Fight for more, or give up on therapy?

[secret squirrel]

I am nearing the end of my time at a MBT (mentalisation based treatment) Day Unit for people with BPD. My main reason for going there was to sort out the self harm and learn to manage my emotions in a healthier way. However, after 18 months of intensive treatment, my self harm is worse than it was at the beginning and I feel totally out of control with my emotional states.

I feel like a complete failure. I don't want to criticise this form of therapy or put anyone else off trying it as it does work for many people. But obviously not for me.

I am not sure what to do next. When I mentioned to one of the therapists that maybe I could try another kind of therapy, she said seemed to think that there was no point. I felt really upset by that - maybe she's right. Maybe no therapy can help me.

Another comment that got me thinking was made by someone from the Crisis Team who first met me 18 years ago, when I first entered adult MH services. She said that maybe I should live with my MH problems and accept that I will always self harm. Part of me feels angry and like I have been written off. But part of me thinks maybe she's right. But my selfharm means that I am in constant pain, have to have hospital treatment and surgery. And I am also risking life and limb. I have been lucky so far but my luck will run out.

I really don't know what to do. Should I push for more therapy (like DBT, which I haven't tried) or just accept my situation? Does anyone have experience of therapies for BPD or self harm and did they work?

[whirlpools]

I don't feel able to make a judgement either way about whether or not more therapy would be helpful, but in my experience, the rule of thumb from professionals seems to be that after you've had a long period of intense therapy, it can be helpful to have a 'break' from it and see how you function in life without it. That break can give you the opportunity to see if there's stuff that needs to be worked on and what changes you might make in future treatment, as well as giving you the chance to put into place skills you learnt in the therapy you just did.

Of course, that's just a general consensus of opinion and it might be different for you - do you have a care co-ordinator or psychiatrist you could get an opinion from, who knows you?

I've just got out of a therapeutic community (day patient) after twelve months. Although I still have a lot of issues, in general I'm much better and find therapeutic community treatment seems to work for me (I also have BPD). So that's an option. I've never tried DBT, but it seems to work for a lot of people with BPD.

Obviously, making sure symptoms are no longer as destructive or life-threatening is one of the main aims of therapy, as well as to improve quality of life, but I think it's fair to say that, no matter how much therapy a person has, nobody's ever really 'cured' - it's more about creating an internal 'toolbox' for dealing with difficult times.

[HildaOgden]

Quote:

Originally Posted by reappear

no matter how much therapy a person has, nobody's ever really 'cured' - it's more about creating an internal 'toolbox' for dealing with difficult times.

I really like the way you've said that because it's really pertinent for me right now.

I can relate to the OP too.

The situation I'm in is I've had years of therapy including a one year intensive inpatient psychotherapy unit - interpersonal therapy. That was 9 years ago. I've had quite a bit of various therapy since.

My self harm has regressed to being really quite bad and risky but in different ways nowadays.

I've got a meeting on Friday with my temp cpn who doesn't really know me and the psychologist i had for 4 years as outpatient. I *think* this meeting is to talk about where to go from here. I'm not actually sure what the meeting is about it needs clarifying. I asked for CAT therapy as a friend had it and although she's not stopped self harming she's not harming as badly.

the locality I'm in doesn't offer DBT or MBT but another friend is being funded out of area for DBT, so I wonder if that could be an option for me.

It's so difficult isn't it because you don't want to feel defeated and like you've given up on yourself, but at the same time, if we've been self harming for a long time (13 yrs for me. I started when I was 25) it's a coping mechanism that becomes ingrained and to some extent works. In the context that I know my self harm sometimes stops me from directly attempting suicide although the action of the self harm could lead to suicide. I think I've made sense??

Sorry, I feel I'm waffling. I just want to say to the OP that I really do think I relate to what you've put and may be we do just have to accept to some extent we'll always self harm but that shouldn't stop us from trying different things, because you never know, something might just work!

[Stellata]

The thing is, mentalisation based treatment is centred around being supported to understand how others have different minds from you, are separate and have feelings that need considering, and also to consider your own feelings healthily. It's all a bit of a shake up inside, so completely understandable things would be messy at some stage in the treatment, these core things being so raw and painful at times.
My take on your situation would be for those involved in your care to properly assess where you're at in terms of the goals [and remember, the goals of gaining a more secure sense of self and of others as separate doesn't necessarily mean all self destructive behaviours are immediately fixed.] and take it from there. The thing they need to look at very clearly, I would say, is how your self harming links to your sense of self, if it does, and what is missing that you need additional support with.

[secret squirrel]

Thanks for all of your replies.

reappear: I can see that maybe a break from therapy can be a good thing. What you said about using the skills I have learnt and thinking about future changes I can make has given me food for thought. I'm so glad that you have found therapy beneficial and I bet you worked really hard to make the changes, so I hope things continue to go well for you.

diagnonense: I hope your meeting goes well and that you keep fighting. Hopefully you'll find the right treatment and so will I!

Stellata: yes, MBT therapy has shaken me up inside and made me reconsider how I think about myself and how I understand others, and how it affects my relationships (or lack of them in my case) I think there is a very deep link between my self harm and my sense of self but I'm not able to clearly understand or articulate it yet.

In terms of my future care, I will be switching to a completely new team when I leave the Day Unit. At the moment, all my care is based there, except for the Crisis Team, which I use sometimes, and they will continue to work with me. I am worried the one of two things will happen to me when I get transferred to the new team - 1. I will be put in a secure ward if my self harm continues to get worse, or 2. they just give up on me and I'm left with nothing. I really don't want either of those things to happen.