Therapeutic Relationships, DBT and BPD.

Hi All,

I did a 20 week group therapy with a clinic locally through the last half of last year.

I quite struggled to remain in engaged consistently, though I went every session bar one. I found consistently that some things came up for me in Group therapy, like a perception that the therapists were addressing things directly to me. For example, when I related trying to be mindful as I prepared coffee at work, there was a comment later in the session about too much coffee, and so I raised that with the therapists who denied it was a direct reference to what I had communicated earlier in the session.

Those kind of things tended to arise with frequency, about once a month, and I would seek to confront the therapists about it after the session.

Because I had a lot of that going on throughout, the fortnightly sessions (the minimum that was required and practically all I could commit to in terms of cost and time outlay where I'm already a 2 hour weekly commitment in for 20 weeks) often sort of derailed into discussions about dissatisfaction around the way I consider I was treated by the therapists. While some instances I can reflect back on and wonder whether I got the wrong end of the stick, on other occasions I am certain that they treated me poorly, and deliberately. As that was going on, it meant that discussions about the target behaviours I identified, were very limited, and for over 20 weeks, I didn't complete a behaviour chain analysis, which in my research around the therapy, I believe is intended to be a significant therapeutic tool.

Since coming out of that session, my therapist has sought to engage with me around the behaviour chain analysis, but even now it's a condensed four step process, rather than the 8 steps in the book.

Because of all this, I am really doubting the therapeutic relationship with the individual therapist. A big sticking point for me was a reluctance to engage in diagnosis (though screening for symptoms as against the DSMV criteria was necessary for intake) and this was a stick point across multiple sessions, where I continued to agitate around that point, but to no positive response in terms of having that need met. I feel there was poor wrangling of me in terms of keeping focused on the identified behaviours (though I do believe he was trying to be responsive to the things arising in the room during therapy), and I am frustrated that the thing I identified from the outset, in terms of social isolation, is not anything I've been guided on in DBT, or since even where I have specifically identified I want some support on specific skills in the manual that are on this point.

Today, after I have raised the issue of structure and what therapy is going to look like moving forward, he raises the issue of diary cards as being a tool to help us what we're doing, but I discontinued this some 4 sessions prior where he said I didn't have to do them moving forward (I didn't see the point where the targeted behaviours identified may have been improving, but was not being specifically addressed in session).

I'm at the point where I have tried to maintain the relationship, because I understand from what I read that consistency and understanding of each other, is something that is likely to assist me in the therapeutic relationship moving forward. However, none of the therapy has looked as I thought it might, and I'm really trying hard not to be wilfull, and wanting to be correct, but the flip side of that is I don't think it's unreasonable to have the things I've identified as targets as being a central focus, and for us to be at a shared place of understanding fairly quickly after over 6 months of fortnightly sessions, and to have a clear structure around our work together that is understood by us both and is consistent.

I'm considering changing therapists, but so much of the therapy asks you to reflect on whether you are being wilful, or trying to control everything, or having to be right or being fixated on an absolute or expected outcome, so I find myself questioning whether this is an incident of the condition and I'm symptomatic, as much as I think it's pretty reasonably to want to have my needs met and be understood in the process. It is my job to advocate on behalf of people for a living, so I am a skilled communicator, and at times it does feel like I am speaking a different language, and it's almost as if everything is being viewed through a lens of the condition, at the expense of speaking directly to me.

I was wondering if anybody has had an experiences like this, where they have considered it's not working and have persevered and been successful, or have changed therapists and had a good/worse time. I know it's a decision for me to make based on everything that has occurred, but if anybody can speak ot their experience of these kind of issues, I'd be grateful to hear from you.