a few that were somewhat fine at best, a couple that were absolutely awful to the point of furthering trauma, and most who were only just decent enough. I definitely agree that the therapist themself matters way more than the type of treatment. It is sadly very hard to change your therapist here. The flipside of socialized healthcare is that every psych ward and facility is horribly busy and mostly understaffed, so you are assigned one person and if it doesn't work out, you can't just find or choose another.
I was lucky to be pushed into a really helpful DBT group while I was in college, genuinely, I credit it with my ability to keep coping through some incredibly stressful years since then. Getting...
I was lucky to be pushed into a really helpful DBT group while I was in college, genuinely, I credit it with my ability to keep coping through some incredibly stressful years since then. Getting the toolbox to (after a big emotional event) digest what happened, work back to what caused it, and then problem solve how to prevent it from happening again was incredibly useful to me. Radical acceptance was mind bending and sounded absurd when I first heard it. It took some time, but I genuinely was able to change the way I think about how others view me.
However, can understand why the author found their experience so hurtful. One of the things that make DBT such a struggle is that it often requires you to hold two almost contradictory things in your head at once - - that while your trauma or other emotional issue is not your fault, it is your responsibility.
I think if a person is not at a stage where they can at least try to radically accept that, or where their trauma is still so painful that there is no way to tolerate it no matter what tools they try, is probably where DBT can be actively harmful and is inadvisable to continue. If distress tolerance skills can't get you to where you can explore your emotions around your experiences somewhat abstractly -- thinking about it, recognize the emotion that comes on, and back away before it overwhelms you), DBT is going to destroy your day. Not only that, but you will push the rest of the group "off track" for achieving that day's skill, which I'm guessing could frustrate an inexperienced provider.
The correct thing for the therapist to do in that situation, imo, would be for them to either remove the struggling member to solely individual therapy until they've got the prerequisite skills, or at larger practices, group together folks at a similar "levels" for fairness. I can't imagine how invalidating it is to be told you're wasting people's time with your pain, or to have it implied that you are purposely being disruptive. Particularly for someone with BPD and thus an unstable self worth.
It's been a few years, I don't have BPD (just overwhelming emotions related to ADHD and an anxiety disorder ) and my experience with the methodology was relatively short, so I hope nobody here feels like I'm talking over them.
I did some editing here to clarify what I wanted to say, but I should be done now
e: i replied before your edit, sorry about that. hope it still makes sense below This is the other side of the coin. Thanks for sharing your experience, you weren't talking over anyone at all. I'm...
e: i replied before your edit, sorry about that. hope it still makes sense below
This is the other side of the coin. Thanks for sharing your experience, you weren't talking over anyone at all. I'm happy that it was helpful for you!
Radical acceptance is one of two things that was meaningful to me. The other being (some) distress tolerance skills. I think the former is very underrated and something that practically every human ought to learn and internalize for life. Cannot overstate how helpful and important it has been.
I think if a person is not at a stage where they can at least try to radically accept that, or where their trauma is still so painful that there is no way to tolerate it no matter what tools they try, is probably where DBT can be actively harmful and is inadvisable to continue. If distress tolerance skills can't get you to where you can explore your emotions around your experiences somewhat abstractly -- thinking about it, recognize the emotion that comes on, and back away before it overwhelms you), DBT is going to destroy your day.
I suppose this is one of the key issues for me as well. I have been in therapy on and off for 20 years. I have seen dozens of psychologists, psychiatrists, therapists, you name it. I have been in outpatient programmes, I have been committed, I have needed hotlines multiple times, etc. etc.. I first started to accept that I have these traumas about 10 years ago and started to dig into it with therapists back then. But 10 years later I still break down when some of it is brought up. I simply can't handle it. I absolutely believe that one has to be ready for it, like AA and NA. At this stage I just doubt that I ever will be fully ready because I have so much experience, and I have truly been trying for so so so long. Some of it causes me to shut down entirely and triggers fight or flight responses. There's some that I can talk about but it is very shaky while I struggle through it, and some other things I can talk with a wall or facade and then it's a certainty that I will crash instantly when I get home after the session. So like you said, I can't tolerate it no matter what and it destroyed my day. It seems like none of the providers I've had has had solutions for it. Maybe I've been unlucky or perhaps in need of someone more specialized.
while not suffering from BPD or having been in DBT (though I have been in group) I feel I do fall into the category that things are still too painful. Every time someone mentions warmth, love,...
while not suffering from BPD or having been in DBT (though I have been in group) I feel I do fall into the category that things are still too painful. Every time someone mentions warmth, love, connection or genuine interest my mind just twitches and instantly loops into the cycle of 'I don't deserve any of it', which is a shame because the MHP's are doing their best. It sucks.
I think mental health journeys are deeply personal, so I won't be writing any advice for people who DBT hasn't worked for, and if DBT hasn't worked for you, none of this is a judgment. I want to...
I think mental health journeys are deeply personal, so I won't be writing any advice for people who DBT hasn't worked for, and if DBT hasn't worked for you, none of this is a judgment. I want to explain why I think the author had the reaction they did.
While I think "it depends on the therapist" is largely true, I also think DBT explicitly refuses to engage with trauma exploration because that's not the goal. It trains therapists to address thoughts and behaviors because that's the best way to change feelings. That can feel like it isn't addressing the root causes, but often changing behavior is what is needed to address the root cause of the issue.
I think DBT works this way because for many, DBT is the last in many different modalities of therapy that they have tried. This was the case for me. There comes a point where continuing to dwell on past events is not helpful and can be avoided, and you just need to acknowledge the past cannot be changed and focus on the future. For many who have done substantial therapy to explore, understand, and (begin to) heal their trauma, that's the right next step. If you have DBT before you have done that processing of the past, I can see why the author would have felt the way they did in response to DBT. Also, when somebody is ready to move on depends on the person. Everyone's journey is different, and that's unfortunate for providers.
I also want to mention a distinction between "provider language" and "patient language", where "provider language" is what providers use to discuss patients in reports, and "patient language" is what providers use to talk to patients. I have not heard this explicitly talked about, but it definitely exists, and you can glean a strong difference between provider-facing material and patient-facing material for this reason. Sometimes my therapist uses phrases under their breath that I have never heard of.
I mention this because the author focuses on "therapy-interfering behaviors" as bad language, and I think this is intended to be provider language, and the therapist in question really shouldn't be using it. I think this because I've heard that phrase maybe once or twice between lots of exposure to DBT and three different DBT providers. It's definitely invalidating, especially when used to talk about behaviors that aren't just 'missing session' or 'not taking meds' or something, but it's useful because you have to address therapy-interfering behaviors first before addressing other behaviors.
I think it makes sense that DBT doesn't work for everyone, and the author definitely seems to dislike DBT for reasons that are pretty specific to DBT. It's also sad that we don't know how to address everyone's mental health issues yet. Hopefully pieces like this help get us a little bit closer.
One recent issue I've seen providers talk about is that patients have easier access than ever to all the provider's session notes. Since providers write notes in provider language, patients have a...
I mention this because the author focuses on "therapy-interfering behaviors" as bad language, and I think this is intended to be provider language, and the therapist in question really shouldn't be using it.
One recent issue I've seen providers talk about is that patients have easier access than ever to all the provider's session notes. Since providers write notes in provider language, patients have a tendency to see their notes and catastrophize them a bit since they're reading them from a different perspective with none of the professional context.
Trauma exploration is not the goal, but shouldn't it be when you're in therapy for BPD? Yes, DBT is proven to work for a majority of people, but at the same time, a majority of people with BPD has...
Trauma exploration is not the goal, but shouldn't it be when you're in therapy for BPD? Yes, DBT is proven to work for a majority of people, but at the same time, a majority of people with BPD has it because of traumas - examples being parental neglect or abuse, or sexual assault. I agree that it becomes unproductive to dwell on it for too long, and I suppose I can only speak for my own experience, but I believe that a part of why DBT didn't work for me was because I had never truly processed my traumas. It was always on my mind during the sessions and it continues to be now 4 months later because of how ingrained it became week after week.
Maybe my providers just didn't spend enough time actually analysing or too quickly concluded in their meetings that I was ready for DBT when it turned out I absolutely wasn't.
I have BPD, along with a host of other mental health issues. I went through DBT and had a moderately helpful experience with a therapist, who helped me through quite a few things. A previous...
I have BPD, along with a host of other mental health issues. I went through DBT and had a moderately helpful experience with a therapist, who helped me through quite a few things.
A previous therapist, prior to telling me she didn't feel qualified to work with someone who has BPD (which I discovered after several sessions and was not upset about in the slightest), recommended I read "Stop Walking on Eggshells," even though it is intended for people who have loved ones with BPD, and not those with it.
I downloaded the audiobook, and I was close to tears from the harmful language used to describe people with BPD. I thought it may have just been the first chapter, so I skipped a bit further in, but it continued. If I read/listened to this book blindly without having personal experiences with BPD, I would avoid anyone I suspect having BPD, because I would be under the assumption that they need to be coddled like children who have frequent tantrums.
This language, along with different treatment from medical professionals, is absolutely contributing to the pain and suffering anyone with a handful of mental health disorders goes through. (This list also includes bipolar disorder and schizophrenia.)
I had a personal experience with a pharmacist treating me like an annoyance after I shared my disorder (which is why I was taking the medication). From that day forward, she was always brief and even rude to me, and didn't even bother having a consult with me when I was filling a new prescription.
So if you ever encounter someone who has tried to get help and "given up," consider that the system may have actually given up on them.
Borderline Personality Disorder is real, but it's also a diagnosis that indicates particularly difficult cases. Many providers will simply refuse to work with borderline patients because any...
Borderline Personality Disorder is real, but it's also a diagnosis that indicates particularly difficult cases. Many providers will simply refuse to work with borderline patients because any amount of treatment is likely to turn into a complicated mess. Ironically, I've heard mental health professionals say the best treatment for borderline patients is often no treatment because any amount of engagement frequently makes the situation worse.
I'm not convinced DBT itself is the issue because it's the therapy method with the best evidence behind it. Unfortunately many psychotherapists are bad and ineffective.
I have had similar experiences with reading material. I was given a pamphlet om BPD once and it was equally triggering to how bad it sounds like this book you read was. It was given to me by a...
I have had similar experiences with reading material. I was given a pamphlet om BPD once and it was equally triggering to how bad it sounds like this book you read was. It was given to me by a psychologist and it had such hurtful language. I still have the text (translated it to English) but fair warning, I hid it for a reason.
Click to view the hidden text
Before vacation or other breaks in therapy, the patient may be sad and say that she is unable to forgo sessions and will therefore kill herself during the therapist's holiday.
Later in the therapeutic process, the therapist should expect demeaning behaviour and angry yelling.
Outside of therapy, one should expect the patient's life to be turbulent and dramatic, perhaps her mother is in hospital, boyfriend in prison, or she herself has been assaulted.
Towards the end of therapy, there may be emotional outbursts in which the patient breaks things and starts cutting herself, or says going to swallow 30 pills when she gets home.
I also had a book on autism recommended to me by a psychiatrist once when it was being explored (for the third time lol) if I had autism. It had somewhat troubling passages as well so it just kind of seems to me that you can't read books about mental health or disorders without being prepared to be confronted, offended, or hurt by something in them. Of course, the one you mention sounds a lot worse than that.
There's generally just so much stigma about mental health, personality disorders even more, and particularly cluster B disorders even more so. It's really quite troubling that professionals themselves have such prejudices about us. Thankfully I don't think I've actually experienced it from a person in real life, but I see it all the fucking time online - just a random reddit thread about some kind of relationship thing or whatever, and someone will for sure go "ya she has bpd/npd for sure" and then someone will add onto it with a personal experience completely demonizing us.
It's not that people with BPD don't do bad things. Of course they do. And it's probably an over represented amount of people. But I don't think it's controversial to say that it's not a majority that's like that..
I think part of it is that mental health professionals tend to see the worst cases. For example, if you work in an in-patient hospital setting, your day-to-day caseload is going to mostly...
I think part of it is that mental health professionals tend to see the worst cases. For example, if you work in an in-patient hospital setting, your day-to-day caseload is going to mostly consistent of extreme patients that need intensive care and observation that can't be provided in an outpatient setting. While the professionals may consciously know their patients aren't representative of the typical population, it's easy to become a bit...fatalistic if you only see the most difficult cases.
Yes. As mental health disorders get easier for people to recognize, you end up with this odd dichotomy between the research for the disorder (which show fire and brimstone) and the reality of the...
Yes. As mental health disorders get easier for people to recognize, you end up with this odd dichotomy between the research for the disorder (which show fire and brimstone) and the reality of the people finally getting help (disabling, but very possible to live a meaningful life).
A similar thing happened with Autism, I think in the early 2000's? Diagnosis drastically increased, and it had the news media panicking, when the reality was just the definition of autism spectrum disorder made it easier to diagnose people with much lower support needs. In turn, the "direness" of an autism diagnosis, and what it meant to be labeled as autistic changed drastically.
DBT = dialectical behavior therapy. The so-called gold standard for treatment of BPD, borderline personality disorder since it's effective for 77% of patients. But what about the remaining 23%?
Posting as I felt very seen by what Rebecca writes here. And I just want to vent a little bit.
My own experience mirrored this. A lot of the language was really quite patronizing and it often felt like I was being gaslit into believing I am a bad person in need of fixing instead of a good person - and I am a good person - in need of healing.
Again, mirrors my experience. There were several times where during a session I could not think of anything else but to go home and self-harm and most of those times I would end up going through with it. The time I was in DBT was the worst time in my life for how often I self-harmed. Even bringing it up in the 1-on-1 sessions was unhelpful and largely dismissive: "you have to use your distress tolerance skills" which I had already brought up as something I had problems with.. it was infuriating.
It really felt this way really often. Most sessions, the things being taught was only aimed at the symptoms and not the underlying cause for my disorder.
Therapists are only human, and maybe Rebecca and I both had grave mismatches of providers with whom we had no chemistry. I took maybe 5% of the teachings with me. The rest was a waste of time and even detrimental to my well-being.
Wouldn't mind hearing from others on tildes, if anyone else has had experience with DBT.
I don't think a patient can reliably count on good results with any kind of therapy, especially behavioral therapy, if they have doubts about the therapist or doctor or whoever's involved in it. Maybe someone does or doesn't agree on the general state of MHPs, but if you don't feel trust and like yours is truly invested in helping you, I don't think that MHP is the right fit to be able to help.
Doctors, Mental Health Providers, are people. And people don't often like complicated things. They especially don't like having to get their hands dirty, to get up out of their chairs and need to work and dig and think. That's so annoying, when they have a whole book of explanations, an education full of obvious answers, and have been to conferences and training that tells them what's happening and how it should be handled. How easy it's supposed to be, because they know everything.
Outliers irritate them. For all the above reasons. They want neat cases and neat, easy answers. Same as everyone wants with everything. It's irritating when people have to get out of their chairs and work.
MHPs can be especially guilty of it. Maybe it's one thing, if a physician misdiagnoses high blood pressure or something. Sure it can be very serious, even cause deaths, but with physical injury or infirmity there are usually physical symptoms. Most of the fight those patients have is trying to get some physician to look at what's there. Maybe it's buried and needs some expensive test to confirm, but it's still probably there because physical aliments usually have physical symptoms.
Any kind of mental issue though? So much of it is opinion, because a lot of "conditions" are up to interpretation. It's why those MHPs can get up in court, and in full good faith without any intent to lie or deceive, disagree very strenuously with each other about some case or another that's come before the court.
When they decide to not really engage, when they sit back and assume they've got everything figured out and that it's the patient who isn't cooperating or trying or obeying ... very damaging for the patient. Especially since you can't always know they're not dealing with you in good faith to the extent of their supposed abilities. Are they truly trying to help you, or are they just taking the easy path because lunch is soon or they have a vacation coming up?
Totally sucks. Especially since, sometimes, a patient's condition might make them question reality or intentions more than others might. Is it you, or is it them just being unhelpful? Should you try to switch MHPs again? Sometimes that's not even possible. Not like there's a surplus of doctors and therapists and psychologists and psychiatrists just laying around begging for new patients. It can take a long time to find someone, longer to figure out payment, and if they're hostile or uninvolved in you and the help you're hoping for, back to square one.
Lots of fun. It's a mystery why some people aren't being helped.
With the caveat that I don't have BPD- I've gone though a good half-dozen therapists over the years, and the quality of the care I have received has ranged from horrific to phenomenal, and helpful in ways I could never have imagined beforehand. And I never knew what I was going to get until after a few sessions.
Which is kind of scary, in addition to frustrating. The one takeaway that I can share is that DBT, CBT, whatever, all seems to matter a lot less than the therapist themselves, and how well you click in those million amorphous ways that are difficult to put in to words. Now, when I'm seeing someone new, I focus on the interpersonal connection first. If I feel we can talk freely, fantastic! If not, I move on rapidly, and without ruminating further on the whys, as I have found doing so unproductive.
Just my two cents. Hope it helps.
I guess I've never really had a truly good or great therapist. They have only ever ranged from a few that were somewhat fine at best, a couple that were absolutely awful to the point of furthering trauma, and most who were only just decent enough. I definitely agree that the therapist themself matters way more than the type of treatment. It is sadly very hard to change your therapist here. The flipside of socialized healthcare is that every psych ward and facility is horribly busy and mostly understaffed, so you are assigned one person and if it doesn't work out, you can't just find or choose another.
I was lucky to be pushed into a really helpful DBT group while I was in college, genuinely, I credit it with my ability to keep coping through some incredibly stressful years since then. Getting the toolbox to (after a big emotional event) digest what happened, work back to what caused it, and then problem solve how to prevent it from happening again was incredibly useful to me. Radical acceptance was mind bending and sounded absurd when I first heard it. It took some time, but I genuinely was able to change the way I think about how others view me.
However, can understand why the author found their experience so hurtful. One of the things that make DBT such a struggle is that it often requires you to hold two almost contradictory things in your head at once - - that while your trauma or other emotional issue is not your fault, it is your responsibility.
I think if a person is not at a stage where they can at least try to radically accept that, or where their trauma is still so painful that there is no way to tolerate it no matter what tools they try, is probably where DBT can be actively harmful and is inadvisable to continue. If distress tolerance skills can't get you to where you can explore your emotions around your experiences somewhat abstractly -- thinking about it, recognize the emotion that comes on, and back away before it overwhelms you), DBT is going to destroy your day. Not only that, but you will push the rest of the group "off track" for achieving that day's skill, which I'm guessing could frustrate an inexperienced provider.
The correct thing for the therapist to do in that situation, imo, would be for them to either remove the struggling member to solely individual therapy until they've got the prerequisite skills, or at larger practices, group together folks at a similar "levels" for fairness. I can't imagine how invalidating it is to be told you're wasting people's time with your pain, or to have it implied that you are purposely being disruptive. Particularly for someone with BPD and thus an unstable self worth.
It's been a few years, I don't have BPD (just overwhelming emotions related to ADHD and an anxiety disorder ) and my experience with the methodology was relatively short, so I hope nobody here feels like I'm talking over them.
I did some editing here to clarify what I wanted to say, but I should be done now
e: i replied before your edit, sorry about that. hope it still makes sense below
This is the other side of the coin. Thanks for sharing your experience, you weren't talking over anyone at all. I'm happy that it was helpful for you!
Radical acceptance is one of two things that was meaningful to me. The other being (some) distress tolerance skills. I think the former is very underrated and something that practically every human ought to learn and internalize for life. Cannot overstate how helpful and important it has been.
I suppose this is one of the key issues for me as well. I have been in therapy on and off for 20 years. I have seen dozens of psychologists, psychiatrists, therapists, you name it. I have been in outpatient programmes, I have been committed, I have needed hotlines multiple times, etc. etc.. I first started to accept that I have these traumas about 10 years ago and started to dig into it with therapists back then. But 10 years later I still break down when some of it is brought up. I simply can't handle it. I absolutely believe that one has to be ready for it, like AA and NA. At this stage I just doubt that I ever will be fully ready because I have so much experience, and I have truly been trying for so so so long. Some of it causes me to shut down entirely and triggers fight or flight responses. There's some that I can talk about but it is very shaky while I struggle through it, and some other things I can talk with a wall or facade and then it's a certainty that I will crash instantly when I get home after the session. So like you said, I can't tolerate it no matter what and it destroyed my day. It seems like none of the providers I've had has had solutions for it. Maybe I've been unlucky or perhaps in need of someone more specialized.
while not suffering from BPD or having been in DBT (though I have been in group) I feel I do fall into the category that things are still too painful. Every time someone mentions warmth, love, connection or genuine interest my mind just twitches and instantly loops into the cycle of 'I don't deserve any of it', which is a shame because the MHP's are doing their best. It sucks.
I think mental health journeys are deeply personal, so I won't be writing any advice for people who DBT hasn't worked for, and if DBT hasn't worked for you, none of this is a judgment. I want to explain why I think the author had the reaction they did.
While I think "it depends on the therapist" is largely true, I also think DBT explicitly refuses to engage with trauma exploration because that's not the goal. It trains therapists to address thoughts and behaviors because that's the best way to change feelings. That can feel like it isn't addressing the root causes, but often changing behavior is what is needed to address the root cause of the issue.
I think DBT works this way because for many, DBT is the last in many different modalities of therapy that they have tried. This was the case for me. There comes a point where continuing to dwell on past events is not helpful and can be avoided, and you just need to acknowledge the past cannot be changed and focus on the future. For many who have done substantial therapy to explore, understand, and (begin to) heal their trauma, that's the right next step. If you have DBT before you have done that processing of the past, I can see why the author would have felt the way they did in response to DBT. Also, when somebody is ready to move on depends on the person. Everyone's journey is different, and that's unfortunate for providers.
I also want to mention a distinction between "provider language" and "patient language", where "provider language" is what providers use to discuss patients in reports, and "patient language" is what providers use to talk to patients. I have not heard this explicitly talked about, but it definitely exists, and you can glean a strong difference between provider-facing material and patient-facing material for this reason. Sometimes my therapist uses phrases under their breath that I have never heard of.
I mention this because the author focuses on "therapy-interfering behaviors" as bad language, and I think this is intended to be provider language, and the therapist in question really shouldn't be using it. I think this because I've heard that phrase maybe once or twice between lots of exposure to DBT and three different DBT providers. It's definitely invalidating, especially when used to talk about behaviors that aren't just 'missing session' or 'not taking meds' or something, but it's useful because you have to address therapy-interfering behaviors first before addressing other behaviors.
I think it makes sense that DBT doesn't work for everyone, and the author definitely seems to dislike DBT for reasons that are pretty specific to DBT. It's also sad that we don't know how to address everyone's mental health issues yet. Hopefully pieces like this help get us a little bit closer.
One recent issue I've seen providers talk about is that patients have easier access than ever to all the provider's session notes. Since providers write notes in provider language, patients have a tendency to see their notes and catastrophize them a bit since they're reading them from a different perspective with none of the professional context.
Trauma exploration is not the goal, but shouldn't it be when you're in therapy for BPD? Yes, DBT is proven to work for a majority of people, but at the same time, a majority of people with BPD has it because of traumas - examples being parental neglect or abuse, or sexual assault. I agree that it becomes unproductive to dwell on it for too long, and I suppose I can only speak for my own experience, but I believe that a part of why DBT didn't work for me was because I had never truly processed my traumas. It was always on my mind during the sessions and it continues to be now 4 months later because of how ingrained it became week after week.
Maybe my providers just didn't spend enough time actually analysing or too quickly concluded in their meetings that I was ready for DBT when it turned out I absolutely wasn't.
I have BPD, along with a host of other mental health issues. I went through DBT and had a moderately helpful experience with a therapist, who helped me through quite a few things.
A previous therapist, prior to telling me she didn't feel qualified to work with someone who has BPD (which I discovered after several sessions and was not upset about in the slightest), recommended I read "Stop Walking on Eggshells," even though it is intended for people who have loved ones with BPD, and not those with it.
I downloaded the audiobook, and I was close to tears from the harmful language used to describe people with BPD. I thought it may have just been the first chapter, so I skipped a bit further in, but it continued. If I read/listened to this book blindly without having personal experiences with BPD, I would avoid anyone I suspect having BPD, because I would be under the assumption that they need to be coddled like children who have frequent tantrums.
This language, along with different treatment from medical professionals, is absolutely contributing to the pain and suffering anyone with a handful of mental health disorders goes through. (This list also includes bipolar disorder and schizophrenia.)
I had a personal experience with a pharmacist treating me like an annoyance after I shared my disorder (which is why I was taking the medication). From that day forward, she was always brief and even rude to me, and didn't even bother having a consult with me when I was filling a new prescription.
So if you ever encounter someone who has tried to get help and "given up," consider that the system may have actually given up on them.
Borderline Personality Disorder is real, but it's also a diagnosis that indicates particularly difficult cases. Many providers will simply refuse to work with borderline patients because any amount of treatment is likely to turn into a complicated mess. Ironically, I've heard mental health professionals say the best treatment for borderline patients is often no treatment because any amount of engagement frequently makes the situation worse.
I'm not convinced DBT itself is the issue because it's the therapy method with the best evidence behind it. Unfortunately many psychotherapists are bad and ineffective.
I have had similar experiences with reading material. I was given a pamphlet om BPD once and it was equally triggering to how bad it sounds like this book you read was. It was given to me by a psychologist and it had such hurtful language. I still have the text (translated it to English) but fair warning, I hid it for a reason.
Click to view the hidden text
Before vacation or other breaks in therapy, the patient may be sad and say that she is unable to forgo sessions and will therefore kill herself during the therapist's holiday.
Later in the therapeutic process, the therapist should expect demeaning behaviour and angry yelling.
Outside of therapy, one should expect the patient's life to be turbulent and dramatic, perhaps her mother is in hospital, boyfriend in prison, or she herself has been assaulted.
Towards the end of therapy, there may be emotional outbursts in which the patient breaks things and starts cutting herself, or says going to swallow 30 pills when she gets home.
I also had a book on autism recommended to me by a psychiatrist once when it was being explored (for the third time lol) if I had autism. It had somewhat troubling passages as well so it just kind of seems to me that you can't read books about mental health or disorders without being prepared to be confronted, offended, or hurt by something in them. Of course, the one you mention sounds a lot worse than that.
There's generally just so much stigma about mental health, personality disorders even more, and particularly cluster B disorders even more so. It's really quite troubling that professionals themselves have such prejudices about us. Thankfully I don't think I've actually experienced it from a person in real life, but I see it all the fucking time online - just a random reddit thread about some kind of relationship thing or whatever, and someone will for sure go "ya she has bpd/npd for sure" and then someone will add onto it with a personal experience completely demonizing us.
It's not that people with BPD don't do bad things. Of course they do. And it's probably an over represented amount of people. But I don't think it's controversial to say that it's not a majority that's like that..
I think part of it is that mental health professionals tend to see the worst cases. For example, if you work in an in-patient hospital setting, your day-to-day caseload is going to mostly consistent of extreme patients that need intensive care and observation that can't be provided in an outpatient setting. While the professionals may consciously know their patients aren't representative of the typical population, it's easy to become a bit...fatalistic if you only see the most difficult cases.
Yes. As mental health disorders get easier for people to recognize, you end up with this odd dichotomy between the research for the disorder (which show fire and brimstone) and the reality of the people finally getting help (disabling, but very possible to live a meaningful life).
A similar thing happened with Autism, I think in the early 2000's? Diagnosis drastically increased, and it had the news media panicking, when the reality was just the definition of autism spectrum disorder made it easier to diagnose people with much lower support needs. In turn, the "direness" of an autism diagnosis, and what it meant to be labeled as autistic changed drastically.
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