@Former-Member 

Whilst we have a lot of data accumulating that treatment for BPD helps, we don’t have a lot of data to tell us which treatment works best or for whom. As I mentioned, there are a lot of similarities between treatments for BPD and one would hope that an ‘ideal’ treatment might involve some of these. There is a mountain of data that suggests that, despite the many treatments out there, one of the main ingredients of helpful therapies is the relationship with the therapist. In my mind, this is a crucial factor in an ideal treatment. It needs to be a relationship in which you feel heard and understood, and that you and the therapist have a way of understanding and approaching your difficulties in a way that makes sense to you. Ideally, it is also a relationship in which you can raise it with the therapist if you feel misunderstood by them, and work through it together.

Another thing to raise is that there are lots of different perceptions about treatment out there. One of these can be that people can expect that after 18-months of treatment that the person no longer has any BPD symptoms, or any difficulties whatsoever. What comes to mind here is that different people need different lengths of therapy – some shorter, some longer. Often the treatment lengths in study trials are decided by a range of factors, balancing trying to offer a significant benefit to the person whilst also balancing the pressures of public health waitlist demands. Put another way, many people will still need help after a course of DBT or MBT, this is not an indication of the person ‘failing’ treatment and, indeed, they may have made significant gains over the course of the therapy.

To further flip the script, I think there needs to be change on a policy level so that treatment becomes more accessible to all those who need it, for the length that they need it. The evidence is there that treatment works. The evidence is there that it is cheaper and more economical to provide psychotherapeutic treatment than to not. People should not have to wait until they get worse in order to be able to access therapy. There needs to be changes to the Better Access scheme for accessing a private mental health professionals, similar to those changes made for the treatment of eating disorders, which allows for up to 40 sessions per year, rather than 10. We also need to improve our public mental health system as people should not have to have things get worse until they receive an evidence-based treatment from a specialist service, such as Spectrum.