In 2021, I created the Facebook group “Stop Dialectical Behavioral Therapy” for mental health service users to have a space to discuss what happened to them while in DBT treatment, without being silenced by mental health providers for doing so. The group has grown to over 200 members in just a few months. I’m not surprised.
For those who are unfamiliar with Dialectical Behavioral Therapy, commonly referred to as “DBT,” it is a treatment that was first created by Dr. Marsha Linehan to be used with those diagnosed with ‘borderline personality disorder.’ A form of cognitive behavioral therapy, Linehan presents DBT as using validation as “sugar coating” so that the “distasteful medicine” of cognitive behavioral strategies goes down (Swenson, 2016, p. 688).1
Despite the majority of the individuals being sent to DBT having histories of severe childhood trauma, little about DBT treatment is “trauma-informed.” Rather, clinicians are trained to label feelings like suicidality, restricting food, self-injury, crying, and feeling sad as “problem behaviors” and are taught to engage in irreverent responses to clients who exhibit them. Talking about trauma is often shunned, and any of the aforementioned “behaviors” are commonly viewed as attention-seeking. Despite 80-90% of individuals diagnosed with ‘borderline personality disorder’ reporting histories of childhood trauma, these individuals are merely viewed through the DBT lens as people with problems that need to change.
Not only is DBT problematic, but what happens to clients prior to starting DBT is too. Many clients report that their therapists quickly terminate them, saying they need DBT without providing them time to process why they are being sent away and all of a sudden shunned. Some report realizing that they don’t like DBT and attempting to return to their previous therapist, but being told no. This was the experience of someone in the Stop Dialectical Behavioral Therapy group who gave permission for me to share:
“My therapist terminated me because she thought I needed DBT and couldn’t provide it. This was months after I dumped all of my childhood trauma in her office. She said she would continue working with me when I completed the six-month course, depending on the report of the therapist running the group. The DBT group exceeded $2,000, which was really difficult for me to come up with, but I did. The DBT therapist said I should also meet with her weekly while in the group, and that appointment would be an additional $150 per week. I could not do that financially. I just could not. So, she reported to my therapist that I wasn’t engaging in the ‘gold standard.’ I received a letter a week later from my therapist who had said she would see me after the DBT group, and it said that she would not see me at any time in the future. So, I was left with this gaping wound of having shared all of my trauma and now it’s just sitting there all raw, and unprocessed, as I deal with a therapist who I truly trusted and really liked, thinking I’m too much for her.”
As I described in my previous personal story, I had a similar experience a few years ago when my “attachment-focused” therapist shunted me off to DBT and then terminated our relationship when I asked to see her again after not finding the DBT helpful.
When I first started the Stop Dialectical Behavioral Therapy Facebook group, I wasn’t sure if my experience of DBT was something others could relate to. When I would write about it in Facebook groups, therapists would put me down and attempt to silence me. On one occasion, a DBT therapist wrote “CALM DOWN!” in response to me merely expressing how I found DBT hurtful. I was kicked out of that group shortly after. For some reason, DBT therapists take great pride in what they call “having swallowed the DBT Kool-Aid” and will defend Marsha Linehan and DBT like their lives depend on it.
I truly do not understand what we are doing with individuals with childhood trauma who do not feel well. We send them to DBT, where we tell them that their normal responses to childhood trauma are for some reason problems. It is astonishing to me that during the time of #metoo, and “trauma-informed” language being all the rage, clients continue to be subjected to this horrific treatment without anyone blinking an eye. How is it that a population with high levels of childhood trauma is being treated like witches in 2022 and nobody seems to notice or care? How is it that we are focusing so heavily on adverse childhood experiences these days and yet, many individuals with ACEs/trauma are being sent to a behavioral treatment and subjected to chain analysis of their said “problem behaviors” that supposedly do not fit the facts, when, in fact, they do? Why are we sending survivors of childhood trauma to a treatment where they are told the problem is them?
This is not just my story. Here are quotes from many others who have been traumatized by Dialectical Behavioral Therapy and have shared their stories in blogs, on Reddit, on Quora, or provided permission to share from our Facebook group:
“DBT was the worst thing that ever happened to me. I needed trauma therapy for years just to process the abuse that DBT was.” ~Anonymous
“Why do I see so many therapists recommending DBT for borderline PD when in my experience, I’ve left almost every session feeling attacked, discouraged, and unsupported? Am I missing something?” ~Anonymous, Quora
“I believe that the borderline diagnosis is the equivalent of a hate crime. DBT plays into this, blowing their own horn about being the ‘gold standard treatment for borderline’ while working to diminish, dismiss, and ignore trauma, including the trauma inflicted by the mental health system, which often mirrors and reinforces childhood trauma.” ~Anonymous
“My mom took me to dialectical behavioral therapy, where a table full of teenagers read aloud from worksheets. Not accepting pain equals suffering, a photocopy declared, insisting that our misery was a choice. Adults had decided that our problem was emotional regulation. We were to learn skills to fix our ‘bad behaviors.’ Shrinks preached the doctrine of radical acceptance, which did not seem like the best fit for my situation.” ~Emi Nietfeld from her 2022 book, Acceptance: A Memoir
“DBT infuriated [me] because it was basically telling me, ‘learn to be passively okay with outrageous unhappiness at what’s been done to you.’ We have our reactions for damned good reasons, and you’re basically treating us like car alarms you want to cut the wires on, and you want to smash it with a hammer, so you don’t have to pay attention to it. Your smoke alarm goes off, so you take the battery out.” ~Anonymous, Mad in America commenter
“I wonder who decided that DBT was the gold standard treatment for people with a borderline diagnosis. Who did that come from? Did it come from the DBT people themselves? Seems like they would be a little bit biased.” ~Anonymous, Mad in America commenter
“I am surprised that you would recommend it to me. Am I offended? Well, yes. There is certainly a diversity of intelligence levels that probably affects a person’s response to DBT, if nothing else. It is such a weird thing to encourage. Don’t diagnose me and don’t try to treat me with your condescending imaginings. I am glad I am not going back. To be in a situation where I am potentially invalidated by professionals moment after moment, to be lectured by the same people who were supposed to care for me last year, to be told again and again that I need to change my reactions, is damaging. It is damaging and re-traumatizing. I’m sick of you.” ~Elisabeth Murray, Surviving Psychiatry
“I went to an eating disorder treatment center a few years ago, and they used DBT almost exclusively. It was a really horrible experience that caused me to get worse in the long run instead of better. My trauma history involves severe abuse, including sex trafficking by a parent. Instead of helping me through it, they ignored what was happening for me and literally allowed me to drown in the flashbacks. Not having the space to talk about my trauma history meant that some really insensitive things were said that I doubt anyone would actually say to another person if they knew that person’s history. I often felt shamed for PTSD symptoms.” ~Anonymous, Reddit
“My therapist was very confrontational. I would try to bring up something that was really bothering me, and she would immediately tell me why I was wrong or that my emotions were wrong. She’d then square her shoulders back and sit up straight and I’d shut down and retreat from the session.” ~Anonymous
“I felt minimized and dismissed. It definitely felt very cold, indifferent, and unsupportive. I didn’t feel empowered in the recovery process, but instead, felt that all agency was stripped from me, and my voice was ignored.” ~Anonymous
“Before moving down to PHP, she told me that if I self-harmed once or lost a single pound while on PHP that she would have me put in a psych ward. The absolute LAST thing I needed was to be told I had to be perfect.” ~Anonymous, Reddit
“I had very upsetting experiences in DBT… some of the skills echoed what an abuser would tell me.” ~Anonymous
“I was told ‘just report it’ (CSA) to the police and then forget about it; and wasn’t allowed to include anything about it in any of the homework set. The week I did, I was asked to leave.” ~Anonymous
“You are told your emotions, ‘don’t fit the facts’ by a therapist who hasn’t experienced what you have and (in many cases) has no idea what your unique experiences of oppression have been. The therapist refuses to talk about your trauma, and instead, insists you talk about your behavior.” ~Anonymous
It is really time that the harm in this field ends. To be truly trauma-informed, one needs to understand intersectionality, developmental psychology, and the basic needs that all human beings possess. This population is not attention-seeking or obsessive. They are merely seeking to form an internal working model of secure attachment so that they may one day wander on their own. This population does not need DBT. They need developmentally informed therapy that acknowledges that trauma isn’t just what happened to you. It’s also what didn’t.
- Swenson, C. R. (2016). DBT® principles in action: Acceptance, change, and dialectics. Guilford Press. ↩
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.
This sounds like something like Cognitive Behavioral Therapy, a form of government licensed torture. Clearly falls within Nuremberg precedent for Crimes Against Humanity. It should be prosecuted as such, no statue of limitations and the penalties can be severe.
I say this as the California State Legislature is on the eve of passing Gavin Newsom’s Care Courts Medical Enslavement Law.
Fist thing that came to my mind was DBT? Does that stand for Don’t Bother the Therapist?
Seems like a fancy method of dumping those who show no potential for making money. Or once their wallets are empty.
Ha! I like that one!
That’s a great shorthand
I grew up in psychiatric care and much of my escape attempts from my teenage years and early 20s were met with DBT.
I think of Dbt therapists like “the system gives me praise and I get the raise”. Anyone else’s abusers generously fund and force their psychiatric treatment? If so, you probably got DBT.
Wow. This is staggering and opposite to what my DBT experience has been. It doesn’t even gel with DBT skills like GIVE where the V literally stands for validate. Sounds like these therapists havent actually consumed what they say they practice.
I also have childhood trauma. My therapists have been beyond understanding, have helped to tease out root causes and skilled approaches to live despite them. Helped put together anti-suicidality plans, none of which involved telling me to get over it or calm down, showed up when I was upset over admittedly minor stuff. The whole paradigm has been skills-based and even the acceptance module wasn’t about calming down so much as feeling what sucks. When DBT hit walls for trauma treatment (not actually gold standard compared to CBT, CPT, or Exposure) they readily admitted that and suggested other models then tailored those models to DBT and vice versa.
Maybe I got supremely lucky. Maybe it’s because they are both young, barely out of school and learning something better than the shit therapists you guys are experiencing. I dunno, but just wow. Y’all deserve better than whatever bullshit you were sold.
Cynical comment. But I bet often true. I think those providing therapy would prefer to have it benefit their clients but I know many themselves often see it as not accomplishing much.
I’ve got no problem with people seeking whatever help they feel they need.
My cynicism comes from not wanting to speak to A therapist (note not MY therapist) resulting in me being ‘spiked’ with date rape drugs and then snatched out of my bed by police when I collapsed because unbeknownst to me I had been made into an “Outpatient” of a mental institution by a Community Nurse (legally there is a need for a diagnosis before you can be made a ‘patient’ but police tend to overlook these minor details when a therapist has gone to the trouble of having someone ‘prepared’ for an interrogation by ‘spiking’ and then ‘planting items for police to find.
This is the method used to have people speak to the therapist when they are reluctant to talk. Tends to work pretty well, though the way they are changing ‘citizens’ into “outpatients” before even examining the person seems a bit much.
Therapist calls police and requests ‘assistance’ with their ‘patient’, and police comply. Add to this the fact they can be ‘spiked’ to reduce the risk of harm (Concealed once in custody with a fraudulent prescription by a doctor who DOES have the right to prescribe date rape drugs. And throw down a knife to make police a little ‘edgy’) and getting people the ‘help’ they need is resolved. Though I note that the ‘spiking’ combined with the acute stress reaction does actually meet the standard of torture set out in the Convention Article 1, not that this matters either because the documents can be “edited” (that is the crimes are removed, commonly called criminal fraud except when hospitals do it with the authorisation of the Clinical Director) before being provided to legal representatives.
Mental patient with a weapon sounds much better than asking police if they would kidnap a citizen because they refuse to talk to a therapist. And it’s not like police are going to notice the person isn’t an “Outpatient” when they are stupefied without their knowledge.
This means that the idea of human rights is just that……. an idea. The laws nothing more than window dressing, and the cowards who stand and watch a bunch of hypocrites who say things like “they wouldn’t do that” and “omG, in my practice I …..”
I am a trauma therapist and have been teaching DBT for many years. I do a whole-person, neuroscience-informed model and it’s been super helpful. I’ve seen it turn lives around. I do know the horrible teachers you talk about here but it’s not always that way. Be careful about making blanket statements. DBT is not CBT…if it’s bad it’s most likely because of how it’s taught. I’m sorry for anyone who has been hurt. I wish there were more holistic programs out there.
I think it is less about holistic programs and more about having therapists who have done their own work and are actually emotionally available to their clients. There is no workbook for caring about another person.
I will continue to make blanket statements about DBT. The reason I feel that it is valid for me to make blanket statements about DBT is that the fully certified DBT therapist who I saw for a year, who I was referred to by another fully certified DBT therapist, was not following protocol. She was not in consultation from the moment she took me on as a patient and when I brought this up to her she blamed it on me and told me that she wouldn’t need consultation if it wasn’t for me, that all her other patients did fine without her being in consultation.
For a treatment that makes as big a deal as DBT does about being evidence-based, the gold standard, adhering to a very specific protocol, etc, it is hugely hypocritical to allow a fully certified DBT therapist to behave in this manner. I did go to the governing board of DBT with this problem which they refused to speak to me about. In this way I learned that it was not just a problem with this one therapist, it is a problem with the entire organization. They don’t stand behind the claims that they make, and if a patient gets harmed by a DBT therapist’s refusal to follow protocol, they don’t care. They refused to address the situation. So, this is a problem with DBT as a whole.
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They are in delusions about that go-to world of “mental illness”.
The “therapists” are a bunch of people who were taught that “personality disorders” belong to those people over there.
So of course they believe it’s not themselves but the other person, and the reason this “other person” has problems is because they do not think “properly”.
So the goal then is to teach you it’s not going to go your way, but their way.
It is unbelievable how many people that should not be in “helping others” professions, are exactly in those positions.
They have no clue what life experiences and backgrounds, cultures influence them or the others.
It is all a crock of poo, and the public bought it.
That’s your right. People who it helped can share that sentiment as well. Ultimately the people seeking it can decide. I think a major problem is the coarsen talked about. Nobody should be strong armed into DBT, or any other therapy, and especially not drugs.
It’s interesting to me that so many think a neuroscience, emotional regulation approach, is what is needed for this population. I see it differently. I think they need a developmentally-informed approach that is attachment-focused and supports them in developing an internal working model of attachment so that they may progress through Erikson’s stages of development and one day feel safe to wander. I think what they need is a corrective experience and to never be shunned for appropriate responses to childhood trauma. The problem with DBT isn’t just because of the way it’s taught. It misses the core of the pain these individuals feel. It doesn’t work on abandonment. It doesn’t address growing up in poverty, being neglected, being abused, not fitting in, experiencing sexism, racism, classism, etc. It labels appropriate responses to horrible systemic issues as a problem with someone’s personality and tells them to do better and have radical acceptance. It’s not okay. Universities and other workplaces are being expected to be trauma-informed and to do away with micro aggressions and epistemic injustice. Why aren’t mental health providers held to the same standards?
You might want to read Bessel van der Kolks 40 years overview on the evidence about traumapsychotherapy in The Body Keeps the Score from 2015. The outcome is very clear and simple. Psychotherapy for people who have suffered violence and neglect in their childhood and struggle with chronic mental health problems are totally useless. However, there is some evidence, he writes, from a couple of interesting small scale studies, that individuals who do get better have two things in common. First thing, they take their recovery journey into their own hands. Secondly, they do something with a lot of yoga as their foundational healing practice. From my own experience I can agree that nothing brings stress levels down so effectively as yoga. And with some experience you might want to go on to mindfulness and loving kindness meditation practices. To process the pain, and rage, and loss of violence you need a very “cool” and compassionate mind and heart. Even the most “cool” and compassionate psychotherapist cannot give you this, you have to become this big, loving heart that is not blown away by hellish pain yourself.
To say that victims of violence have stopped at a certain point in the development of their personalities what you do with referring to Erikson is nonsense and on top an insult. This is a 19th century style of sexist, classist, and racist thinking at its best when it suggested that women, the poor, people of colour, and the “mentally retarded” stood at the level of children in their development. You are answering your question about why there is so much hate and oppression against people who have experienced violence in staying invested in such theories yourself.
This whole idea that stands at the foundation of your thinking about this topic that people who have experienced violence need someone else to fix or maybe you’d prefer to heal them is also deeply problematic and highly self-serving of the psy-professionals too.
Healing begins there where you stop to belief that you are broken and defective as an effect of experiences of violence. It is really a tragedy that this bullshit could become such a “truth” in the clinical psychological, psychiatric, and mainstream thinking of the West.
When I feel lost and hopeless about this deeply ingrained belief of our societies I remember Teresa, the couragous and loving reformer of Christianity from Spain from the 16th century who traveled her country incessantly in a carriage until she was 80 years old to teach the priests, the monks and the nuns to stop thinking of themselves as broken and defective sinners. That, she saw as a completely confused account of who human beings were in the eyes of god.
I absolutely agree!
The people in this were coarser into DBT which is problem though. It’s one thing, if people are willing, but people shouldn’t be forced.
Do you mean coerced? I agree with you 100%. Actually, there can be no such thing as “involuntary treatment.” If the person has not genuinely consented, it’s at best “management,” and more likely punishment. Force is not and can not be part of any “mental health treatment.”
Yes, that’s what I meant, thanks. Yes, I think “forced treatment” is an oxymoron, and should be made illegal. People also don’t have due process, because courts don’t take it for what it is, removing people’s rights. They take it as “help”. Even when not outright forced, like these DBT situations, it’s not conducive to treatment.
“it’s not always that way” but when it is that way, patients have no recourse. They just have to accept the fact that someone got paid to abuse them in the name of help and no one cares and no one will listen to them. Why don’t the people in the profession who realize that there are some horrible ones out there do something to stop the horrible ones instead of just shrug and say oh we’re not all like that?
“Be careful about making blanket statements. DBT is not CBT…if it’s bad it’s most likely because of how it’s taught.”
since this post is blowing up again, I want to point out this threat? warning?
DBT is bad!
I think we should educate MIA faithful professionals on the evil behaviorism influences they teach, IRREVERENT THERAPY and its links to attack therapy, and their Holy Emporer Supreme Marsha Linehan.
DBT is terrible! Always make those blanket statements, please. It is a cult.
I think the “experts” think they can school us here and intimidate us the way they did in the environments where they held all of the power.
The arguments are ridiculous. Responding to claims of outright abuse with, “be careful not to overgeneralize” and flipping from “this is objective fact” to “”ah, well, it’s more art than science” when they are called out.
People who were abused in the mental health system are experts in how the system abuses people. I guess some people just can’t handle that objective fact.
“People who were abused in the mental health system are experts in how the system abuses people. I guess some people just can’t handle that objective fact.”
“Every major horror of history was committed in the name of altruistic motive” Ayn Rand
They think they’re good people KateL, and that the large numbers being abused are ‘outliers’.
Thank you KateL, for pointing out how the “experts” try to defend themselves by discrediting people who don’t share their views with stupid phrases like, “‘be careful not to over generalize’, and flipping from ‘this is objective fact’, to ‘ah well, it’s more art than science.’”
Did it ever occur to the “experts” that psychiatry and psychology ARE BASED on over generalizations???
When it suits the “experts” narrative they call it objective fact, and when THAT fails they haul out the old bromide, “it’s more art than science”, which simply means they don’t know what they are talking about.
KateL says, “People who were abused in the mental health system are experts in how the system abuses people. I guess some people just can handle that objective fact.”
Very true. Your statement reveals how most “mental health experts” are incapable of self-reflection.
I applaud you for your courage in speaking out and giving others a voice. I am a licensed therapist in NY and the “one size fits all” approach causes more harm than good. For me the basis of trauma therapy is connection…For the patient to feel seen, heard and understood. Without that there is little chance of healing. Thank you so much for sharing this. 🙂
And with it, it has been shown that school or type of therapy practiced is not a significant variable!
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I actually had a great experience with DBT, very little like what you described. Perhaps it was more of an issue of poor administration, which unfortunately I don’t think we’ll ever overcome as a society. Incompetence is an inescapable reality. But I wouldn’t condemn the whole technique when there ARE those who benefit from it. Should they just be left to suffer just because it doesn’t work out for everyone?
It may be of interest to know that lots of good research has shown that the relationship with the therapist is much more important than what school of therapy is being followed. I am guessing that the reason it “worked” for you and “didn’t work” for others is because your therapist extended genuine caring to you while theirs followed a “cook book” approach to DBT without recognizing the damage their lack of engagement did to their clients.
It is easy to assume that “DBT” is the same for each person who experiences it. That assumption is absolutely wrong, as the evidence here suggests.
I don’t consider “therapies” with a significant chance of traumatizing or otherwise severely harming participants a net good, no. They can help a fraction of patients and still be unacceptably risky. Unfortunately at this time we have no reliable way of predicting who will be helped vs. harmed by DBT… and I hope it gives you pause that some abuse survivors find DBT “skills” like “radical acceptance” and “benefit of the doubt” triggering or even tantamount to grooming. DBT is not the only option for help… frankly I suspect the risk/reward profile looks much better for hobbies than DBT.
DBT is as big as scam as anything else in the mental health system. A fully certified DBT therapist who I was sent to by another fully certified DBT therapist, was not in consultation the entire time I was in treatment with her. She colluded with a psychiatrist to pressure me into going inpatient for more ECT treatments even though I explained to them in no uncertain terms that the ECT I’d already had had disabled me and that the doctor who performed it, their close colleague, had said that it hadn’t worked because I was borderline. I tried to report that she wasn’t in consultation from the start. I talked to her about it. I talked to the referring fully certified DBT therapist about it. I went to the higher-ups, the DBT certification board or whatever it’s called. Apparently they don’t speak to patients. And yet they collect fees from all their therapists every year under the guise of needing these funds to ascertain whether their certified therapists are still adhering to protocol. But nobody was checking to see if this woman was in consultation or anything else she was doing. She dumped me without any notice at the end of a year of absolute hell during which she spent 85% of the sessions talking about where she was going to send me for treatment. One week she would talk about McLean another week someplace in Philadelphia. She pressured me into applying to a place called the Parents Foundation which I couldn’t afford. After I went through the entire application process I was laughed at and mocked by the admissions director because of my diagnosis. The DBT therapist hadn’t checked to see whether the people with the borderline diagnosis were welcome at the parents foundation. They were not welcome. It was a year of wasted time wasted energy and wasted money. She never missed an opportunity to blame me and shame me. She said that she was validating my shame, like that was her job. Unbelievably destructive. I’ve never recovered.
How long will it take before the people who love DBT come here and blame people who were harmed by it? I’m guessing not very long. “You didn’t try, you didn’t listen to the treatment providers, maybe you were too tough a case, they’re not perfect, did you do the homeworks? Did you learn the skills? DBT saved my life and you are not allowed to say anything bad about it. Marsha Linehan is a saint.”
Heard it all before.
I read this article this morning and became so depressed I had to close it and go do other things. But I’ve been thinking about it all day. So much so that while lying in bed tonight, I had to get up to re-visit it.
I identify with many of the infuriating stories shared about in-therapy invalidation, threats and re-traumatization. It’s especially depressing to realize that this sense of you-must-act-and-think-the-way-WE-determine-is-right-or-we’ll-fire-you is common not only in society at large where there are massive power imbalances (workers/employers, citizens/government officials…) but also in the “healing arts.” It’s just about more than I can bear to anticipate that when you’re at your weakest, overcome with effects from trauma, you’re likely to be dismissed from a healthcare relationship or gas-lit in expensive therapy your main relationship is contingent upon. That is, IF you can even afford the expensive adjunct therapy like DBT.
Worst of all, the community at large accepts this model. So, it’ll persist. THIS is what they mean when they demand you “get help.” Makes me feel much worse and alone than normal.
It is indeed gas lighting to try and make a suffering person “into” something else. And I’m not sure what that something else is anyway.
I mean heck, we could all make a pretty penny and preach to suffering people. LOL, “redirecting” the little children.
I have seen sadistic tendencies in many professions that like to control their environments and other people.
Sam says, “I have seen sadistic tendencies in many professions that like to control their environments and other people.”
“Sadistic tendencies” best describes most of the therapists I had experience with. Even worse was the awful feeling I was supplying the therapist their weekly fix of schadenfreude. It was beyond humiliating.
Labeling people with psychiatric diagnoses is morally judgmental and unconsciously sadistic. Why? Because they’re created with the idea that something is “wrong” with the person that needs to be “fixed”. In any case, “professionals” get an unconscious kick out of doing it (“diagnosing”). But stuff like “DBT” — now THAT takes their cruelty to a whole new level.
Wanna know the best way to shut up a mainstream psychiatrist or therapist? Ask them to deal with you as a human being. Works every time.
Labeling people with psychiatric diagnoses is morally judgmental and unconsciously sadistic. Why? Because they’re created the idea that something is “wrong” with the person that needs to be “fixed”.
In any case, a lot of “professionals” get an unconscious kick out of diagnosing. But stuff like DBT — now THAT takes cruelty to a whole new level.
I think labeling people with psychiatric diagnoses is morally judgmental and unconsciously sadistic, because it’s done with the belief that there’s something “wrong” with the person that needs to be “fixed”.
And with bullshit like DSM paired with something as potentially abusive as DBT, how much worse can things get for people?
In any case, I think a lot of “professionals” get a kick out of diagnosing. But stuff like DBT takes cruelty to a whole new level.
Wanna know the way I learned to shut up the psychiatrists and therapists I knew? By politely asking them to deal with me as a human being. And it worked every time, but it didn’t do much else. I think that says a lot about the “mental health industry”.
Thank you for shedding light on this. America’s system of helping people with real issues, Is to pretend they don’t exist and pass the buck. We have failed those of us who really need help. Being scared into compliance does nobody any good.
I see so many comments that say don’t challenge therapies or treatments it will discourage people from seeking assistance. The most discouraging aspect is that treatment doesn’t help and makes matters worse. The field of psychology needs to known what can be harmful and in which ways it is harmful. Those providing therapy should care, investigate and make corrections around concerns. There shouldn’t be pressure for everyone to use therapy that some find useful while others find harmful.
Everyone sees their own struggle differently. People want different things in response. So we, as a society, need to stop thinking we know what best for others and imposing our beliefs.
Well said! Most “mental illness” is in my view CAUSED by more powerful people deciding they know best and imposing their rules on those who have less power than them. I see no way that using power to enforce/attack/undermine/invalidate people can possible help them become more “mentally healthy!”
I really wish I could go back in time, armed with this information! I knew there was something wrong, my gut was telling me…but between the ECT, psych drugs, and the intense pressure to comply (which, of course, having a borderline diagnosis, the message is that if you’re not in intensive treatment, you’re just a bad person and you’re going to ruin everyone’s life), it’s so hard to see everything for what it is. Even the language, the whole concept of willingness vs willfulness…it was used to get patients to agree to things they absolutely didn’t want to do. And then of course there was “treatment interfering behavior”, which was a top target of the DBT therapists. It went suicide (suicide was the highest priority) and then treatment interfering behavior, which was considered a higher priority than self-harm, substance abuse, or quality of life issues. Treatment interfering behavior could be, “I find this outpatient therapist to be abusive. She has already done several things that hurt me including calling me malicious. She makes me come three times a week because she wants to milk me for as much money as possible, and she never gives me the same time slots. Every week it’s three appointments with whatever random time slots on whatever day she chooses according to her own schedule.”. And they would be like, “This is treatment interfering that you don’t want to continue working with your outpatient therapist when what you need to do is do a Dear Man to the therapist where you express your needs. You can work on a Dear Man in skills group. Are you willing to do that?” (And then after you deliver the Dear Man to the abusive therapist or whoever it may be, and nothing changes, then you just go to distress tolerance, radical acceptance etc).
In this way I got stuck in an abusive relationship with an outpatient therapist three different times. I wasted so much time money and energy, all because I was trying to be willing and not willful. Be a good little DBT patient. Oh the other thing was that they made me put a line on my diary card, under problem behaviors, “arguing with treatment providers”. Every day I had to say what was my urge to argue with treatment providers from 1 to 10, and star it if I actually did the behavior. And then that would get discussed in diary card review. I was still completely alone with all the same problems I had come into DBT with. They just gave me a boat load of new problems, like dealing with abusive treatment providers, and dealing with being on toxic drugs, that I didn’t have before DBT.
Wow, so it is worse to have criticisms or just a general dislike of your therapist than to be bulimic or massively depressed or be unable to go out of your house? Though I suppose the last might be “treatment interfering,” because you’d be inconveniencing someone who might have to come and get you.
This is sounding more and more insane. From what little I do know of DBT, this certainly sounds like some “interpretations” that were willfully entered into by people who just didn’t like the clients and wanted to whip them into line! How can anyone consider any of that “therapeutic?”
Yeah, therapy interfering behavior is more important than anything quality of life. In my case and in many others, there was always some treatment interfering behavior that needed to be addressed. Because treatment included whatever the psychiatrist wanted the patient to be doing (which drugs, what doses, whether they needed to go into the hospital or not, take a drug test, etc), and then of course the needs of the DBT team,… there was always something that they wanted a patient to be doing differently, and then in the IOP DBT program I attended, we were required to have an outpatient therapist. That was a huge target because there were so many terrible outpatient therapists (we had a small pool to pick from: therapists who were accepting patients, who took our insurance, which was usually Medicare or Medicaid, therapists who had an office that we were able to physically get to, therapists who were willing to take on a patient with a borderline diagnosis who’s in an IOP DBT program) but if you wanted to quit seeing them, that was therapy interfering and even if they did relent and let you stop seeing a therapist, then the discussion would immediately turn to, you need to find another therapist, have you looked for another therapist yet? It was never ending.
This is the basic rundown:
In DBT there are 3 categories of targets which are prioritized respectively: life-threatening behavior, therapy-interfering behavior, and quality-of-life-interfering behavior. Imminent and upcoming risk takes precedence for discussion over past patient behavior and urges.Oct 5, 2021
https://psychotherapyacademy.org › …
The DBT Hierarchy: Prioritizing Treatment Targets – Psychotherapy Academy
Well, there is is in black and white.
I think anyone with a truly therapeutic orientation would find this prioritization horrifying. To prioritize the needs of the therapist and/or program over the needs of the client simply reinforces all the bad “lessons” these folks have learned from teachers, parents, clergymen/women, and abusive partners or caretakers prior to showing up for DBT. It quite frankly is going to make the DBT provider into another abuser, and reinforce the very “coping mechanisms” DBT supposedly is there to help us learn how to circumvent.
It’s all coming back to me now!
There’s also a DBT core assumption, “Patients may not have caused all of their problems, but they have to solve them anyway.”. I think the belief on the part of the DBT therapists is that patients’ problems are mostly due to their ineffective coping mechanisms, their problem behaviors etc. So, if patients stop behaving in problematic ways, their problems will disappear. This is so far from the truth for so many people who wind up with that diagnosis and in DBT.
Or maybe the DBT therapists believe that the patients will be able to use distress tolerance and radical acceptance indefinitely, once they have stopped engaging in problem behaviors and their life problems have not gone away.
KateL and Steve Crea, absolutely yes!
I was diagnosed with BPD while I was a child. This field is violent..The richest, most powerful and most comfortably sadistic psychiatrists need to punch down. When these MH careered bullies aren’t mocking scared kids and battered women (the actually diagnosed borderlines), they mock any colleagues they relegate to the BPD wasteland alongside their targets. Those DBT therapist colleagues either 1) see the bullying for what it is and use their own DBT skills to not engage or 2) Conform and pass that hatred onto their clients whom the clinicians decides to blame for the clinicians low status.
Obligatory disclaimer of *not all counselors* (obviously).
Would be helpful if the truly sadistic ones, who take the step further into abject brutality, finally lose their licenses. Abusive doctors hide their misdeeds by diagnosing BPD. If you give restoration to their harmed, you guarantee mental health outcome improvement.
As it is, the mental health field refuses insight into their own condition, hence their incessant endorsement of absolution rituals via DBT.
“2) Conform and pass that hatred onto their clients whom the clinicians decides to blame for the clinicians low status.”
There’s something in the comments for me, though I find it difficult to put my finger on it.
A therapist being given the ‘crap jobs’ (the newbie in the Clinic for example), and who is failing in their ‘case load’ finds it easier to give a diagnosis of BPD (Borderline?) and have their ‘failing to respond to treatment’ clients referred for ECTs to at least extract some profit from them?
I mean I never heard the words of Borderline PD mentioned until I complained about my medical records being unlawfully released from the Private Clinic. Which when you think about it, and given the fact that this Clinic does a lot of legal medico reports for the Courts is quite a breach of the Privacy Act which would require informing ALL their ‘clients’ of the potential for ‘reputational damage’. This including sitting politicians etc………..
Or you could call it BPD and ‘treat’ the complaint right? This would also mean a little bit of “editing” on the part of the State to ensure that the breach didn’t ‘spread’ through the legal system and corrupt all the other decisions made based on compromised reports produced by the Private Clinic (in the same mannner the exposing of a lawyer acting as a paid informant for police did [Nicola Gobbo]….. that is organised criminals and murderers walking free and being compensated for their wrongful convictions).
So the States ‘confidential informant’ was unlawfully breaching the Privacy Act, and could not lawfully obtain the protections afforded such informants?
The High Court decided;
“Generally speaking, it is of the utmost importance that assurances of anonymity of the kind that were given to EF [Gobbo] are honoured. If they were not, informers could not be protected and persons would be unwilling to provide information to the police which may assist in the prosecution of offenders. That is why police informer anonymity is ordinarily protected by public interest immunity. But where, as here, the agency of police informer has been so abused as to corrupt the criminal justice system, there arises a greater public interest in disclosure to which the public interest in informer anonymity must yield.
EF’s actions in purporting to act as counsel for the Convicted Persons while covertly informing against them were fundamental and appalling breaches of EF’s obligations as counsel to her clients and of EF’s duties to the court. Likewise, Victoria Police were guilty of reprehensible conduct in knowingly encouraging EF to do as she did and were involved in sanctioning atrocious breaches of the sworn duty of every police officer to discharge all duties imposed on them faithfully and according to law without favour or affection, malice or ill-will. As a result, the prosecution of each Convicted Person was corrupted in a manner which debased fundamental premises of the criminal justice system.”
The ‘public interest immunity’ in my instance has also corrupted ALL of the decisions made by the courts in regards the reports produced by the Private Clinic. How many files have been compromised? And we are to believe the claim by the clinic psychologist that she doesn’t do it often? I suppose what the clients don’t know, can’t hurt them right? Or they won’t know until after the ‘reputational damage’ has been done?
So a Private Clinic psychologist (with a Masters degree) is releasing confidential information from files held under the Federal Privacy Act is claiming ‘public interest immunity’ as a ‘confidential informant’? So the people placing their trust and confidence in the Private Clinic for reports for the courts are simply not aware their medical records are being handed around with ‘immunity’?
It is my firm belief that their is a greater public interest in disclosure as a direct result of the methods employed to corrupt and pervert the course of justice in these matters. And the High Court, it would appear, agrees with me.
“Treatment interfering behavior” – yikes! Service users should have the right (and perhaps even be encouraged) to remove themselves from harmful situations, always! Sounds like DBT is yet another “therapy” geared towards creating perpetual patients rather than facilitating recovery. Who wants the “skills” to stay miserable indefinitely? I loathe how psychiatry and psychology distract from social problems by blaming marginalized people for reacting to their circumstances. Imagine how much service users could improve their lives by prioritizing their quality of life instead of expending their precious energy on DBT exercises…
“Arguing with treatment providers” was problems behavior? Give me a break. Isn’t this DBT supposed to teach you how to effectively disagree with people, and help come to some mutual understanding. Sounds like your treatment providers could use DBT themselves. They can’t handle someone arguing with them or in an appropriate, and effective way. Maybe they should write out a dear man talking about how your arguing was personally impacting them.
These experiences are terrible. I am a DBT therapist. I am horrified that other DBT therapists would teach or pervert things in such a way as to make people feel so bad.
In my practice, I go out of the way to be critical of everything we talked about skills wise and encourage people that we are looking for effectiveness of behavior through a lens of always valid emotional responses. I also challenge the idea of borderline personality disorder in general. My understanding of the social emotional theory aspect of DBT is that it is part of our mission as DBT therapists to challenge it and normalize the behaviors associated with it as reasonable responses to traumatic events. I hate the idea that this stigmatized diagnosis is still used to hurt people seeking help as well.
This article has also encouraged me to be more critical and reflective of my own practice. It is something that I will also be sharing with my own skills group members. My understanding of DBT is that it is meant to use validation, acceptance, and love to help us heal while changing things in our lives for the better. That must involve being critical of things anyone says to us from ourselves to the terrible people who’s have hurt us as well as everyone in between. I hope that this article helps to spur some reflection by other providers and people in treatment.
BPD was invented by a man for women. Period.
The “therapy” reeks of pompousness.
Absolutely. I hope DBT therapists start to understand this. Kind of ridiculous that our experiences are so shocking.
This type of lived experience seems to be common:
Psych doctor asks patient on a date, patient is obviously uncomfortable and rejects them. Psych doctor diagnoses them with BPD. Any inquiry into psych’s behavior is dismissed via stigma about “that population”. This usually shuts down official inquiry. If the patient confronts the psych doctor, psych doctor then claims to have acted ethically and appropriately. They do this by citing currently practiced and clearly abusive forms of therapy against BPD like ‘irreverent therapy’ (sometimes done with DBT and is the precursor to the TTI’s attack therapy). they may then continue to DARVO by recommending male gaze-ridden scientific literature on BPD by misogynist psychiatrists. Nothing is stopping them from claiming the patient is ‘a risk to themselves or others’ so they may have their patient commited too. Plus, everyone knows that this population is (whatever convenient insult fits) so no real risk to this psych doctor’s career for any of this.
If the doctor decides to harm their client, the BPD dx is their weapon of choice.
Psych researchers and therapists need to investigate their field. As of now, the ranks of psych survivors are increasing because therapists may feel shocked by their colleagues, but they make no move to rectify the situation. There is a preferable solution to feeling horrified and that is to not license bad apples and to forge a genuine regulatory body. that whole “we investigated ourselves and found no wrongdoing” doesn’t work
“Any inquiry into psych’s behavior is dismissed via stigma about “that population”.”
When asked about a report into the claim that nearly 50% of the women who had been hospitalised over the previous year had been sexually assaulted, our Minister for Mental Health stated in Parliament…..”You can’t listen to them, they’re mental patients”.
I can’t think of better documented proof of what your saying that the Parliamentary Hansards.
Oh absolutely Boans! wow. The mental health system always tells on itself. They are so big, so proud and getting sick of winning.
The behemoth’s strongest remaining scaffolding is that the comfortable believe in it. They think psych survivors are others, unfortunate, to blame for their disability.. but the MH System is expanding services! Everyone gets access to the bs!
When the majority of the people are scared to become one of “them” , then we will get reform real quick. no effort needed, they’ll finally fix their mess.
Guess it shows how almost anything can be twisted into something oppressive (TMS, microdosing, and other things coming your way).
I’ve even heard it’s started to happen with trauma-informed therapies, which is unfortunate.
Wow! Sorry your experience was so disappointing. For me, DBT Therapy has helped me break through over 60 years of “feeling” less than others – not by invalidating my experiences/perspectives (as this writer seems to imply) – but opening my eyes to the simple fact that I, alone, feel/think/experience MY own life – and I don’t need others to agree or disagree with my perspective(s) to make them valid. It’s a very powerful shift!
Sorry, I didn’t read the entire article.
Once I got tot the feeling of… “I’ll give you something to cry about!”
Who are these therapists? I’m a therapist and I don’t abandon clients. If I feel that a client’s symptoms are beyond my skill level, I’m honest with them and explain why I am not able to give them effective assistance. When I refer to other therapists or higher level of care, it is with the understanding they can return if they’re incompatible with that provider. I’ve had this happen many times over my career and I think it’s important that clients have a sense of security with their treating therapist. Also, all of the therapists I know are trained in many different modalities. I am trained in emdr, CBT,exposure therapy and prolonged exposure for trauma, and motivational interviewing. One approach doesn’t work with all clients and a well-prepared therapist should have numerous tools.
You sound like the kind of therapist someone would be more likely to benefit from seeing, and you clearly travel in such circles. I had a great therapist way back in my 20s. I know it can really help. But you can also see that many people do not have that experience. I believe the newest crop of therapists are trained much less in meeting the client where they’re at and much more in DSM diagnosis and brain chemistry and brain scans and a lot of pseudoscientific “facts” that get in the way of the real deal in therapy, which is getting to know and respond to your client as a unique individual rather than a collection of brain cells.
“Who are these therapists?”
Is this a real question, or rhetorical? I ask because I tried to report a therapist via “appropriate channels”, including the patient relations dept of the hospital that ran the IOP DBT program and also through the DBT committee for certification, and I couldn’t get anyone to listen or take me seriously.
There is no oversight of this profession. The profession “polices” itself, and does a terrible job of it, allowing abusive therapists to continue harmful practices.
“I couldn’t get anyone to listen or take me seriously.
There is no oversight of this profession. The profession “polices” itself, and does a terrible job of it, allowing abusive therapists to continue harmful practices.”
Yeah, that’s what I thought until I saw the photo of the guy on the front page of the newspaper because he had been eaten by a Great White shark. Waaaahahaha they ‘perfumed’ his wet suit (with blood) and got him to go snorkelling with a Great White? Okay, so there was a little bit of setting up, but in the end it was Gods will. The look in his eyes, when he realised we had known all along what he had been up to.
Trauma informed programs are few and far between. I had early childhood problems, a hellish home, abandonment. It colored my whole life. I was kicked out of daycares as a problematic toddler. Seriously. And it didn’t get much better. Imagine telling a toddler their behavior is shameful.
Learning about the 4 Fs, fighting the past in the present, even understanding why my selfishness was a survival mechanism opened doors. I’m healthier than ever.
I had a PTSD reaction so bad it appeared as a bipolar manic episode. In fact my php psychoanalyst told me narcissistic rage is rooted in trauma.
My behavior was problematic but it was revolutionizing to have someone tell me why I was the way I was.
Moreover what I really needed was to reinhabit my body. And to learn what bodily safety feels like. For too often we focus on the mind. Polyvagal theory has been incredibly helpful in this regard. Now it’s a little bit easier for me to socialize and be myself.
Removed for moderation.
id encourage everyone to read the critics of the therapy research and realise its not evidenced based at all – sad to read a therapist on here waffling about ‘neuroscience-informed model’ all sounds so scientific and so settled when its simply self serving waffle.
These resources might help
Read all of David Smail’s books – they are older but still very relevant – why therapy doesn’t work, The origins of unhappiness, Power interest and Psychology etc
Read all of William M Epstein’s books – they can be expensive but do come on sale occasionally, The Illusion of Psychotherapy, Psychotherapy as religion, Psychotherapy and the social clinical etc.
The Therapy Industry by Paul Maloney
This article reminds me of the counselor who reacted to my revelation of abuse by telling me I needed IOP, and when I declined, he fired me from his practice and then yelled, “I’m not abandoning you!!!” I’m frightened by the prevalence of invalidating and referral-hungry practitioners. Seems like the subtext from many therapists is, “Remake yourself in my image or be destroyed.” I’m not interested in lessons to become a better abuse object by practicing “radical acceptance” and frankly find the whole concept disgusting.
Another skill that I was told I needed to use more of in DBT, in addition to radical acceptance (of the abuse I’d been subjected to in “mental health treatment”) was “benefit of the doubt”. As in, “put aside your paranoid ideas about this therapist / psychiatrist, and tell yourself that they are only there to help you, they will never hurt you, and if by chance they hurt you, it was not their intention.”. Giving the benefit of the doubt to these people was one of the biggest mistakes I ever made, and I made it repeatedly because pretty much everyone around me was brainwashed/brainwashing me into believing that this was help.
Wow, they SERIOUSLY tell you this nonsense? I’d think they’d maybe teach you the skill of “how to tell whom you can really trust” rather than “give everyone the benefit of the doubt.” How many abuse victims got that way partly BECAUSE they gave someone the benefit of a doubt whom they should not have?
I am finding that particular “skill” kind of disturbing!!
Very disturbing, and looking back, every time I was pushed to give the benefit of the doubt, my gut instinct had been right:. My mind / intuition was trying to protect me but DBT said, no, you’re being paranoid, you need to trust your treatment providers if you want to get well. I was even asked by one DBT therapist during one of these conversations, “do you want to wind up completely alone?”. The message being, my inability to trust people, my “paranoia”, was going to lead to me being completely alone. Actually I did wind up completely alone but more because of psychiatry-induced damage than my non trusting nature.
I wrote a book about how to avoid abusive partners early on in the dating process (“Jerk Radar”). The last chapter, and in many ways the most important chapter, is called “Trust your gut.” It goes into how abusive people give off a ‘vibe’ or engage in certain behavior that raises one’s hackles, as it were, or sets of alarms intuitively. Little kids tend to go by these “gut level” assessments consistently, but I talk about how we are trained as kids by adults to not believe ourselves, and eventually stop believing our very accurate perceptions of reality. “Uncle Eddie is just being friendly, dear, they kiss on the mouth in his family” or “Don’t say such things about your grandfather, show respect for your elders!” or “Oh, Johnnie, your teacher doesn’t HATE you, they’re just trying to teach you some DISCIPLINE!” The ‘gut level’ instinct is trained out of most of us rather systematically, and this makes us extremely vulnerable to predatory people. Almost all of us need to find ways to re-learn how to listen to and respect our intuitive warning flags.
Of course, those subjected to abuse by caretakers have this sense utterly trampled in most cases. Up is down, in is out, love is hurting, you love me means I have to take care of you, and on and on. Your perception of reality is brutally attacked at every turn in the road. Is it surprising that a person subjected to such atrocities would have some difficulty knowing whom to trust? Why would you tell them to explain away their considerations by a call to “be reasonable” or “understand the others’ point of view?”
Clearly, the most helpful thing for such a person is to a) acknowledge that their sense of trust has been systematically violated and that difficulties with trust would be totally normal under the circumstances, and b) help the person to re-learn how to trust and act on their own gut-level instinct that has so thoroughly been invalidated, so that they learn that while not everyone is untrustworthy, it makes good sense to keep one’s boundaries up and to listen to and respect our intuition.
The idea of teaching such a person to automatically “give the benefit of the doubt” is quite outrageous. It’s the very last thing in the entire world you’d want to teach them!
Being left alone sounds like a refreshing and healing alternative to psychiatry! So sorry to hear you were harmed 🙁
I am a bit confused by people’s comments regarding DBT. I had been in every type of therapy, even having ECT’S administered to me on and off since I was 7 years old. I will be 61 and have the most amazing DBT Therapist now. I fought against this type of therapy for 10 years. I am now VERY thankful for it. January 11, 2021, I was on an overpass ready to jump. A good Samaritan called the cops; they saved my life. Seriously? I have no idea where I would be without this type of therapy. I am extremely grateful.
You have an amazing DBT THERAPIST. There is excellent evidence that the quality of the relationship between client and therapist is more important than the school of therapy practiced. It is great that you found the right therapist taking the right approach with you. But I can tell you, after years of experience as a professional in the mental health industry, that not all therapists are capable of doing what needs to be done for people with traumatic pasts, and reading these stories should give you an idea that simply saying “I do DBT” does nothing to guarantee a positive experience, or even a neutral one.
The therapist’s ability to connect and create a safe space is more an art than a science, and you simply can not learn that ability by reading and abiding by a workbook. It’s MUCH more complicated than that, but the therapist/client relationship is at the core of quality therapy, regardless of the “brand” of therapy practiced.
Good for you for finding the right fit and getting yourself on a new path!
“Clearly, the most helpful thing for such a person is to a) acknowledge that their sense of trust has been systematically violated and that difficulties with trust would be totally normal under the circumstances, and b) help the person to re-learn how to trust and act on their own gut-level instinct that has so thoroughly been invalidated, so that they learn that while not everyone is untrustworthy, it makes good sense to keep one’s boundaries up and to listen to and respect our intuition.
The idea of teaching such a person to automatically “give the benefit of the doubt” is quite outrageous. It’s the very last thing in the entire world you’d want to teach them!”
Valuable information Steve. And dare I say that it may just be that there is misunderstanding about what it means to ‘give the benefit of the doubt’. Where you say there is a need to learn how to trust with their own gut level instinct, that can’t be done without first trusting in some small way. And sure the radars are all finely tuned to set off a reaction that will result in withdrawal from social situations etc…… I’m thinking of Seligmans dogs here, who were trained to be ‘learned helpless’ and then needed to be ‘forced’ to see that the floor was no longer electrified. What if the use of force then becomes the reinforcer for the helplessness?
I know in my situation the knowledge of such ‘psychology’ was deliberately used to cause harm…… yeah yeah, “they wouldn’t do that’, they’re doctors”. Of course they would do that to avoid going to prison.
Point being your right in what your saying, and it is much more of an art form. Shame I couldn’t find someone such as yourself in this shithole where I live. Even the Army psychologist who trains people in the art of torture (though keep it between you and me) couldn’t put Humpty together again.
You are right, re-learning who can be trusted does require trusting someone for at least a period of time to find out if it will work. The key is figuring out WHOM to try it with. There are ways to gauge trustworthiness with some level of accuracy, and this CAN be taught to a willing student. But of course, the person playing the “helper” role has to be the first one trusted, and that can take some time and mean dealing with some hostility and other emotions. At least that’s my experience. But to keep in mind who is behind this and that it’s all about trust to start with can help me be patient with the process. Sometimes the FIRST level of trust is to say out loud, “I know you probably don’t trust me, and I don’t blame you for that.”
I guess the ‘problem’ can change significantly if and when the person does come to trust you? I would imagine from my limited experience that it becomes like a life raft where you can at least take a break and get some breath. And you tend to return to the well where the water is good.
I know also from experience that the psychologist who ‘turned’ on me and started asking questions for police (“Who else has got the documents?” and the bold faced lie [“it never happened”] that police hadn’t tried to make a referral when I turned up with the proof they thought had been retrieved). Needing to steal my laptop to find out who else I had been communicating with and who may have figured out what was actually done, rather than the “edited” version of events presented to the Law Centre to slander me with.
I could see he was torn between his duty to his patient, and the police who were threatening his family to have him get the information they wanted, so they could ‘bury’ the truth surrounding my torture and kidnaping by their fellow officers.
And the poor psychologist knowing I had already reported to the corruption watchdog, and had spoken for an hour and a half with a Member of Parliament, and that in all likelihood they were watching to see where police ran with what was now THEIR little problem.
Still, it’s a dog act to breach the trust of someone you had originally helped with their trust issues. And I get it that he tried to have me referred to a police ‘friendly’ psychiatrist, and left an ‘escape route’ for me. Which I took, or I wouldn’t be writing this …. or maybe someone without the stomach for it would have ‘intervened’ again?
I still laugh about the look on the face of the doctor who was about to inject me in the E.D. when he was rudely interrupted. It reminded me of the look on Wiley Coyotes face just before the 100Lb Anvil dropped on his head lol
And I have no doubt the psychologist thought I was mad…… until the police started threatening him, and he possibly realised I had been speaking the truth the whole time. Not unlike the lawyer “I thought you were mad, but you’ve got the proof”. First to turn on their colleagues gets the best deal from the prosecutors.
Kudos to him for getting me to the point where I could face Goliath and hit him between the eyes. Shame he tried to hold him up when he started to fall.
“Your information is strictly confidential”. Yeah right, until police start making threats, or the Operations Manager wants to fucking destroy you, then you’ll find your ‘personal information’ becomes public knowledge fairly easily. So careful what you tell these people, beyond what they fabricate about you, or torture you into ‘confessing’.
And consider, a Social Worker had documented some highly sensitive information about me some 10 years earlier, all in good faith. However, it was fairly easy for the Operations Manager to weaponise that information (after digging for dirt with which to carry out her overt threat to fucking destroy me and my family), and use it in the “editing” of the documents for the Law Centre. Complaining now means your most personal information is being handed around ….. like poisoning yourself. She seemed like such a nice lady too, for such a vicious cant say that on MiA
This reminded me of me being told byt he psychologist who conspired with my wife, about my complaining regarding being drugged without my knowledge, tortured and kidnapped, that I wasn’t being “morally relative”.
Morally relative? Is that like when a rapists says, ‘well I thought eventually you’d like it, and it isn’t my fault you didn’t’?
Glad to hear that the Chief Psychiatrist can’t ACTUALLY remove the legal protections afforded the community in that area of law……… or can he? The removal of the Criteria from the Mental Health Act an act of gross negligence, and the only means to make what were crimes, into ‘medicine’. Quite clever, and I’m sure such vicious psychological attacks on people who have already been harmed are in many cases quite effective.
The ability of the State to deny citizens access to legal representation can be demonstrated (democracy?), and the letter showing this significant power of our Great Protector is there for all to see……. if only someone would actually look. Then again, not a lot of people looked at the photos of the physical damage done to those kids who were being repeatedly raped in institutions for 40 years either.
Where were the journalists and ‘the public interest’ then?
Can you imagine applying any of those DBT tenants outside of DBT?
If you get in a fender bender, have to deal with the police and insurance agencies, do you do a DEAR MAN? no, because the police would think you were drunk .
those DEARMAN instructives do not work in any practical setting. They never work when you’re begging the system for a morsel of dignity. My years of DBT “training”, First in the troubled teen industry, then at the neighborhood DBT clinic, then in adult rtc’s did not help me or my situation. Not because I was too difficult, but because DBT’s social programming is incompatible with life success
Just one example: If you remove context of BPD stigma, how would their “may not have caused all your problems…” slogan look?
“Escaped child soldiers may not have caused all their problems, but they’re responsible for fixing them.”
“Starving shipwrecked castaways may not have caused all their problems but they’re responsible for fixing them.”
This would be ridiculous and if anyone said this, they would be seen as a jerk. DBT therapists get the pass because they stigmatize their “patient population”.
The nooks and crannies directly outside of the mainstream system are as perilous as any other human rights abuses, hence the near ubiquitous use of DBT in institutions. While you’re there, you have to know as a SMI patient: “my fault. my fault”
To the providers here: if the treatment modality is authoritarian, it will be used in authoritarian settings to force compliance. I don’t know the disconnect in understanding unchecked power. The MH field has unchecked power and it is corrupting.
Wow, those are really excellent examples!
Thanks Steve! I’m liking this forum and glad I took the plunge and started commenting.
We as a society are not okay with any acknowledgement that people suffer.
To say you were abused and now feel angry and hopeless and afraid- that’s not ok.
But to say you were abused and then developed a completely unrelated, lifelong biological mental illness- that’s somehow correct? and logical?
that social paradigm screws with your psyche in and of itself. no antipsychotic damage even needed, but the skinner-esque social programming, pharmaceutical “medications” and dangerous unproven treatments really sell the scam
Quite so! Biological causes are popular because “no one’s to blame!” (Except the poor client, but really not, because it’s not YOU, it’s your DISORDER that’s at fault!) The idea of social causation might mean someone has to DO something, to alter their own behavior or the structure of our institutions, and that is just TOO HARD! So let’s all blame the brain, whether or not it makes sense, because it makes us all FEEL less responsible! (Except the client, of course…)
Anotherone, Thanks for speaking out. You explain the problems well. Society needs to deal in truth. That’s what you’re telling.
Thank you Christine. I loved your explanation of DBT and the acknowledgement that its design may benefit or harm people. I agree with your assessment and appreciated your understanding of the divide
Thank you, Squid (I couldn’t find where to reply to your comment to me). Yes, you make a good point! I need to remind myself of this when I start feeling like being alone is the worst thing in the world. It’s way better than a psych ward or IOP! And, if I get very lonely, I can always take a walk outside.
Thanks for this, very humbling.
I want to write a proper comment, but I’ll spend way too long obsessing over how to write it, so…
1. Marsha Linehan came from privilege. She did not experience the hardship that many folks who are referred to DBT have faced (and often continue to face while in treatment). Someone laid it out here: https://empathyinthecontextofphilosophy.com/2020/05/10/saint-linehan-marsha-linehan-dishes-on-what-she-had-to-survive-to-innovate-her-way-to-dbt/
2. The emphasis on doing things the way Saint Marsha wants them done, and seeking her approval, is disturbing to me. The Marsha worship is gross in general. It’s bordering on a cult.
3. DBT, by the book, doesn’t provide space or accommodations for people who experience executive dysfunction, have learning disabilities, etc. The skills can be useful but the program rarely is.
Agree on all 3 points!
Indeed, dismissing and denying child abuse has been the primary business of psychology, since Freud’s day.
And I know, first hand, that when one tells a psychiatrist that the medical evidence of the abuse of one’s small child was handed over. The psychiatrist thinks the healing child abuse survivor should be neurotoxic poisoned … this is a systemic problem, and this systemic child abuse covering up is by DSM design.
DBT will bite you.
There was a time 25 years ago I thought I needed “help”…to be the kind of person that is the way we are supposed to be.
So I saw an ad in a newspaper and thought yep, that sounds like a great course.
I called but they said I needed a referral. So I asked my physician to refer me, and she asked why.
I thought it a good idea, so she referred me.
I showed up for a few “lessons” and the shrink everyone saw once per month offered me “antipsychotics”. I declined since that word scared the crap out of me…On a break, I heard all the other women were on “antipsychotics”.
In one session, a mild mannered woman tried to get a word in, but was not heard, so I made the “boss’ aware of it. She asked me to leave the room, since I had interfeered.
I waited outside until “group” was over and I spoke to her.
I found out later that she had told her “boss” that she felt threatened by me.
Interesting, because I guess we could name that sensitivity a disorder.
Needless to say I left, never to return.
7 years ago I became ill, a doc dug around my old medical records and alluded to the fact I had attended this garbage.
He never said how I got there, he never said how long. Nope, he just wanted to plant a seed.
I was then treated with the exact “STIGMA”, that they preach the public should not treat others with.
No it’s not “STIGMA”, it’s a witch hunt that becomes convenient when chronic illness is a pain in the butt for docs.
I think it’s a horrible practice to do to people and I don’t care if you’re a NICE therapist or someone that was helped.
The whole thing is a lie. I have friends with these labels. It is a lie.
Ok so I did DBT as a client and I teach DBT skills online. I hate the DBT industry. The board of certification is messed up. It is HUGELY expensive to get “certified” as an “official” DBT therapist (an obstacle to oppressed folks of all identities) and you have to follow the book and the rules to a T. So, many DBT clinics are run by white people in wealthy areas. Additionally, in order to train as an official DBT therapist you have to take a massive pay cut in exchange for your (fully DBT complying) clinic paying for your training – another way it’s prohibitive to people of color and other oppressed identities.
Also, DBT does not reasonably accommodate neurodivergence. That’s a whole other convo.
I think its original goal is great. Give chronically suicidal people the tools to build a life we actually want to live and keep us out of hospitals where further trauma can occur. But DBT has since become a cure-all. They send all sorts of people into official DBT programs, which are inaccessible (expensive and hard to find) and clog the long waitlists for folks who are literally suicidal.
Also, “safety contracts” have gone out of fashion and are now recognized as abusive by many providers. And yet many DBT clinics continue to use them. Harm reduction is built into the original DBT and yet few DBT therapists practice that way anymore. They’re more scared of being sued and quite honestly, of folks with BPD (ironic, huh).
What’s also ironic is that DBT is literally built on dialectics – two things can be true at the same time. And yet the rules and therapists are so black and white about DBT. It makes no sense. DBT ought to be compassionate with structure and skills training for suicidal folks to build their life worth living. It’s not “coping skills lite” for everyone in life.
TL;DR – DBT has gotten far away from its useful original purpose and is now just coping skills for anyone with an obstacle.
My short response? It has saved my life.
I did a year long Linehan certified DBT program 6 years ago when I was 17, and have very mixed feelings about it. On the one hand, when performed correctly, DBT does what it’s advertised to do which is that it reduces self-harm, suicide attempts and ER visits. I did not attempt suicide for four years after I completed the program and I only self-harmed 3 times within that same period. However, my quality of life was not significantly improved and I was still having suicidal thoughts. It made me feel hopeless that the one therapy that was supposed to help me didn’t completely work. It wasn’t until I started working with a psychology grad student at my college that I realized that the reason I still felt miserable was because I hadn’t addressed my childhood trauma.
DBT is essentially a band aid treatment. You can keep using skills every time you are in a crisis, but until you get to the source of the problem, which for many people is trauma, you are just doing damage control. Another issue that I had with DBT is that my individual therapist was rigid and inflexible. She made it seem like I wasn’t even allowed to cry without using a DBT skill to calm down, and I can’t even count the amount of times she hung up on me during phone coaching. I understand that therapists need to set boundaries but she made me feel like I had the plague and needed to keep as much distance from me as possible. It’s also frustrating that even after you complete a DBT program, regular therapists still won’t accept you as a client if you have a diagnosis of BPD.
I am so sorry that all of you had such horrible experiences with DBT. While my DBT experience wasn’t horrible I did experience a lot of the same problematic treatment in residential treatment centers and therapeutic boarding schools. Everyone deserves compassionate and empathetic care, and not to be degraded and treated as something that needs to be controlled. I’m sorry this comment is so long, I have been thinking about this issue for years and stumbled across this article that literally describes all the thoughts I’ve been having, so I got kind of carried away.
You had a horrible therapist. They are not supposed to hang up on you and not allow you to feel. I had a trauma therapist like this and he did more damage than good. I have a dbt therapist that has made all the difference for me. I’m sorry you had a bad experience.
It’s striking to me the degree of separation in how people are impacted by DBT. Some saying it was very abusive and damaging and others saying it saved their life. I haven’t been in DBT therapy but I’ve read about the model. Some says that the difference in impact is a matter of the therapist administrating the therapy. Although I’m sure the therapist’s viewpoint and characteristics have an impact, I think the model itself would lead to different outcomes for different people. I, personally, would be among the people upset by it. But I can see where someone else who’s looking to deal with their struggle a different way than I was, could find it helpful. I was trying to work through all the emotion, thoughts, unresolved issues. I suspect a lot people would feel that there’s too much baggage to possibly work through it all, they are unsure of where it all came from and therefore it doesn’t make sense to try to work through it all. I can see in their view it makes sense to do mindfulness, coping strategies, acceptance. But for me, I knew where my struggle came from and although it was too much to work through, it was also too much too bury and have any kind of life I would want to live. Although there were days where I though I couldn’t deal with anymore, I never considered possible ways to kill myself because that would hurt people I really didn’t want to hurt. However, the day I move toward acceptance over recovery would be the day I started looking for ways to kill myself. So I think if I went to DBT that would increase the possibility of suicide for me. I think when a service user doesn’t want to engage in a particular therapy there’s often a reason that the service user knows that the therapist doesn’t. Services users themselves know the most about their struggle, what will help and what will upset. So it’s not that I think DBT shouldn’t exist. It’s that I think there shouldn’t be any pressure to engage in it.
In my case, when I landed in DBT at age 40 after being disabled by ECT, which happened after I was called treatment resistant, I was told I had treatment resistant depression because I hadn’t responded to years of drugging with SSRIs, Klonopin and then Adderall. The doctor just said to me, “you have borderline personality disorder. That’s why the ECT didn’t work. You need dialectical behavior therapy.”
When I wound up in DBT, at that point I had a 16-year-old son, there was tons and tons of damage, tons of incredible trauma. When I was a teenager and my problems in living first appeared, they were completely ignored and I was treated like a spoiled brat. I made a serious suicide attempt at age 19 and beyond having my stomach pumped and tubes stuck in me, it was completely ignored. I begged and begged and begged for help and only was met with abuse. They just considered me as someone spoiled who was looking for attention even though the family history showed very clearly that there was something extremely wrong.
And then when I started DBT at age 40 they were very adamant about their belief that the past didn’t matter, that they are not going to talk about the past. They said you only have to learn skills and you will recover. They said, you might decide later on that you want trauma therapy but you do that on your own. That’s not what DBT is about.
Now most of the DBT programs have a trauma component but I was denied entry to the trauma program. I fully believe this is because they considered me a failure. And of course they didn’t take into account all the abuse I experienced as a patient while in the DBT program.
Now I’m 56 years old, have no family, a son who I am completely out of contact with except for the occasions when he decides to text me and remind me what a horrible useless person I am. I haven’t worked in years.. I don’t even have an emergency contact. I really don’t have any options beyond get through one day to the next completely on my own. I can’t even approach anyone representing the system, like a an internist or something, because they won’t believe me and will just tell me to do more treatment. I had to stop seeing the most recent internist because she wanted me to look for an internal family systems therapist and ketamine clinic that I would pay out of pocket for. I can barely pay my rent.
The DBT therapists I saw made multiple statements that I was too much, that I was failing, that they were in over their head with me. One of them asked me, “do you want to keep going around in circles?” Like it was all my fault. Like the system doesn’t lead people in circles. That was the same therapist who asked me if I wanted to wind up completely alone because I wouldn’t give the benefit of the doubt to an abusive therapist.
I don’t know what they expected honestly. They live in a fantasy world and get angry when you try to wake them up. Then they start threatening ECT. That was my experience.
So sorry to hear about your awful experience, KateL… it’s certainly aligned with my experiences with “mental health” providers as well, in the sense that providers can refuse to adjust their assumptions to reality and instead try to force the service user to meet their assumptions (which, all too often, involves invalidating our lived experiences and threatening us with dangerous “treatments”). Sadly I don’t see these issues going away until the public recognizes DSM labels for what they are: hypotheses attached to patients by biased providers. The doctor/patient power imbalance in psychiatry isn’t supported by the scientific findings nor by psychiatry’s awful track record, and it needs to end.
Thank you, Squid. I agree, drastic change is needed. It’s hard to find hope that things will improve, even when there’s so much clear cut evidence that many people are being badly harmed instead of helped.
Me too, Kate. I am so sorry about the horror that you have been through.
I was in a comparable situation for some time a couple of years ago.
I remember that at one point I tried out a support group that was not really helpful over all but where one person said something very interesting to me. When I described that I had tried out everything that I had found out as possibly helpful but that I hadn’t found support nowhere but I was harmed everytime when I didn’t ran away fast enough he suggested that I acknowledge my situation. He repeated word by word how I described my situation and thus it became okay, it became normal. I don’t know whether he knew such a situation from his own experience or why he could relate but after he had acknowledged it something in me shifted. I could accept that my situation was like that and would maybe stay like that for some time and that then things would change at some point because nothing stands still. Everything evolves by itself and a new opportunity comes up. Either because of your doing or maybe from somewhere else.
I realised back then that in my country there was a collective belief that there was easily accesible help in whatever situation you were and that it was only necessary to admit to yourself that you needed help and ask for help and you would find valuable support.
I think that the day after this conversation I realised that this collective belief was just not true. That it was an illusion that had to do with how people wanted to see the governmental (I live in Europe) social and medical support systems and not what they really were.
I saw your comment a few days ago under Karin and Marnie’s Blog where you already wrote that you don’t know where to turn for support. I listed a couple of resources that I have found or still find helpful in a comparable situation that you maybe find interesting to try out. They are all either for free or you can apply for sholarships.
Thank you, Lina. I can’t remember if I replied to you under the other article. I’ll look into the resources you linked. What you describe in your country — the sort of agreed-upon idea that help is available to those who seek it — has been true for a long while in the US also. I track it to the 1980s, not so coincidentally, the decade that Prozac and the other SSRIs along with the atypical antipsychotics and some other psych drugs came onto the market. All of the sudden there was all this messaging, “if you need help, don’t be afraid to ask for help. If you feel suicidal or depressed or anxious, reach out. You’re not alone.” That sort of thing. Looking back armed with the knowledge of how money and power were basically dictating everything about the mental health system and how it operated, I think this messaging was probably funded by the pharmaceutical companies. It makes sense that they would promote this messaging along with this idea that “mental illness is due to a chemical imbalance and there are medications to fix it” was all a very clever scheme to sell their drugs, while keeping Psychiatry relevant and not just something that happened in Woody Allen movies.. Because even a few years earlier, when I was still in high school, there was no talk like that. Suicide and mental health problems were things that you didn’t talk about.
I think I understand what you mean about acknowledging the situation. The toughest part of it for me is that I passed on the trauma that I had experienced to my child, who is now in his 30s and is in so much pain and so angry at me. I don’t blame him. He said to me, “I would never inflict this on a child”. I would do anything to go back and change it but of course it’s not possible, so I will have to find a way to try to accept it.
Thank you for the resources.
I’m in agree with both Squid and Katel. I think what Katel describes in the norm. It’s especially true with teenagers that the focus is on change in behavior through discipline with a disregard for the life experiences. Suicide attempts or self harm are just “attention seeking” in some programs. It’s treating any pain with indifference. Something I would say abusers do. I know Mad In America formed to bring attention to misinformation and harm around the Medical Model. However, I glad there is also concerns around therapy discussed. The medical model is a very serious issue but definitely not the only issue.
‘The Best Tool We Have’ for Self-Harming and Suicidal Teens https://nyti.ms/3CxJeSQ
Well, the paper of record loves DBT. Of course they do. And they still call psych drugs “medications.”
This whole article talks about DBT for suicidal teenagers. Says nothing about, say a middle-aged woman whose pain was mocked invalidated and ignored by the system for 30 years and who only wound up in DBT after getting a borderline diagnosis because she failed to improve after ECT treatments (“You have borderline personality disorder. That’s why the ECT didn’t work. You need dialectical behavior therapy.”)
I remember sitting in DBT group at the IOP. I was definitely not the oldest woman in the group. Women who were in their 50s and 60s, closer to the age that I am now, were often extremely resistant. I didn’t understand it, but I do now. DBT wants to treat everyone like a teenager. They want to pretend that it’s possible for everyone to have a life worth living (“It’s not too late!”)
And then they blame people whose lives are in shambles — likely were not only abused as children but then abused for decades by a broken and brutal system, and often passed on that trauma to their own children — for not working hard enough on the skills, for being untrusting, for being unwilling. It’s bad enough telling a teenager that you’re not going to address the past, that the past is irrelevant, that they just need to learn skills and focus on the moment. It’s something else to tell that to someone who’s been through decades of hell.
But the New York Times is obviously not interested in anything except “studies show” how more DBT is desperately needed, more psychiatrists are desperately needed.
Quote from a DBT proponent under this article:
This Teen Was Prescribed 10 Psychiatric Drugs. She’s Not Alone. https://nyti.ms/3CS0oef
Please consider Borderline Personality Disorder (BPD) which is often misdiagnosed for other disorders including Bipolar. Medication has not been proven to be effective in that disorder and can lead to polypharmacy as they don’t respond. DBT is the most proven therapy. Some of these teens have features of BPD during puberty and would be helped more by a validating environment and skills training that DBT promotes”
Marketing DBT as though the therapists don’t push psych drugs and ECT. When I was in. DBT, the diary card had a line, under problem behaviors, “urge to skip medication “. That was a top tier, second only to suicide, problem behavior as it was considered treatment interfering. The group I was in, if someone had a high urge to skip meds, had skip meds, or had any issue with their meds, they would be lectured in front of everyone. “Are you a doctor? Did you go to medical school?”
Also, “…can lead to polypharmacy as *they* don’t respond “….? They’re still making this argument, as though it hasn’t been widely demonstrated that almost no one “responds” to being psych drugged. But, yeah, Let’s pretend we’re in 1985 and blame the “lack of response” on the patient being borderline. (He/she wasn’t alone though. The article the comment was under was even about a teenager who “hadn’t responded” to 10 different psych drugs.; And there were definitely people in the comments suggesting “sounds like borderline”.)
Also the suggestion that there is any scientific legitimacy to either a bipolar or a borderliine diagnosis.
And, advertising DBT as a “validating environment “. Saying that doesn’t make it so. Nothing about BPD is validating. I was silenced, blamed, threatened and abandoned.
Not very scientific. If person responds to SSRIs is depressed. If person becomes manic on them is bipolar. if responds to anti convulsants is bipolar. If patient responds to stimulants is ADHD. If stimulants makes someone psychotic is schizophrenic. If someone doesn’t respond to any med has BPD. Those are all commonly held sentiments in psychiatry.
DBT core assumption:. “Patients can’t fail treatment. Only the treatment or treatment provider can fail.”. Then they need to start giving refunds!
Well, nothing new– a “mental health professional” who doesn’t tell the truth.
The labeling of behaviors/reactions as “attention seeking” is VERY Prime problematic. It silence s you. Confuses you. Makes you feel bad.
I’ve gotten this from drs, nurses, friends, anyone. I have legitly had a very hard time, self harmed in some way, or was crying upset, only to ALWAYS be told: you’re attention seeking. Knock it off. You are having mental illness by attention seeking. You wont get attention.
So what happens is, you are shamed and silenced for reacting to severe mental anguish. That anguish is dismissed, mocked, and you have to be silent about what is wrong cuz : nothing is wrong with you but the fact you are attention seeking cuz you are ill. 🙁
I’ve gone to Drs and crisis saying I’m struggling. Tri new saying I’m struggling. No you’re not you’re fine quit attention seeking I’m told. If I do selfnharm, off to hospital for a week, more my ds, come back and you better be good. Struggle is relapse they say.
The worst thing a mentally ill person can want is attention, apparently. Jesus wept!
Thus,no gave up trying to solve struggles. Why would I try? Its attention seeking to struggle. Take pills and shut up and kiss the doctor-gods’ feet.
I know many who equate Drs withbgids. Do not question. Ever. Its a sin to ever question a Dr and questioning Drs is an illness. Bow to your lord. Even if it kills you.
Yet if you talk about this, it is attention seeking and blaming others for your illness. Never ever say that your problems started from childhood, you will be labelled as blaming and not accepting your illness.
I know many ppl with like 10 different mental health diagnoses!! thing is they believe it. They sit and talk of all their disorders. Our lives are nothing but meds, appointments, drs, nurses, grouos, hospitals, illness, pain. Forever.
Dbt makes you silent. Radical acceptance. All that. Just be grateful. You are the problem end of discussion. You are in debt cuz you are deemed worthless by society. It pretends to fix trauma. In does not. Another snake oil. If you do not want to forgive abuse, you are ill. I could go on and on.
Boycott mental health industry. Hit em in their wallets, lord knows they don’t really care bout ppl.
Yes, I think everything you said is getting to the core of the problems with DBT. I object to the way it’s imposed on children and adult are pressured to attend it. There is a support group for those who want to speak out against it. Stop Dialectical Behavior Therapy
Thank you, thank you, thank you for this post! DBT was one of the most invalidating experiences I have ever had. It felt like a campaign to break me so they could refashion me the way they wanted. It also felt like being told: ‘We don’t care what you’re feeling, just behave yourself’.
I definitely agree about the Kool-Aid aspect. DBT is an absolute cult.
I heard EMDR (Eye Movement Desensitization & Reprocessing) was the best type of treatment for trauma. However, I don’t believe it’s covered by Medi-Cal. This is the problem of healthcare not being affordable, unless you have the cash, or parents to help, your basically f*****. (Pardon my language).
EMDR is as effective as other treatments if it appeals to you. That is the case with ART as well (Accelerated Resolution Therapy).
It depends a lot on how able you are to identify traumatic targets in the past as well as what level of connection you have to those memories. There is a bit of kool aid required for this modality as well.
It is covered by insurance and typically billed as 90837(50min session). Due to the cost of training, equipment, and therapist effort, many providers do not take insurance. Though when done correctly, EMDR is a short term treatment option which keeps overall cost down vs years and years of talk therapy in some cases.
It is often NOT covered by insurance.
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On YouTube a Canadian named Dr. Gabor Mate talks mainly about trauma, who believes in doing body type work to heal trauma. He spoke about the book The Body Keeps the Score.
Jake9001 What if a person has comorbid disorders with PTSD, such as OCD? (Therefore, they can’t just get only trauma-related treatment.) I realize it’s not going to be cost effective having a few diagnoses, especially when that trauma happened to someone at an early age, also how much trauma they endured will likely make an impact on how long treatment will be needed.
The very concept of “Comorbid disorders” presumes that the DSM is able to distinguish between one “disorder” and another, while the DSM itself asserts its own inability to do so.
“In DSM, there is no assumption that each category of mental disorder is a completely discrete entity with absolute boundaries dividing it from other mental disorders or from no disorder.”
In other words, there is no clear line between “disorders,” so the concept of “comorbid disorders” is totally invalid.
Agree, Steve. It really does seem like there are some who are invested in keeping the grift going no matter what.
How is it that the response to stories of *abuse* from the mental health system is so often, “Aw, that didn’t fix you? Have you tried this treatment?”
I’ve had to cut so many people out of my life we who didn’t understand that I had been badly injured, physically and mentally, by “treatment” and that continuing to seek out “help” from the system would put me in more danger.
Maybe instead of trying different flavors of Kool Aid, it makes sense to stop with the Kool Aid altogether!
Steve McCrea, definition says “Comorbidity describes two or more conditions appearing in a person. The conditions can occur at the same time or one right after the other.”
I know I have it, because I do have covert OCD (not typical OCD, it’s intrusive thoughts) with PTSD. I get the dissociative feelings with extreme stress (that’s related to trauma.) But I think you may mean it’s all under 1 “Anxiety” category.
I understand that you believe these “disorders” have some real scientific meaning. I do not. Being very familiar with the DSM, these “disorders” are very simply descriptions of behavior or thoughts or emotions a person might have which tend for whatever reason to occur together.
Intrusive thoughts are VERY common with people recovering from traumatic experiences, and seem to actually be part of the DSM description for PTSD. So how can you tell if you have “covert OCD” or “PTSD” or simply have thoughts you don’t want to have that seem to come from the outside? I’m not against DESCRIBING things I just think putting a name on something one observes is not the same as “diagnosing.” A diagnosis ought to be aimed at establishing cause, distinguishing between seemingly similar presentations based on cause, and distinguishing between effective treatments/interventions for the situation. As a former counselor/therapist, I found little to no value in labeling a person’s experience based on the DSM. I simply went directly to “What are you experiencing?” and then looked for the underlying reasons the person may be experiencing these things. “Intrusive thoughts” can have many different origins, and I’d start by asking what the thoughts were and when they arose and go from there. No “diagnosis” is needed – all I needed to know was that the client was willing to share their experiences with me and help me understand what was happening to them. The only reason I ever gave a DSM diagnosis was for insurance reimbursement, and that’s about all they are good for, IMHO.
I’m sorry if that clashes with your beliefs, and I don’t expect you to agree with me or think less of you if you don’t. But my opinion is based on decades of experience and I’m not likely to change it, as I feel I have a very good handle on exactly what these “diagnoses” really represent.
Removed at request of poster.
Resent 2x mistake–Mental disorder diagnoses are classified under headings, which are organized into chapters of the DSM-5. These include:
Schizophrenia Spectrum and Other Psychotic Disorders
Bipolar and Related Disorders
Other Mental Disorders and Additional Codes
Obsessive-Compulsive and Related Disorders
Trauma- and Stressor-Related Disorders
Somatic Symptoms and Related Disorders
Feeding and Eating Disorders
Disruptive, Impulse Control, and Conduct Disorders
Substance-Related and Addictive Disorders
Other Medical Disorders
Medication-Induced Movement Disorders and Other Adverse Effects of Medication
I don’t care how the DSM 5 “organizes” their fictional definitions of “disorders.” As I noted, the DSM itself admits it can’t clearly distinguish between someone who has Disorder A or Disorder B or Disorder A and nothing at all wrong with them. It goes on further to say that “There is also no assumption that two people with the same disorder are alike in all important ways.” In other words, two people with the same “disorder” may have very different needs and very different causes and very different approaches may be needed to help them, even though they have the same “diagnosis.”
What is the point of “diagnosing” people with something that they may or may not have, when even those who fit the same “diagnosis” may have totally different problems requiring totally different solutions? It makes the concept of “comorbidity” more than a bit of a joke. Do I have “excessive digital-nasal insertion disorder” or do I have “itchy nasal passage disorder?” Maybe it’s comorbid, because my nose itches AND I pick my nose to relieve it? Or is the latter simply a consequence of the former diagnosis?
The real question is, why should anyone care what label you put on my behavior? Why not just let me pick my nose, or help me with the itchiness or find something useful to do besides “diagnosing” something you have absolutely no understanding of?
Thank you for this comment. It reminded me of the term “willful ignorance”. So I looked up the definition and think it perfectly describes most “mental health professionals”, from instructor on down.
Willful ignorance is: “Tactical Stupidity. The practice can entail completely disregarding established facts, evidence, and/or reasonable opinions if they fail to meet someone’s expectations”
One of the biggest problems I have had has been the fact that when the word “diagnosis” is mentioned, they all become amateur psychiatrists….. the discussion revolves around whether the diagnosis is the correct one or not.
Personally I’d prefer the discussion takes the path of …..okay we have established I am not a witch, there are no witches, and was burning me alive for being a witch lawful?
Okay, we have established that I was not an “Outpatient”, that the “Provisional Diagnosis” was in fact fabricated, and was arbitrarily detaining and torturing me lawful?
But for some reason the ‘glasses’ go on and ‘they’ start discussing the subtleties of the “Provisional Diagnosis” despite it having absolutely nothing to do with whether what was done was lawful. Like if they look hard enough at that they will find proof I was a witch…. because the alternative is to admit they’re wrong, and have always been wrong.
Steve McCrea I’m willing to be open minded. I’m confused on your belief if you’re against therapy. I just don’t know how else to describe a behavior without a label. For me anxiety provoking situations can cause intrusive thoughts. My intrusive thoughts variants of images of past scary experiences or mind-created images of doing something out of control and stand out in a negative way. But you really can’t eliminate anxiety situations, unless you’re maybe in solitary confinement. I know some Drs think it’s a misfiring of the brain. Do you believe a “disorder” can be predisposed in genetics? (My dad was very outgoing, genius physicist with mild, overt OCD symptoms (I think was triggered off by his childhood abandonment). He was able to compartmentalize and didn’t hinder his daily functioning. His dad also had mild type OCD. I’m more introverted, my “disorder” wasn’t mild, (more early physical trauma) it very much got in the way of functioning.
It is extremely easy to describe a behavior without a label. Some examples: “I feel worried every time I go out of the house. I’m not afraid of anything specific, just have this big surge of anxiety.”
“When Mary visits her mother, she sees things in the house that remind her of her sexual abuse as a child by her father, and she often experiences flashbacks of the event.”
“Monique has never left her children with another caregiver in 5 years. She states that she is afraid that her children will be sexually abused. When asked, she relates that she was also sexually abused as a child.”
These describe what is happening far more accurately than “I have agoraphobia” or “She suffers from PTSD” or “She’s got an adjustment disorder.” And they invite an exploration of why these things are happening, and what might be done about them. In the latter case, a very short intervention inviting her to find someone she knew would NOT sexually abuse her child and make a plan to get a break led to a COMPLETE TURNAROUND in her life, from suicidal to passionately pursuing a sexual abuse recovery program. I met her two weeks later and she was virtually unrecognizable, she was so pumped. So why did she need a “diagnosis?” She did not. She needed someone to be interested in her situation and to drill down as to her motivations and to help her take some sort of effective ACTION to challenge her unproductive but understandable fears.
Some doctors THINK “mental illness” is a ‘misfiring of the brain,’ but no one really knows what that really means, even though they say that. There is no evidence of “proper firing” or “misfiring” that they can point to, no measurement of correct “chemical balances” that they can perform, no “normal brain” they can compare yours to and show some sort of abnormality. I find (and science supports me in this) that this kind of explanation leads many folks to feeling hopeless and disempowered, and deflects attention from the causes and possible interventions that might let the person herself take more control of her life.
I am certain that different people have variations in their genetic makeup, and I don’t exclude the possibility that in SOME cases, this may create some kind of vulnerability. But that does NOT make the genetic differences a “disease” marker. First off, there is absolutely no reliable evidence that any “mental disorder” associates with any “genetic abnormality” in the brain. The best correlations are in the single digits for large groups of genes considered together, but none is even close to being able to predict ANY “mental disorder” in the entire manual. Whereas most “mental disorders” correlate at over 80% levels with childhood adversity and mistreatment. Since genes are the one thing in the entire equation we can NOT change, it seems pretty silly to spend billions researching genetic causes when we know that childhood adversity is a very ADDRESSABLE reason for these “disorders” occurring.
In your case, you yourself identify that others with similar genetics have some similar behavioral tendencies, but your case became more severe because of the abuse you suffered. It seems if you need a “diagnosis” it ought to be “Victim of childhood violence,” which is at least observably true. Saying someone “has OCD” and trying to blame it on your brain is very typical psychiatric narrative, but it is pure speculation on their part, they know NOTHING about the actual causes of these behaviors and emotions.
If their approach works for you, more power to you. I would never want to take that away from you. But your personally benefiting from what they did with you does not legitimize the DSM, which the head of the NIMH himself said “lacked validity” a few years back. The NIMH even stopped using the DSM diagnoses for research after that time. It is VERY legitimate to question the DSM categories scientifically, and it has nothing to do with believing or not believing that people in distress need assistance. I think everyone should do what works for them, but I am opposed to lying to people about what is known just so they’ll be more comfortable accepting whatever treatment is offered.
I’ve been called brainwashed, but if I never got treatment and away from my environment when younger, I would have continued a very bad path of dysfunction. As a last resort I was sent to (reshaped my path) “troubled teen” boarding school CEDU (now shut down by the government). Like the army but forced self-realization (I believe was the only way for me to improve at that age). Yes, that program needed revision, but eradicating all and every treatment won’t help people.
I am not calling you “brainwashed,” and I have never suggested eliminating all treatment, and I don’t know how you would draw that conclusion from what I wrote. My comments clearly criticize not TREATMENT but the idea that the DSM can “diagnose” people accurately of some kind of medical problem using checklists of problematic behaviors, thoughts, and emotions.
Perhaps you are thinking that DSM “diagnoses” are the same as treatment? I understand that people benefit from getting outside help, and professional assistance CAN be quite useful to some folks if you have the right professional and the right approach.
But pretending that somehow professionals can distinguish between “obsessive thoughts” and “intrusive thoughts” and normal thoughts is not scientific, and the DSM itself says it is unable to do that. I’ve helped lots of people over the years improve the condition of their lives, and never once did a “diagnosis” play any role in helping bring it about.
Steve McCrea replying back to you, I wasn’t meaning you personally calling me brainwashed or suggesting elimination of all treatment. And about “no reliable evidence” of brain differences- neuroscientist Dr. James Fallon looks at killers’ brain scans (including his own). FYI I’m not comparing anyone to a murderer lol. YouTube: 3 ingredients for murder. He also talks about individuality interestingly.
It’s always interesting to listen to these ideas, but they are mostly very unscientific, relying on the assumption that correlation = causation. The fact that there may be some similarities between brain scans of two people who happen to be murderers proves absolutely nothing at all. Until we can see that most or all murderers have the same brain activity/structures and that no one or almost no one who doesn’t murder doesn’t have them, we have nothing of use scientifically. Murder, like all human behavior, is extremely complex, and there is no reason to believe that it is “caused” by a particular physiological state.
I just wanted to clarify where I was coming from. My main point is that you can’t vote diseases in and out of existence. There needs to be some sort of objective means of distinguishing between who does and does not “have” a particular “diagnosis,” and such means simply do not exist for ANY “DSM diagnosis.”
The cormorbidity doesn’t matter too much. As Steve wrote, there isn’t necessarily a clinical case for complete distinction. There is a ton of overlap as well as a lack of replication. The DSM, at least in my practice is there to allow me to code things for insurance. If I can only provide EMDR to someone with PTSD, I will find a way to make that case.
If we are looking to differentate based on DSM classification, to support PTSD over OCD as a primary diagnosis, I would be looking at how compulsive thoughts relate to traumatic experience. If they are closely related and involve any kind of dissociation, there is very easy case for PTSD.
Diagnosing is as much an art as it is a science (unfortunately). It’s also very dependent on a clinicians knowledge of the DSM as well as how thorough they are in compiling a list of symptoms. If you don’t ask about a person’s sleep and nightmares for example, you could miss identifying PTSD. Just because we forget about a recurring nightmare that’s normal for us doesn’t mean it isn’t happening.
That part of diagnosis, of finding the questions to ask, how to ask them, and knowledge of the DSM is where I see most clinicians lacking as I train them. Empathy can’t be trained but critical abstract thinking can be trained. Without it, you have an EMDR clinician or some other modality unable or unwilling to help someone because they can’t justify it to an insurance payer.
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I don’t know if it’s been brought up yet, but part of the problem with DBT is that it markets itself as the be all and end all. People who have very little knowledge of the mental health system often accept the premises that borderline is a real thing and that DBT is the gold standard treatment to “fix” borderline.
Patients who enter into DBT experience a kind of indoctrination where their language is policed and everything they do, right down to a thought they have, can and often is labeled by the DBT therapist as a problem behavior and or ineffective behavior. This gives the therapist an inordinate amount of power over the patient, and in my case it did serious harm. My belief that other treatment providers were being abusive to me was labeled as an ineffective or problem thought. My ability and instinct to protect myself from further harm from the system was systematically taken from me by DBT.
It’s important to remember the “core assumptions” of DBT, which in my experience were introduced at the start of treatment and were repeated very often. I see this now as a piece of the indoctrination.
One of the core assumptions is that “patients can’t fail in DBT treatment”. If a patient goes through DBT and does not make progress toward their life worth living, or if in fact their life actually becomes worse, according to DBT, it is not the fault of the patient. It is the fault of the DBT treatment providers or of the treatment itself.
If the treatment providers or the DBT hierarchy actually believed this, they would be open to speaking with former patients who feel that DBT harmed them. They are not open to it. There were many, many times during treatment when a DBT therapist said things suggesting that my life situation — which was alarmingly bad by the end of DBT treatment — and the treatment failures were entirely my fault.
I was asked, “Do you want to keep going in circles?” And, “Do you want to wind up completely alone?” By a DBT therapist who I had trusted, listened to, followed the advice of, acted willing for, tried to be a perfect DBT patient for, for many years. I was crushed! I have been out of DBT for almost a decade and am still dealing with the harm. DBT robbed me of my ability to trust myself and protect myself from further harm when that ability was desperately needed.
When DBT ended (I was dropped by a fully certified DBT therapist, by phone, with no notice, after about 8 excruciating months during which she made me feel like a huge burden and spent every second of our “sessions” talking about how she needed to farm out my treatment to someone else, anyone else. One week she would show up with all the paperwork for admission to McLean inpatient unit for borderlines.
Another week, she would pressure me to apply to a residential program that I couldn’t afford and where the admissions director was extremely prejudiced – vocally – against anyone with a borderline diagnosis. At one point she worked with a psychiatrist to try to get my brain shocked again despite my protestations that ECT was the thing that had disabled me and the psychiatrist who had suggested it had told me afterwards, “you have borderline personality disorder. That’s why the ECT didn’t work.” These two psychiatrists were very close colleagues and all he had to do was pick up the phone and call the one who had done the ECT to see if I was telling the truth. But that was too much for them I guess. And they just put me inpatient for what they were calling an ECT consultation.
When I brought up my concern to the DBT therapist that she wasn’t in consultation, which is a violation of DBT protocol, she told me her other patients do fine with her not being in consultation. She said I was the only one she needed consultation for, and then she tried to send me to an IOP DBT program so that she could get consultation from that program. It was the program that had referred me to her! She wasn’t honest though about that either because she told the DBT therapists in this program, where I had just been discharged for the fifth time, that it was my idea to go back there. She didn’t tell them that it was her idea as it would be a solution to her not being in consultation and that she was there getting the paperwork to readmit me despite my protests.). She called me one day, a day after what turned out to be our final session, a session during which she took the whole 50 minutes telling me about how hard her life was. She had work problems, family problems. Her daughter was sick and was being discriminated against at school. Her husband was cold and unsupportive. She was being discriminated against at work, where her colleagues had filed a complaint against her. I had no idea at the moment why she was telling me all these things, and then the next day she called me and said that she was going out of state indefinitely to deal with family issues and would not be reachable. She gave me the name and address of a therapist I had never heard of, let alone spoken to, who was an hour’s drive away and who didn’t take my insurance. She told me I needed to go see her and she would get back in touch with me whenever she returned to Connecticut. When I said no to this plan, she got off the phone with me and called my psychiatrist and told him that I had quit treatment. So I never saw him again and had to cold turkey off all the drugs he’d been prescribing. I never got to tell him my side of the story. He only heard it from her that I had quit.
After that, I had spent so much time money, energy in treatment and had been so badly burned and treated like a failure by everyone including so-called friends and family. The idea that someone who had a bad experience in DBT can just pick themselves up and dust themselves off and subject themselves to more treatment and be fine with it, fairly ludicrous in my mind. And that’s if the therapist doesn’t hang up the phone. The second they hear that the patient looking for help has a borderline diagnosis and has already been through DBT. I’ve been rejected by a multitude of therapists when they heard about my treatment “record.” Ones that took insurance, ones that didn’t take insurance. Schema therapists, EMDR therapists. Almost none of the ones that do anything the least bit alternative don’t accept insurance of any form and are really only an option for the very wealthy.
I think many therapists are completely unable to put themselves in the shoes of a patient who has been through the ringer. And that is not at all unusual. They also need to stop making false promises, like saying that they have a core assumption that patients can’t fail. People don’t have unlimited patience, money, time and trust to get burned over and over and over again. They need to stop demanding that patients. trust them. Trust is earned.
At this point, even if I were offered free trauma therapy, I don’t think I would do it. The trust has been broken completely.
Your DBT therapist was gaslighting you. It’s the typical therapist’s modus operandi.
Except, in most states, 90837 or 90834 for a shorter session are regular therapy session codes. These ARE COVERED. There is no specific CPT code for EMDR. If a provider that takes your insurance tells you there is then they have lied to you. Further they are violating their provider contract with the insurance payer to refuse acceptance of a plan for EMDR. For example, when I agreed to be paneled with Anthem I agreed to accept it for all those covered by Anthem. I don’t get to say: I won’t take it for EMDR. If you have mental health coverage, your EMDR treatment will be covered by a paneled provider. You are working on old information or from a provider who fed you BS.
Here is a sample document from an insurer that specifies EMDR is covered under the codes mentioned:
I just looked up whether my Medicare advantage plan (Aetna) covers EMDR. It apparently covers it for PTSD. It does NOT cover EMDR for a long list of other diagnoses, including borderline.
This is so typical. I have a borderline diagnosis. I don’t have a PTSD diagnosis. Never got one, despite the fact that it was completely obvious I had PTSD and even my DBT therapists, who started out saying, ” The past is irrelevant. Just learn skills” were eventually telling me that I absolutely needed trauma therapy, except by that point because I was disabled and had a treatment record and a borderline diagnosis and was on Medicare, so I could never get trauma therapy and still can’t.
It sure would have been nice if the DBT therapist who told me I needed a trauma therapy had added PTSD diagnosis to my record, but he couldn’t be bothered I guess.
And then, even if insurance did cover it, so often the trauma therapist refuses to treat ” borderlines”…which is extremely common.
Yeah, at some point the best decision is to say, screw all the therapies. At some point, the patient realizes that maybe the “treatment providers” enjoy seeing patients face rejection, suffer, fail. It’s the only thing that makes sense.
“…at some point the best decision is to say, screw all the therapies.”
THAT was the beginning of healing for me.
“At some point, the patient realizes that maybe the “treatment providers” enjoy seeing patients face rejection, suffer, fail. It’s the only thing that makes sense.”
THAT’S what I’ve always thought! I think a lot therapists unconsciously live to experience schadenfreude; why else would they seek power over others?
And some are definitely full-blown sadists.
There does seem to be a compassion chip missing in a lot of cases. Case in point: on a critical psychiatry website that’s chock-full of personal narratives of horrific experiences in “mental health treatment”, under an article about how many trauma survivors were re-traumatized by DBT, in a comment section filled with more stories of trauma survivors having terrible experiences in DBT, a therapist’s main concern is to pick an argument about whether EMDR is covered by insurance or not. Like, read the room.
It’s uncanny how typical it is for therapists and psychiatrists to turn a deaf ear to people’s real concerns, as they usually demand to be seen as having more knowledge than anyone else, especially when they know they don’t!
Hi Katel, You may be familiar with the the Facebook group named Stop Dialectical Behavior. If not, in it, there are many people with the same experience and feelings about DBT as you describe. The group discuses the problems with DBT and provides support for those harmed by it. I feel that therapies, in general, are based on inaccurate theories and are often harmful. But the behavior therapies are particularly egregious. To just pressure someone struggling to change behavior, that someone has decided needs to change, without any concern for why it’s there is inappropriate, I would say abusive. No one is a chameleon even if they would want to be. No one can just wave a magic wand and all the baggage from every problem they have ever had will just go away. No one has the ability to prevent their issues from affecting their view and behavior entirely. Part of the problem with therapy is the therapist brings their own issues into the mix. No one is truly objective or able to set their unresolved issues aside.
As I have always maintained, people act a certain way because on some level it seems necessary or wise for their own survival. To think that folks can simply “think away” their own history and the reasons for their fears and their insistence on or avoidance of certain situations is actually quite invalidative of their experience. And suggests simplistic answers, such as “Just think the right thoughts and you’ll feel better soon!” which are hardly realistic for people struggling with past and often current abuse, often by the very system that’s claiming to help them. And it provides cover for blaming the victim for “failing to think the right thoughts” or “failing to take the program seriously” when it doesn’t work for them.
I’ve been told by several people that DBT practitioners sometimes FORCE people to engage in “mindfulness” activities. Nothing could show more ignorance of how mindfulness really works than thinking you can force someone to do it and expect any kind of results. These manualized “therapy programs” are of very little use in most cases, as what the person really needs is someone to LISTEN and UNDERSTAND them, and help THEM make their own minds up about what they want to be different and whether or not a certain approach is working for them.
And your last comment is most important. There is no way to completely set one’s issues aside as a therapist. The best one can do is to be aware that you DO have issues and you WILL bring them to the session, and to be aware enough of them to distinguish between your own needs and the client’s needs. The number of people who can actually do this is incredibly small!
Thank you, Christine.
Reading the room is correcting a HUGE piece of misinformation. People refer to EMDR as something potentially helpful that they can’t access. That is simply not the case. Reading the room is treating everyone with the respect and dignity to handle a correction in misinformation. Whether that is about adaptation of technique, coding, access, availability etc. or something else. If you suggested the earth was flat I would also question that.
I am not arguing with anyone’s experience. Rather advocating for accuracy when referring to objective information.
There are a TON of terrible therapists. I have had many myself. I strive NOT to be one. I still screw up a lot. Sorry your experience was sh*t. Now please be accurate when referring to objective information.
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Now, if you think I was inaccurate, please tell me where and how.
I’m getting really tired of being attacked and being patronized. I stated that my insurance carrier — which I named — does NOT cover EMDR for borderline personality. There was no misinformation, and you are not correcting any statement of mine, since I didn’t state anything that was untrue.
I also stated that many therapists, including those who consider themselves trauma therapists, refuse to take “borderline” patients. This is common knowledge. The discrimination against patients labeled with this diagnosis is rampant in the “mental health community”.
Please spare me the “if you had said the earth was flat” nonsense.
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It’s one thing to say it is “covered” as in “it is reimbursable.” Whether a person can actually GET coverage is much more complicated, as they require the insurance company to decide the treatment is “medically necessary,” which is hardly a black and white decision, and biases and financial conflicts of interest often enter into the equation.
I was trying to reply under your comment about the neuroscientist. He didn’t just scan 2 killers’ brains. He’s looked at many and based his hypothesis of his years of research. He said he’s been asked for legal trials. You could also say there’s no point in doing ANY research into mental health either, since everything is debatable.
Not saying that at all. I’m saying to do legitimate scientific research, you need a legitimate research group of people who have something that makes them the same. Murderers don’t qualify as such a group, as they are selected by a specific kind of behavior AND by the fact that they got convicted. It could be an interesting subject that might LEAD to some scientific hypotheses, which could then be tested, but simply comparing brains of convicted murderers smacks of “phrenology,” where the head shapes of criminals were compared to conclude what commonalities criminals shared in order to predict criminality. It was, of course, a complete bust, but it all sounded very “scientific.” So far, brain scan research has been used to “explain” a lot of things that it doesn’t explain at all. I’m very skeptical based on the sketchy history of brain scan research as well as the obvious heterogeneity of the group of “convicted murderers” and would have to see the basis for the research to judge.
Steve McCrea-That neuroscientist was also talking about the importance of nurture compared to nature. I know many people want to avoid that topic completely.
I am glad to hear that. Anyone claiming that either nature or nurture is the sole cause of aberrations in human behavior is selling something!
Steve, The medical necessity part is up to the therapist. Insurance companies look at only a very small percentage of documentation. For some providers, there is never any review of the documentation. The common thread in terms of barriers to coverage seems finding providers willing to justify treatments as well as access/money.
Quite so. But you and I are in no position to judge how easy or difficult it may be to find a provider willing to support/justify the treatment the client wants. I’m saying it’s important that folks with professional backgrounds, like you and I, learn to step down from our one-up power positions and listen to the people actually in the trenches seeking services. If someone says, “I can’t get a therapist who will provide EMDR because I have a BPD diagnosis,” it is our job to listen to and believe them, because we are not in their position. A more respectful approach would be to ask some questions, like, “What state are you in? What have the therapists said to you when you asked? Is it the therapist refusing to ask or the insurance company refusing to cover it? What kind of “reasons” are you getting from the insurance company?” Then maybe we can help that person find a path toward getting it covered. Just saying, “No, you’re wrong, it’s covered by your insurance” comes across as both condescending and invalidative of the very real experience of the poster. It is, for lack of a better word, a rather unprofessional approach, IMHO.
Steve, to your most recent comment: This is an online discussion board. I don’t have the resources to go through the steps you lay out. That’s up to them.
It is up to all of us to find the resources we need. I have been through the system as a patient and more recently as a provider. I have provided general information to demsytify and remedy some of the issues a person may face. I see it as disrespectful to assume someone capable of engaging in this kind of discourse isn’t capable of doing the legwork themselves. It WOULD be patronizing to assume that responsibility for them.
You are not taking responsibility for the impact of your invalidation of others. You have not demystified anything that I can see, it comes across that you have simply told another poster they were too stupid to figure out how to get EMDR paid for. It came across as condescending and had a hurtful effect. I would hope that you as a professional carer would want to know that so as to avoid doing similar harm in the future. At a minimum, you could own your own experience (“I personally haven’t had that problem” or “It’s my understanding that most insurance will pay for EMDR”) without telling the other person they were wrong for saying otherwise. You don’t know enough about their situation to presume to tell them what can and can’t be covered in their context, and I think you’d be well served to remember that next time you comment on another person’s experience.
If your carrier covers your therapy then they will cover your EMDR. That is the misinformation that I am correcting. It is on your provider to justify the treatment they believe necessary.
Your therapist/EMDR person can code BPD as PTSD. It’s really that simple. Both carry really similar symptoms. If your provider won’t do that to get it covered then find a different one.
EMDR is covered under a normal therapy code 90832;90834;90837 NOT some special one regardless of diagnosis as well. The note would likely have to read multiple interventions within a single session to cover any possible issues under audit. CPT codes for sessions are based on time spent with people and not the treatments.
For example, “Joe was engaged in his session after arriving on time. He reported depression and flashbacks this week. Therapist supported processing, engaged in behavioral reinforcement, and provided EMDR. Joe responded well and made a follow up appointment.” BAM! A session covered under 90837 that won’t be questioned under audit no matter what the diagnosis. (Behavioral reinforcement refers to anything encouraging or validating; processing is the general conversation about the things leading up to the symptoms over the past week; EMDR is the EDMR.)
A provider who treats BPD but won’t add PTSD to the diagnosis codes being submitted to get you treatment is not doing their job. They are one of the providers that so many are upset about.
A new provider is ethically bound to be doing their own diagnostic work- so it doesn’t really matter what someone else says or thinks. Unless you hand them a piece of paper that says BPD, there is no way for them to know unless you report the symptoms.
Past diagnoses (reported by people) are not meant to anything other than inform the questions asked during an intake. I’m not referring to self diagnosis either. That is valid when a person knows how to read and has a DSM. I might disagree and would explain why.
I’ve been doing this awhile and have never taken another providers’ diagnosis for granted. That would be lazy and unethical. It also does speak to the lack of scientific validity of DSM diagnosis that I might have a completely different view of it than another therapist or psychiatrist. Under the DSM system, we are both right too.
I have no issue with anything that you said other than the coverage for EMDR. To push the idea that it isn’t covered for BPD isn’t accurate since any competent diagnosing provider would also diagnosis PTSD or diagnose PTSD without BPD to avoid stigmatizing someone because of systemic issues. Both diagnoses are correct under our system.
I don’t think it’s patronizing to disagree with you. Or to feel that the way you wrote something is pushing misinformation that might discourage someone from seeking a potentially helpful treatment.
If that’s patronizing then I need to rethink this whole free speech thing we push in the US. Especially when I have been respectful throughout the process. Though in reading through many of your comments, it would seem that part of your goal is to discourage treatment from therapists. I believe you wrote F the therapists was the thing that helped you start your recovery. I have a very different goal which is to promote critique and improvement of broken system. In these, goals, we can both be valid and right.
Further, something about me, I have never turned anyone away with a BPD diagnosis. Please don’t group me into the kool aid guzzling DBT consultation crowd. F them. They are nuts! You are not. My other posts in this discussion have been quite critical of the mental health system and DBT in general. The providers people have written about sound pretty bad. They certainly do not align with the way I conduct myself professionally though I have completed the DBT training program.
I have made it a point to specialize in this area of treatment because there is so much BS and negativity within treatment provider communities about BPD. In my understanding, people experiencing BPD spectrum are reacting to a set of terrible circumstances in a pretty reasonable way (based on their context). Just like with other people experiencing some set of symptoms whether it’s ADHD, depression, anxiety, etc.
I think you are speaking in technical terms of what is theoretically possible, while the other posters are speaking in terms of what ACTUALLY HAPPENS in the real world. It’s probably neither possible nor appropriate for those of us who haven’t been in the position of seeking “treatment.” I defer to those who have been on that side of the table.
That being said, I really do appreciate your efforts to destigmatize the BPD “diagnosis.” I think your framing of these “diagnoses” is about as sane as anyone working within the system can make it. But I do think it’s important to remember that you (and I) are/were outliers and that most clients of the “mental health system” are not treated with anything close to the degree of respect for their context than what you are describing.
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Rachel, I’m baffled how many times you seem to have taken the exact opposite from my words that I am intending to communicate! I am a HUGE believer in the impact of environment and family upbringing as the MAJOR CAUSE of most of the DSM “diagnoses,” and science backs me up on this point. Where on earth did you get the idea I thought otherwise? I need to figure out what I’m saying that is not getting across to you. It’s really confusing to me how you are mistaking my meaning so frequently, even though I sense that you are doing your best to make sense of it!
And I don’t think he was saying nature or nurture was the “sole cause.” I think he was saying it has an influence. I don’t see how anyone that studied psychology could disagree. But then, maybe you think psychology is all Bullcrap (not judging).
I do not. Nor was I saying he was saying that, in fact, I was lauding him for saying it was not an either/or thing. I’ve known WAY too many in the psychiatric world who DO insist it is an either/or thing and have had many a frustrating conversation about it with “professionals” who ought to know better.
Maybe I misinterpreted your comment saying, “I am glad to hear that. Anyone claiming that either nature or nurture is the sole cause of aberrations in human behavior is selling something!” (I do think that neuroscientist seems to be more on the Nurture side.) Your perspective hasn’t been really clear to me, so thank you for clarifying.