Tag Archives: Psychotherapy

P – #AtoZChallenge on Mental Health

Welcome to day 16 in the #AtoZChallenge on mental health. Todays’letter is P. There ae many obvious mental health terms starting with P, but also some you may not know.

Privileges

Privileges are what freedom of independence and movement someone has while in the mental hospital. In Believarexic, the book by J.J. Johnson I read a few months ago, the main character rightfully says that what are called privileges in the mental hospital are basic rights in the real world. For example, every adut in the real world is allowed to shower independently, whereas some people in mental hospitals need to do such basic tasks under staff supervision.

Of course, restrictions to someone’s freedom even in the mental hospital need to be motivated. If a person isn’t a danger to themself or others, they should really be allowed to go wherever they want unless this is a hindrance to their treatment. What I mean by this is of course even a person with full privileges should show up for their treatment appointments. Usually, even people with full privileges need to ask for permission from their clinician to leave the hospital overnight.

Psychiatrist

A psychiatrist is a medical doctor specializing in mental illnesses. NOwadays, they’re commonly seen as human pill dispensers, because prescribing medication is their primary task. However, in the Netherlands every psychiatrist is also a qualified psychotherapist. A psychiatrist is usualy a person’s head clinician. Head clinicians are the only ones who can open diagnosis-treatment combinations in the Netherlands. Diagnosis-treatment combination is insurance lingo for the patient’s diagnosis and the treatment that is suited to that diagnosis according to protocols. As such, a head clinician is the only one who can change a patient’s formal diagnosis. By the way, clinical psychologists and psychotherapists can also be head clinicians.

Psychologist

Psychologists do most of the talk therapy part of mental health treatment. There are three levels of psychologists employed by mental health agencies in the Netherlands. Basic psychologists are fresh out of college with a Master’s degree in psychology. We have a basic psychologist employed at my unit but I’m clueless as to what his duties are. Anyone can call themself a psychologist. Then there is the health care psychologist, which is in fact a protected title. Only someone who has completed two years of additional trainign after college and is licensed can call themself a health care psychologist. This is the most common type of psychologists employed by mental health agencies. They can do basic psychotherapy but cannot be head clinicians. Last are cliniical psychologists, who’ve got two more years of specialized training and many also have a Ph.D. These people can be head clinicians and do more specialized psychotherapy too. Clinical psychologists are often assigned to the more complex cases. My unit currently does not employ a clinical psychologist.

Psychotherapy

There are many forms of psychotherapy, both individual and in a group. Psychotherapy usually employs talking to help the patient recover, though some psychotherapies are partly non-verbal too. In many countries, the term psychotherapist can be used by anyone who so desires. Not so in the Netheraldns: psychotherapists are psychologists who’ve had I believe it’s four years of training in psychotherapy techniques. They are bound by the same laws as doctors and health care and clinical psychologists. A psychiatrist is registered separately as a physician and as a psychotherapist. As such, they can lose one license but keep the other. I once read about a psychiatrist who mostly practised psychotherapy and due to abuse of power lost his license, but only his physician license at first.

Changing Myself

“When we are no longer able to change a situation, we are challenged to change ourselves.” – Viktor Frankl

This past week, the above quote was the prompt phrase for Tuesday at Ten. I am very late to join in, but I find the prompt particularly interesting. It signifies how we cannot have control over every situation in our lives, but we can have control over how we handle said situation.

I am just a tiny bit hypocritical (oh well, not a tiny bit) writing about changing one’s thoughts and actions around an uncontrolable situation today, because I just spent hours on or over the edge of crisis. There wasn’t really a situation I needed to change that led to it, other than my unquiet mind itself. So for today, I am going to write about changing that aspect of myself.

I remember in 2007, when I had only been on the acute psychiatric unit for a few weeks, moaning to my fellow patients that I’d gone to all sorts of rehabilitation and training places and still hadn’t learned how to handle my unquiet mind. Now I can add to these places three different psychiatric units. The thing is, however, wherever I go, I take me with me.

It is terrilby hard being me. However, I can change. I change all the time. Whether I grow is up to me. That is a terribly ironic phrase to write down for a pessimist with a terribly external locus of c ontrol. I’m not even sure I believe it myself. Maybe that is where I need to start: believing that I can’t change all situations of my life, but I can change myself.

I can change the way I think or act. I have come a long way already, because I have far fewer meltdowns than I had in 2007. I usually think my medication deserves the credit, but it isn’t like anyone forces these pills down my throat.

Also, while medications can alter your brain chemistry, so can thought processes. It is a myth that therapy works on the mind only, as if the mind is somehow separate from the body. The mind and body mutually influence each other.

I have never been all that great a psychotherapy client. As I said, I have yet to fully believe that I can change my brain chemistry by changing my thoughts. However, I practise this changing my thoughts sometimes already, like when I try to reassure myself. Now I just need to practise on.

My Experience With Therapy and Counseling #Write31Days

31 Days of Mental Health

Welcome to day 23 in the #Write31Days challenge on mental health. Today, I’ll focus on another question in the 30-day mental illness awareness challenge. For day 23, the topic is your opinion on therapy. I will share my experiences of therapy and my opinion on various approaches. I have decided to include both traditional psychotherapy approaches and non-verbal approaches.

I had my first experience of therapy as a child, when I had four sessions of play therapy. I didn’t like the therapist, didn’t have insight into my problems, and four sessions obviously wasn’t enough to garner any results. In hindsight, my play behavior did show my problems with rigid thinking, emotion regulation and behavioral control. For example, I’d throw out the dollhouse dolls with purple hair because “people don’t have purple hair”. I also preferred to play with toys that allowed me to show anger, such as toy guns. One vivid memory I have is of me trying to overflow the water tray. The therapist did show me why it wouldn’t work, but I tried anyway.

My first experience with verbal therapy was when I was nineteen and attending the rehabilitation center for the blind. Once again, I didn’t like the therapist, who appeared a bit inpatient towards my difficulties adjusting to blindness and misunderstanding of my social ineptitude. She tried to offer practical advice, while I felt I needed to process the rollercoaster ride that my life had become. Of course, time constraints – I had only about twelve sessions -, prevented us from going deeper.

During my first sixteen months in the psychiatric hospital, I didn’t have a psychologist. I did do movement therapy, which helped me greatly to release my emotional tension. It was here that I learned to rate my distress level – I came up with a system myself. Thhat being said, when later people asked me to rate my distress level, I was often stuck. This moveement therapist I had at the acute ward was one of the more helpful therapists I’ve had.

At the resocialization ward, I tried cognitive-behavioral therapy for a bit. It hardly worked, because I and my therapist agreed I had good reason to be anxious. Then, when I was diagnosed with DID and PTSD, the therapist pushed me to try EMDR, but I resisted. I didn’t have that severe PTSD symptoms, after all, and did have quite a bit of trouble with self-regulation and dissociation.

When I moved to my current institution, I got diagnosed with BPD. My therapist’s expertise was schema-focused therapy, an approach I’d wanted to use for a while. Unfortunately, it didn’t work out. The therapist told one of my parts, who hides her inner weakness behind a stubborn attitude, that she’s a “punitive parent” and needs to disappear. I strongly feel that each part of my personality has a function, so this dismissive attitude didn’t fit me well. Besides, though I learned some from the book the therapist recommended, most of the information was just a bit too abstract.

This therapist left in 2014 and I’ve had a new psychologist for a little over a year now. With her, I focus on supportive counseling and rehabilitation. I find this is most constructive. I do hope that, in the future, I can get some formal psychotherapy again. I have a dialectical behavior therapy self-help book, which is quite interesting. Then again, I find it hard to make a long-term commitment to sticking to one thing to focus on. That is probably the main thing keeping me from engaging properly in psychotherapy.

Anxiety

One of the Friday Reflections prompts for this week is to write about anxiety. How does it affect me and what do I do to cope? I will write here about my experiences with various types of anxiety. It ties in nicely with last Monday’s post, in which I share tips for relaxation. However, throughout this post, I will share some coping strategies that have and haven’t worked for me too.

In the psychiatrist’s manual, DSM-5, there are various types of anxiety disorders. Now I don’t have a diagnosis of any of these disorders, but they are a good reference point for the various types of anxiety that people may experience.

Generalized anxiety disorder (GAD) is a condition in which a person feels anxious or worried about a variety of situations. This worry is accompanied by a feeling of restlessness, fatigue, difficulty concentrating, irritability, sleep disturbance and/or muscle tension. Generalized anxiety disorder often co-occurs with depression.

Though I haven’t had a diagnosis of GAD, partly because my owrrying can be explained by my autism, I have been a chronic worrier all my life and experienced many of the associated symptoms I mentioned above. Antidepressants can help this type of anxiety and in fact are more effective for GAD than for depression. I have been taking the antidepressant Celexa since 2010 with moderate success.

Some people worry about specific things happening to them. For example, I have a lot of anxiety about getting a serious illness. This is called hypochondria or health anxiety. In the psychiatrist’s manual, it is classified as a somatic symptom disorder rather than an anxiety disorder, but the symptoms overlap with those of anxiety disorders. Some doctors have tried antidepressants for health anxiety and documented significant improvement in their patients. It is also commonly thought that people’s health anxiety lessens, ironically, when they do get seriously ill.

My health anxiety is associated with compulsive behaviors. For example, when I was a child, I was afraid of contracting leprosy. As a means of keeping my worry at bay, I’d count my fingers and toes, since I heard that people who had leprosy had those fall off.

Later on, when I lived independently, obsessive worrying and the resulting compulsive behaviors extended to other situations. For example, I’d be afraid of carbon monoxide poisoning and would have to check that my heating was off and windows open at night. I often checked this twenty or thirty times a night.

Obsessive compulsive disorder (OCD) is classified in DSM-5 under its own category separate from anxiety disorders. The obsessive compulsive spectrum also includes disorders that aren’t commonly seen as anxiety disorders, such as hoardng and trichotillomania (compulsive hair pulling). However, OCD used to be seen as an anxiety disorder. Antidepressants can help, but so can exposure and response prevention. In this type of psychotherapy, the patient is gradually taught to lessen the compulsive response (eg. checking) to a feared scenario. For example, people who have hygiene-related compulsions gradually move from say a three-hour shower down to normal shower time, decreasing their time under the shower by one minute a day. For me personally, my obsessions and compulsions related to the risk of carbon monoxide poisoning decreased dramatically when I was hospitalized.

Another type of anxiety disorder is specific phobia. Everyone probably has something they are fearful of, but a specific phobia is only diagnosed when the fear and resulting avoidance of situations greatly impairs the person’s daily functioning. Similar to OCD, specific phobias are treated with exposure therapy, where the person is gradually intrduced to the feared situation or object and learns to endure the fear. For example, a person with a spider phobia might be first intrduced to pictures of spiders, then videos, then look at a live spider, etc. You can also be asked to simply imagine the feared scenario (eg. looking at a spider). After all, with certain phobias, it is not feasible for the therapist to take the client on to the real experience.

A final type of anxiety is social phobia. A person with social phobia is extremely fearful of social situations because of the fear of making mistakes or being criticized. As a result, people with social phobia avoid certain or all social situations. Many autistic people develop social anxiety as a result of their real social ineptness. I for one do not consider myself that socially anxious, but when I filled out a social phobia questionnaire online, it said I had very sevre social phobia. This is probably because I get overwhelmd by social situations easily and avoid them because of this.

People with social phobia, often children, may also suffer from a co-existing condition called selective mutism. This is an inability to talk in certain situations (eg. at school) while the child has adequate speech in other situations (eg. with parents). I displayed signs of selective mutism as a teen. Though this was in part anxiety-related, it also related to my autism.

There are still many other types of anxiety and related disorders, such as panic disorder and agoraphobia. Post-traumatic stress disorder (PTSD) also used to be classified as an anxiety disorder. I used to have a diagnosis of PTSD and still have some of its symptoms, but I may discuss this at a later time.

Reflections From Me

Mental Health Awareness: Living with Significant Mental Illness

Today, I’m linking up with Vicky’s mental health linky for Mental Health Awareness Week in the UK. As regular readers will know, I’ve been diagnosed with a mental illness for years. My original diagnosis was adjustment disorder, because I had landed in a psychiatric crisis when living indpendently and just didn’t meet the criteria for depression. My parents joke that I just didn’t wake up at the right time, because my doctor told me when I had sleep disturbances, that they weren’t typical of depression. I’m pretty sure I wasn’t clinically depressed.

Then came impulse control disorder NOS, which was basically an extension of the adjustment disorder I suppose, except that it reflected just my behaviors and not my moods.

In 2010, I was diagnosed wit dissociative identity disorder and PTSD. I want to tell anyone with a diagnosis of PTSD that it’s not a life sentence. I had a mild case as far as the regular symptoms were concerned (I also had symptoms of complex PTSD, and still do). EMDR treatment was suggested a few times, which can be very effective. However, because I had such a mild version of PTSD, the symptoms lessened to the point where I no longer needed the diagnosis with a lot of talking about my traumatic experiences. I later found out that talking and talking on about your trauma under a therapist’s guidance until it doesn’t hurt as much anymore may in fact be effective in people not responding ot EMDR. I don’t know the specifics of this therpay, which is called imaginary exposure, and I didn’t get any formal form of treatment for the PTSD myself.

As for the DID, I have or had a mild version of that too, probably more dissociative disorder NOS, and was able to hide the symptooms when people weren’t accepting of them anymore. There are many people, mostly peers, who believe my diagnosis of DID was incorrect. As for my therapist, she changed it to borderline personality disorder and feels this includes mild versions of DID too, so that I don’t need an additional diagnosis.

What is it like living with a mental illness? Well, for me, it is one confusing experience. I am very suggestible and have a poor sense of self. This means that I absorb many emotions from other people, and yet I do not know how to handle these emotions. I can have rapidly shifting, dramatic mood swings. One momnet, I’m fine; the next, i’m raging. Then again, my definition of “fine” is probably not the same as a currenlty mentally healthy person’s, because I’m always somewhat anxious and/or depressed.

Borderline personality disorder often co-occurs with other disorders. I have no additional diagnoses (other than autism, which I don’t consider a psychiatric disorder), but I could likely have been diagnosed with a range of disorders if this would make a difference. As I said, I have dissociative symptoms. I also have suffered from chronic, low-grade depressive moods since my teens, and likely had what is now called disruptive mood dysregulation disorder as a child. I also have some level of anxiety and used to have quite bad obsessive-compulsive symptoms in my teens and early twenties. They however went away witout treatment when I was hospitalized, so were likely a response to stress. Same with many of my somatic symptoms.

There is treatment for most of my mental health symptoms. In fact, I have improved a great deal over the years. That doesn’t mean my mental illness can be cured. I strive for recovery, which means living a meaningful life in spite of my mental illness.

Living a meaningful life, for clarity’s sake, does not necessarily mean not needing mental health support. It is a common misconception, which I fight even with my therapist, that needing less support is the ultimate measure of quality of life. I, for one, am likely to need support for the rest of my life. This doesn’t mean I can’t find joy or even happiness. I find joy in my hobbies, which include blogging, crafting and reading. I find happiness through my relationship with my husband. I do still have significant mental health problems, and I won’t say they don’t limit me. Then again, I’m more limited by the idea that needing less support is more important than feeling better.

Long-Term (S)care Planning

Next year, my institution is going to undergo restructuring and all people with the lower levels of care will be kicked out. Lower levels of care in terms of institutional care, that is, so my level five (out of seven) care package does count. Exceptions are being made for those who’ve been completely institutionalized, so that they can’t live in the community, but that doesn’t include me having spent “only” seven years in an institution.

Honestly, I’m worried, but also determined. I was actually going to be referred to the Leo Kanner House workhome. The Leo Kanner House is an agency for autistic children and adults, specifically those without an intellectual disability. The workhome is their institutional, long-term placement for the more severely disabled adults, but firstly they have a waiting list a mile long (or two miles, or three), and secndly, my care package will likely by the time they have a place for me, not qualify me for care there anymore. Five out of seven sounded heavy duty when I first was assigned this care package in 2009, because I got there from three and that was already called something about “intensive support”. Currently, those with any care package below five are expected to live independently with outpatient and home supports. Fine with me, and I would’ve loved to attain this level of independence, but it’s not like the people in these care packages get the additional care that living on yur own requires versus living in a group home or institution.

As far as I’m aware, the people in care package five are allowed 24-hour care until the Long-Trm Care Act passes, which is only God knows when. 24-hour care, for clarity’s sake, means having someone available on call or at best in the group home or on the ward 24/7. There’s absolutely no-one who is allowed 24-hour supervision under the Dutch care system. Anyway, assuming that I’m entitled to group home care until whenever, but will be kicked out of the institution next year, I decided to E-mail my therapist to discuss referring me to supported housing.

There are two supported housing agencies in the area that cater to psychiatric patients – and autistics without an intellectual disability fall under the mental health system here. One of the agencies is a larger one which has existed for several decades. On their page about autism care, they only advertise a training home where autistics are trained to live independentlly and have to move out within a year. Not suitable for me, as 1. I already got enough training home experience to know I’m not going to learn much there, and 2. there’s no way I’m going to learn to live with only home supports in a year’s time, if ever. My husband and I are going to E-mail them anyway as, being a larger organization, they might be able to provide some kind of accommodation where we can live together with enough support for me.

The other organization is smaller, having only about six or seven group homes throughout the province, though mostly in my area. They have an autism-specialized group home in the nearest big city, in which they work together with the Leo Kanner House, but there are two drawbacks. Firstly, this group home is located down town, which means I won’t be able to travel safely even for just a walk around the block. The second drawback is that it is part training home too. Then there are two group homes in the countryside near a neighboring town from here. It is one of these group homes I’m asking ot go on the list for if I pass the intake interview. I will be calling this organization tomorrow after I speak to my therapist. Not sure how or when I’ll be contacting the larger supported housing agency.

One of the positives about moving into a group home is that my therapy falls under a different insurance scheme then. Under care packages for those in institutions, you’re only entitled to 50 minutes of “treatment” a week. That’s normal, you’d say. The thing is, “treatment” includes not only psychotherapy, but also art therapy, social work, consultations with a psychiatrist, etc. Basically anything other than staff support and day activities. Based on this, I get psychotherapy only once every other week at best (even though until recently I had no other forms of treatment, but oh well). Under group home care packaging, support will still be covered, but treatment isn’t covered. You’ll have to get that paid for through health insurance. That means, if I’m correct, that you can get more treatment paid for if your diagnosis warrants it, which mine does if I have to believe my therapist, who says that people with borderline personality disorder normally get at least a session a week. (Day activities are from 2015 on covered through the local government to make things complicated, so I have no clue how m uch I can get of those.)

I also asked my therapist to contact the Leo Kanner House about doing a consultation there. In all honesty, I’d like to get therapy there (they offer psychotherapy too) rather than at my local mental health agency, but as far as I know, getting both agencies involved is also possible if you have a dual diagnosis. As I wrote a few weeks ago, however, my diagnosis of autism is being questioned, so I’m asking my therapist to call my old institution to request my old records, too. I don’t mind having to answer a zillion questions about my autism for only about the fourth time (yay, I can do sarcasm, does that make me NT?). What I do mind is having to get my parents to come over again, for the third time in their case, to do the developmental assessment. Oh wait, what if my childhood development has changed since 2007? My therapist had better get the records, and she’ll hopefully straighten up about my blindness, as the Leo Kanner House had a blind client several years ago.

Emotion Regulation Skills for BPD Sufferers

In the Netherlands, borderline persoanlity disorder is sometimes also called emotion regulation disorder. There were in fact psychiatrists advocating for this name change in DSM-5, but it didn’t happen. Indeed, I myself notice that emotioon regulation problems are, besides having little sense of self, the most prominent symptom of my BPD. Tonight, I noticed how being told that I had to ask a fellow patient to help me with something minor rather than a staff member, set into motion a train of emotions and behaviors that I now realize, at least to some extent, was uncalled for.

Learning to regulate emotions does not mean stuffing them. Rather, it means observing and describing your emotions, decreasing your vulnerability to negative emotions and increasing positive emotions. Identifying what emotion you are feeling is usually the first step, and it can be especially hard. Many people, even those without mental illness, learn that certain emotions are not allowed, so they convert them into others. I for one often act angry when I’m sad or overwhelmed. However, all emotions have value.

Changing emotions requires first observing them without judgment, then letting go of them through for example mindfulness. Mindfulness allows you to experience the coming and going of emotions like a wave. In mindfulness, you shouldn’t try to block or suppress an emotion or try to keep it around. Rather, let emotion run its natural course.

This does not mean acting on emotions the moment they come up. We are not our emotions. Therefore, another step in emotion regulation is choosing whether to act upon your emotion. This seems impossible at first – at least, it does for me -, which is why mindfulness is important. When you have chosen to challenge an emotion, some therapies, like dialectical behavior therapy (DBT), explicitly teach acting opposite from the emotion. The most useful example of this I’ve heard is from a woman who suffered from bipolar disorder. When she was sliding into depression, she was encouraged to become active, while she was encouraged to take it slow when she was climbing towards mania. Other therapies, like rational emotive therapy, emphasize the fact that an emotion doesn’t come out of the blue, and encourage sufferers to challenge the thoughts that lead to their emotions. I believe that challenging cognitions may be best done when emotions are not overflowing you.

Writing Letters to the People Who Hurt You

One of the steps in changing maladaptive schemas, according to the authros of Reinventing Your Life, is to write letters to the people who contributed to the formation of these schemas. You obviously don’t need to send these letters, but the goal is to have your inner vulnerable child speak out.

I have told my story of the traumatic expeirence sin my life many times, but it is hard fo rme to actually write letters to the people who caused or didn’t protecct me against these experiences. I am not at this point in therapy yet, but one of the things that I think will hold me back is the need to address these people directly. Even if I’m not going to send or publish these letters, it still feels as though I’m telling these peole to their face that they abused, abandoned or failed to protect me.

Another thing which the authors acknowledge, is the fact that sometiems people who abuse or otherwise trumatize others, are well-intentioned. In my case, the people who hurt me didn’t know better, had the best of intentions, and/or didn’t realize what they did was causing me long-term trauma. I struggle with this big time. When I still had a DID ddiagnosis, I struggled with the connotation of severe, usually sadistic abuse. After my diagnosis was changed to BPD, I told some of the people who hurt me that I realize they aren’t sadists and that I had been struggling with this connotation in DID. Reading this chapter in Reinventig Your Life, I found for the first time someone acknowledging that well-intentioned treatment can still traumatize children (or adults). The authors say that, in writing the letters to the people who hurt you, you need to let go of excuses like this and let the vulnerable child in you speak freely and express her feelings.

Later in the process, the authors say, you may choose to forgive your parents (or others who hurt you, I suppose). I have often written aabout forgiveness, and I realize now that it’s required to feel your true feelings before you can come to forgive. Forgiving means accepting what happened, but also letting go of the need or want to be angry about it for the rest of your life. I have often tried to forgive the peeople who hurt me, without feeling the true extent of the hurt. That is stuffing feelings, not forgiving people.

The Importance of Day Activities

Over the past week, I’ve been having a hard time of it at my ward. I decided on Sunday that I wanted to leave and go backt o my old city institution. Then over the week, I participated in some day activities on my ward, in the activity building and in the multipurpose room at another adult long-term care ward. This made me realize that at least day activities are much better here than they were in my old institution, and I softened up a bit. I had a talk with my therapist on Thursday, and this made me decide I don’t want to leave for now. This talk contributed to that decision, but the good experience I’d had going to day activities did more.

I’ve heard on some institution wards day activities are not provided, because the clients need to learn to occupy themselves. This, in my opinioon, is the biggest horse manure around. Currently mentally healthy people have a job, too, so why shouldn’t those who are too disabled or ill to have a regular job? Most people here go to some kind of industrial arts type of day activities, so it’s actually real labor. For some, like me, this is not suitable, and they end up doing arts and crafts. This may seem more like a replacement of leisure rather than work, but don’t mentally healthy people have a variety of jobs, too? For some mentally ill people, just getting out of bed is hard work, and simple day activities can provide them with the structure that a job does, too.

There are many benefits of day activites. Some of them, like a daily structure, are applicable to real jobs too. Others, like distraction from one’s mental health problems, are not, but that doesn’t make them any less useful. Becoming mentally healthy, after all, involves more than being able to do a regular job.

I for one find that day activities provide me with meaning to my days, structure, as in a reason to get out of bed, social interaction, distraction, and enjoyment. Day activities are in my opinion more beneficial to my mental health than the psychotherapy I get. This is one reason I’m willing to put up with somewhat unsuitable psychotherapy in exchange for much more suitable day activities.

BPD Day

Today, my husband and I attended an evvent for sufferers of and family of people with borderline personality disorder. First, a psychiatrist spoke about what BPD is. He was interrupted mid-sentence by three women who had BPD themselves and felt they were in a better position to tell what it is. This looked a bit foolish as it was obviously planned. After the women were finished, the psychiatrist took over and explained about causes and treatment. One important point is that there is no one cause of BPD. In fact, BPD is caused by many factors interacting, such as environment, traumatic experiences, genetics, neurobiology, etc. Another interesting point was that there are four different therapies for BPD which are on average each equally effective. Also, the therapeutic alliance is more importan than what type of therapy you’re following. He said that therapeutic skills are important in all psychotherapy practice, but to an exaggerated extent so in BPD treatment.

Then we went to meet some peer supporters who told their stories and had us ask questions. I had expected to sit and listen but ultiately was the most talkative on my table. One of the peer supporters said she suspected she was born borderline. I have discussed this topic before. Some personality traits, such as aggressivness or risk-taking, make someone more prone to end up in traumatizing situations. Also, people with certain traits experience more seemingly minor evetns as traumatic. For example, my husband later told me he had experienced the same event that one of the peer supporters said was traumatic to her, and he was unaffected. This is one reason I don’t like the narrow DSM-5 definition of trauma in PTSD. PTSD too is as much a brain-based and genetic condition as it is trauma-based. So are the dissociative disorders by the way. I hope eventually the DSM developing people will realize this and remove the mandatory connection of PTSD to specific traumas. Science is already there on the dissociative disorders, but sufferers need to follow. Note please that I am not saying that abuse or trauma has no role in these conditions, or that it isn’t horrible when it occurs. All I’m saying is that it’s not like you’ll only and always develop PTSD or a dissociative disorder if you’ve experienced a certain trauma.