Talking Therapies and BPD

by Sarah Myles

I am a big advocate of talking therapies as a treatment for BPD.

My experience of talking therapies began in London, with a counsellor and a course of Cognitive Behaviour Therapy (CBT), aimed at bringing my OCD and anxiety back under control.

Developed by the merging of cognitive and behavioural techniques during the 1980s and 1990s, CBT is recommended by the National Institute for health and Clinical Excellence (NICE) for the possible treatment of issues such as bulimia, OCD, PTSD, clinical depression and stress disorder. The basic goal is to regain control over extreme thought spirals by making connections between events and thoughts, feelings and behaviours. It also includes work on challenging assumptions and core beliefs, development of relaxation and mindfulness, and the reduction of the need for avoidance.

Working through these skills effectively leads to increased ability to rationalise and ultimately the stabilisation of psychotic thinking.

My CBT counsellor worked through a book with me – “Mind Over Mood: Change How You Feel By Changing The Way You Think” by Christine A Padesky and Dennis Greenerger – and together we mapped out my automatic negative thought processes and catastrophic thinking. The following sessions were about unlearning learned behaviours, and essentially trying to reverse 25 years of social brainwashing.

This process was difficult and uncomfortable, and was underpinned by a course of anti-depressant medication. Many months down the line, however, my anxiety and OCD were manageable once again, and I had slowly crawled out of my deep, dark pit of despair.

Several years and a move to North Yorkshire later, my experience of talking therapies continued with Dialectical Behaviour Therapy (DBT), following a diagnosis of Borderline Personality Disorder (BPD).

BPD is notoriously controversial when it comes to treatment, with patients often referred to as being difficult, manipulative, resistant, demanding and seeking attention. This view comes most often from the health professionals dealing with BPD sufferers, who are considered to be among the most challenging to treat due to the problems associated with dealing with an emotionally intense and unstable personality. A diagnosis of BPD generally comes during a crisis, and so the negative reaction of health professionals to that label can be highly distressing and can exacerbate the problem, intensifying the animosity between patient and doctor.

This difficulty in the relationship between therapist and patient led to the development of DBT by Marsha M Linehan, specifically for the treatment of BPD (although it has been applied to other mental health problems with some success). It combines the usual CBT techniques of reality testing and regulation of emotions with acceptance, distress tolerance and mindful awareness taken from Buddhist meditation.

At the core of DBT, however, is the therapist/patient relationship. Before therapy commences, the entire process is explained, in detail, to the patient – including the fact that the process will be extremely uncomfortable. A full commitment and agreement is required on the part of the patient, as motivation and resistance is a main issue in BPD sufferers. Once this is given, the therapist provides unconditional acceptance and validation of the patient’s thoughts and emotions at all times, while simultaneously highlighting unhealthy feelings and behaviours, and giving guidance to healthier alternatives.

The emphasis is on acceptance and change, with the therapist as an ally rather than an enemy encouraging self-motivation and setting clear boundaries.

My own DBT was first introduced to me during sessions with a Community Psychiatric Nurse (CPN) who visited me at home for several months, and was then conducted intensely by a psychotherapist at a local surgery. Again, we worked through a book together – “The Dialectical Behaviour Skills Workbook: Practical DBT Exercises for Learning Mindfulness, Interpersonal Effectiveness, Emotional Regulation and Distress Tolerance” by Matthew McKay PHD, Jeffrey C Wood PsyD and Jeffrey Brantley MD – and mapped out the nature of my BPD and where my therapy should focus. What followed was an astonishing process of self-realisation, self-acceptance and self-understanding.

Talking therapies are not a cure. You do not emerge from your sessions free from mental illness and able to leap tall buildings in a single bound. They do teach you about yourself, your illness and the skills you need to manage both for the rest of your life, provided you go into them when you are ready to be completely open and honest. Often, initial talking therapies are prescribed in conjunction with medication - this can be effective, as the medication alleviates the worst symptoms giving a clearer view to focus on the roots of the problem.

Undertaken properly, and with the right therapist, talking therapies give you the tools that you need, so the next time you feel a crisis brewing, you are in a better, stronger position to head it off at the pass. And each time, you get there a bit quicker, and the crisis is a bit less critical.

Incidentally, all of these hours of therapy and access to qualified, talented mental health professionals who have improved my health and quality of life immeasurably, were provided by NHS. For free.

Sarah Myles


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