Just when I thought we hit the bottom: what can you tell me about DBT

[Anonymous]

My son's psychiatrist is now adding another diagnosis - borderline personality disorder. His recommendation is for DBT. I've been reading everything I can and trying to learn about it, but it's new to me. What I've found is a therapy group that offers individual DBT and it is covered by my insurance. I think it's weekly but no guarantees that I can get an after school slot. I can probably work with that.

I've also found programs that offer group and individual therapy multiple times a week. I am finding two problems with this. None of the programs take insurance and the cost is $2k+ per month for like 18 months (in addition to the psychiatrist, individual therapist and medication, which is $200+ per month). I am not sure we can afford it and I'm not sure that we can make it work given that we are a two working parent family.

I was hoping that you could share your experiences with me. I know it's only anecdotal, but it might give me some insight into how to look at things and make decisions. Mostly what I'm hearing is that one of these programs will give him the best chance but that prognosis is far from a sure thing. I really want to do everything we can so that he doesn't end up living under a bridge someday but this feels hopeless given the financial and time commitment.

[Anonymous]

There is no cure or quick fix for personality disorders. I'd be weird of a program offering a and that sounds very high.

[Anonymous]

How old is your son? I’ve been in DBT since January. I’m happy to answer any questions you have, it’s hard to give a general overview of my experience so far.

I’m very lucky that my state Medicaid covers the program in full.

[Anonymous]

Anonymous wrote:There is no cure or quick fix for personality disorders. I'd be weird of a program offering a and that sounds very high.

DBT does not offer a cure or quick fix. DBT teaches skills to help manage and improve the dysregulated emotions. 6 to 18 months is typical.

[Anonymous]

Anonymous wrote:How old is your son? I’ve been in DBT since January. I’m happy to answer any questions you have, it’s hard to give a general overview of my experience so far.

I’m very lucky that my state Medicaid covers the program in full.

Reminds me that I also need to apply for Medicaid for my son.

I am not even sure what I need to know. How often is it? Do you have to take a lot of time off from work - or is my perception off? Do you see changes? Is there an end or does it go on forever? Do even eccentric kids fit in and do ok?

[Anonymous]

My nephew has borderline personality disorder and DBT helped him tremendously. It's a long road though, took a year to see any results at all, and maybe another year to really make him well. This was with multiple individual and group sessions per week.

If you can at all swing the more intensive program, I'd say it's worth the effort. My brother got insurance to pay even though the place didn't take insurance, but they had to go through multiple appeals and get the psychologist to enter a special contract with the insurance company.

But if you have to go with the one place that takes insurance, at least do that. DBT is the best treatment for borderline.

[Anonymous]

Anonymous wrote:

Anonymous wrote:How old is your son? I’ve been in DBT since January. I’m happy to answer any questions you have, it’s hard to give a general overview of my experience so far.

I’m very lucky that my state Medicaid covers the program in full.

Reminds me that I also need to apply for Medicaid for my son.

I am not even sure what I need to know. How often is it? Do you have to take a lot of time off from work - or is my perception off? Do you see changes? Is there an end or does it go on forever? Do even eccentric kids fit in and do ok?

My program is one hour of one on one therapy and 1.5 hours of Skills Class per week. I think this is fairly standard. I am currently unemployed so I go to both mid-day on weekdays, but there are several options for the Skills Class including some that meet in the evenings outside of 9-5 hours. I’m assuming one can also schedule their individual therapy outside of work hours as well.

There are about 8 people in my class. Every class follows a simple routine with the facilitator. We work out of a giant binder. First we do a 5 minute or so mindfulness exercise - sometimes a game, a meditation, things like that. Then we go over the homework from last week, which is typically practicing a new skill. Last week we learned the STOP skill (there are a lot of acronyms in DBT) which helps you step back from high emotion situations and not act impulsively and make things worse. So tomorrow each person will take a few minutes to share the situation they experienced and how they applied the STOP skill. The facilitator might ask questions or suggest something we could have done differently. If you didn’t do the homework the facilitator will ask what prevented you from doing it and help you come up with a quick plan to get it done for next week. After everyone has shared, we discuss the next topic, assign new homework, and we’re done.

The folks in my class range from about 22 to over 60. I know my program has classes just for teens though. Everyone is nice, and there are definitely a couple eccentric people but everyone does fine. I’ve seen a few emotional outbursts but the facilitators are trained to get through them with the individual and keep the class moving.

There is a definite end. It takes about 6 months to get through the entire binder in class and learn all the skills. My program recommends going through it all twice, once to learn the skills and then again to really instill them, so about a year commitment. And they do expect a commitment. I don’t know whether there are those who keep doing it for longer or indefinitely. I do know when they’re done with DBT some people return to their previous talk therapy or seek other specific kinds of therapy to work through trauma, etc. DBT is primarily about learning skills and applying them to life rather then delving into the past and dealing with trauma.

The one thing that surprised me was that it feels a little more “woo” than I expected, but I don’t know if that’s just because of the area I’m in.

I think I am improving, slowly but surely.

[Anonymous]

Borderline personality disorder has a reputation as a dump-all diagnosis for people with unpleasant personality traits. I would be very wary of how this diagnosis was reached, especially if your child is under 18.

If your child is annoying, neurotic, etc. that doesn't mean he has BPD.

[Anonymous]

Anonymous wrote:Borderline personality disorder has a reputation as a dump-all diagnosis for people with unpleasant personality traits. I would be very wary of how this diagnosis was reached, especially if your child is under 18.

If your child is annoying, neurotic, etc. that doesn't mean he has BPD.

23:35 PP - thank you so much. That is so helpful.

My son is 16. He is very ill - far beyond annoying and neurotic - and I do think the BPD diagnosis makes sense, given what I am reading. I also think that he really has the potential to become a successful adult if we can just get him the right tools. Sometimes it feels like a overwhelming responsibility to have been given this child to raise. I will probably never stop wondering if we did enough for him.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Borderline personality disorder has a reputation as a dump-all diagnosis for people with unpleasant personality traits. I would be very wary of how this diagnosis was reached, especially if your child is under 18.

If your child is annoying, neurotic, etc. that doesn't mean he has BPD.

23:35 PP - thank you so much. That is so helpful.

My son is 16. He is very ill - far beyond annoying and neurotic - and I do think the BPD diagnosis makes sense, given what I am reading. I also think that he really has the potential to become a successful adult if we can just get him the right tools. Sometimes it feels like a overwhelming responsibility to have been given this child to raise. I will probably never stop wondering if we did enough for him.

Personality disorders really shouldn't be diagnosed in teens. That said. DBT is a great opportunity to learn skills that are very valuable regardless of a personality disorder or not. Many people would benefit from DBT as it focuses on mindfulness, emotional regulation, distress tolerance and interpersonal effectiveness.

[Anonymous]

I would be very cautious about putting a 16 year old into a group of adults with borderline personality disorder. You need to find a youth orientated group.

[Anonymous]

We did a DBT teen/parent program. It had the same structure as an earlier poster described: 1 hour per week of individual therapy for the teen, 1.5 hours of "skills training," where the teens met in one group, the parents in another for about half the period, then came together for the other half. There's also a "coaching" piece, where the teen has access to coaching check-ins with the therapist.

It was a substantial time commitment (2 visits per week), with minimal coverage from our insurance provider.

For us, the experience was not positive. DBT (like most cognitive therapies) requires a LOT of buy-in from the teen. The practice we went to recommended a two-month assessment period before starting DBT. We didn't do that--BIG mistake. Generally speaking, I would say that DBT doesn't do well with resistance and refusal--and isn't especially helpful in getting to the reasons behind resistance to therapy (eg, trauma).

[Anonymous]

Thanks PP9:21. The buy in is what we're concerned about. My son will take medication and attend therapy. But he has not committed to behavioral changes to promote his recovery.

[Anonymous]

Anonymous wrote:Thanks PP9:21. The buy in is what we're concerned about. My son will take medication and attend therapy. But he has not committed to behavioral changes to promote his recovery.

My nephew with borderline didn't buy in at the beginning either. Good rapport with the therapist and lots of family support was essential. Eventually he saw the benefits, I think because he didn't want to continue suffering through his own mistakes.

[Anonymous]

Is “suffering through their own mistakes” and “making things worse” Boarderlime or can it be ODD or just emotional regulation ?