SPECIALISED BPD THERAPY

Thanking for landing on this page and your interest in potentially working with me.

For most of my career as a social worker/ therapist, I have specialised in working with people affected by traits of emotionally unstable/borderline personality disorder.

I emphasis ‘traits of’ because we believe that psychological disorders are often extreme expressions of a continuum of normality.

 

My approach to working with BPD is to blend evidence-based methods designed for attachment trauma such as Schema Therapy, Dialectical Behavioral Therapy, Mentalisation-based Therapy, EMDR with other more intuitive models such as Sandtray Therapy and Art Therapy. On top of 'fire-fighting' with the imminent issues,  we aim to make changes to the deep-seated life patterns that cause similar issues to come up again and again in your life. This process can create lasting changes because it looks beyond the surface and addresses the core emotional roots.

 

I bring together scientific research and clinical knowledge that were particularly effective in tackling the following issues: difficulties in regulating emotions, interpersonal relationships (e.g. standing up for yourself or asking for what you want), managing anger outbursts, impulsive behaviours and compulsive urges, or having suicidal thoughts and urges to self-harm. 

Below are some information you might find helpful. Please feel free to contact me if you have more questions!

Imi


Assessment and diagnosis

 

about the diagnosis

 

Borderline Personality Disorder (BPD) is also known as emotional dysregulation disorder or emotionally unstable personality disorder. Despite being referred to as a ‘personality disorder’ in the diagnostic manual, many have proposed that the term 'personality disorder' is best understood as a limitation in the capacity to self-regulate. This means that a person can have feelings that are overwhelming, spiralling out of control, and rapidly changing. These symptoms often go hand-in-hand a sense of emptiness.

I think the diagnosis says ‘trouble maker’. You are ignored, you are not taken seriously.. ‘

‘Everything seems to be your fault when you have a personality disorder.’

‘They say it is not a mental illness but something I should be able to control.’

‘I feel like the black sheep of the community, that I don’t belong anywhere’.



Given the stigma and negative associations that are potentially attached to a personality disorder diagnosis, can getting a diagnosis ever be a good thing? 

The answer is yes. 

In fact, many people are relieved to get a diagnosis. The value of a diagnosis is in getting the right treatment. Although it sometimes come with the terror of being associated with a ‘personality’ defect,  stigma and shame, it can help people make sense of their experience. Being able to put a name to experiences that are intangible and often misunderstood and be hugely validating. After getting a diagnosis, you may decide to tell family, friends and colleagues (if you want to) about it. Sometimes, when the people close to you understand that there is a reason for your difficulties, it's easier for them to empathise with you and offer the right kind of support. You may also then be able to identify and find others who share the same difficulties, and realise that you are not alone. Ultimately, you are the only person who can decide if this is the best choice for you.

‘For a long time describing my life was a train wreck , and I could not make sense of it. This was all before I was diagnosed ‘



How do I support someone I care about through this process of getting a diagnosis? 


If you feel that your friends or family members have personality disorder traits, here are some bullet points that may help you to support someone through the process of getting a diagnosis:

  • Remember that a diagnosis is not a brush stroke statement. It is important to allow the person you are supporting to speak about their individualised, subjective experiences.

  • Knowing that being attached to a label can bring up a mixed bag of emotions, please respect your loved one’s ambivalence towards getting a diagnosis.

  • Even when a person is given the diagnosis of personality disorder, he or she has the right to disagree with it. Your job as a supportive friend, family member or partner is simply to be there for him, and be a kind witness to any emotions that arise.

  • Though you may want to encourage treatment or provide guidepost to it, do not ‘force it’. Treatment would not be effective if the person is not motivated.

  • Remember that being given a diagnosis does not dilute a person’s heart and soul, and certainly does not take away the positive traits, creativity, passion and other virtues there is in him/her.

 

 

The assessment

Do you offer clinical assessment?  

Yes. 

If you would like to be clinically assessed to see if you fit the diagnostic criteria for Borderline Personality Disorder, I would be able to run a clinical interview, based on The Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-II), for this purpose. Although I would not be able to prescribe medication or provide medical advice, I will try my best to communicate with your medical provider to make sure that we are on the same page. 

 

The SCID Interview

The Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-II) is a semi-structured interview for making DSM-IV Axis II: Personality Disorder diagnoses.  The instrument was designed to be administered by a mental health professional who has relevant professional training and has had experience performing unstructured, open-ended questions, diagnostic evaluations.

 

What happens during and after the assessment?

The interview time varies, from 20 minutes to more than an hour, depending on the presentation and complexity of your difficulties. Typically, it will take 30-45 minutes.

You will be asked a set of open ended questions based on your past and current experience. there is no need to prepare anything and I will guide you through the process. Afterwards, I will write up a one-page report stating the results and my impressions. All information will remain confidential and will only be revealed to you (except in circumstances where I believe that you are in serious risk of harming yourself or others, or when required by law).

 

Are there reliability and validity data on the SCID?

The range in reliability for SCID is enormous, depending on the nature of the sample and research methodology (i.e., joint vs. test-retest, multi-site vs. single site with raters who have worked together, etc.). Please click here for information regarding SCID-II reliability (including tables summarising reliability results). Determining the validity is a more difficult question because of the lack of established gold standards for psychiatric diagnoses. In lieu of such a gold standard, "best estimate" diagnoses are often used as the clinical standard. You may click here for information regarding SCID-II validity.

  

   ‘ It’s not the label that matters but what happens afterwards’ 



 



BPD THERAPIST- WHAT TO LOOK FOR? 



Due to one reason or another, we may not be able to work together. Although there remains many misunderstandings and ignorance around BPD traits, there are also  good resources and therapists who can help. Here are some further thoughts on what to look for when seeking to work with someone regarding BPD- related difficulties. 

 Given the variety of therapeutic approaches, knowing what to look for in a therapist can be difficult. Existing research and literature into the essential therapeutic elements in successful treatment with BPD may be able to provide some guidance.



Responsive to your individual needs

Although it can be tempting to paint people with BPD with a single brush, considerable evidence suggests that the BPD diagnosis is highly heterogeneous. People with the same diagnosis may have different presenting issues, and therefore want different things from therapy. Real therapeutic work comes from working collaboratively, honoring both your goal and your therapist’s knowledge.

Either across individuals or within one person, therapeutic goals should not be reducible to one theory-driven meta-goal. For instance, we cannot assume that it is ‘all about’ correcting dysfunctional cognitions or ‘all down to’ aligning self-concept.

It is also likely that a person with BPD would have very different needs at different times. It is particularly crucial for your therapist to be flexible enough to tailor each session based on your affective state and arousal level. They need to be able to ‘meet’ you in terms of the intensity of feelings, whilst remaining centered and grounded.

This can be a real challenge, but is fundamental to a working relationship. For instance, when you reach out to your therapist in crisis, or in a heightened emotional state, they being cold and distant might leave you feeling rejected and abandoned. Yet, on the flip side, you don’t want your therapist to be so drawn into your emotional turmoil that they becomes just as lost.

Collaborative work

On revision of the existing treatment protocol for BPD, client involvement is one of the most important factors for creating changes. Essentially, treatment for BPD would not succeed unless the therapeutic alliance is built on the agreement of therapeutic goals and strategies.

There should be a ‘shared understanding’ of the origin and nature of the presenting problems. It is not something that the therapist alone decide on, but an ongoing thread of discussion and negotiation.

 

Hope and faith

The BPD journey is a painful one, and there may be times when you feel hopeless; this is when your therapist can offer an alternative perspective, teach skills or provide a temporary holding environment. Your therapist may be more directive in offering guidance and advice in the beginning, especially if you did not have relevant containing parenting experience in early life. However, just like a good parent, your therapist’s ultimate goal is to help you recognise your own strength and agency rather than fostering dependency. Your therapist is also there to help you recognise your uniqueness and abilities, and eventually make use of them. Eventually, you will be able to internalise the hope your therapist holds in recovery, and the faith your therapist has in you.

 

Emotional Validation

Validation of your emotions is a central component for therapeutic alliance in all the empirically effective individual therapies for BPD. A therapist’s ability to resonate with your painful emotions and to tolerate the intensity of them can be transformative. The therapist must show a willingness to mindfully explore the process and content within the therapeutic relationship, and demonstrate acceptance of a wide array of experiences, including the unpleasant ones. This does not mean agreeing with all that you do, especially when it comes to behaviors such as self harming or disordered eating. However, this does not take away the validity of the painful emotions behind these coping behaviours. By experiencing and learning that your feelings are tolerable within the relationship, you may gradually be able to develop the capacity to self-regulate in a healthy fashion.

Owing to the unique nature of BPD, effective treatments call for high level of responsivity/flexibility from the therapist, a collaborative stance, trust and shared authority. These are perhaps essential qualities in all therapies, but are particularly important for BPD clients. Psychotherapy for BPD should only be delivered by a trained professional. Do not be afraid to ask about their experience. It is within your right to look around before you decide!