In a previous article we discussed why psychotherapy is eventually more effective for BPD than medication. This is good news! This means we can get the most troublesome symptoms of BPD better (and eventually healed) without medication. Medication can help, especially in the early stages of treatment, but most of them have unwanted side-effects. So, what are the options for psychotherapy, and how do we get to see the right psychologist? And (because we live in the real world)- how do we pay for it?
Firstly, let us look at the different psychotherapy options:
- Individual vs group therapy
In South Africa individual psychotherapy is the norm. This means that you arrange to see the psychologist when it is suitable for you, usually once a week. The advantage is that the psychologist can focus on your individual needs and that our medical aids provide funding more in favour of individual therapy, especially if you have a Prescribed Minimum Benefit) PMB condition. The disadvantages of individual therapy include that it is more expensive, which means you eventually will have less sessions or the sessions will be spread over a shorter time. Then there is also a special “power” in a group. The patients in a group are like- minded people and they support each other, a process which is always a privilege for me to see.
- Inpatient vs outpatient therapy
When a patient is in hospital, we can offer group as well as individual therapy. We recommend admission to hospital in times of a crises, or when there is a good reason to believe that intensive treatment over a short period (three weeks or less) is the best option. If admission is not indicated, outpatient therapy has the huge advantage that it gives the patient the opportunity to practice in the real world, vs a hospital environment which is regulated.
Practical factors to consider regarding psychotherapy
Psychotherapy is an extremely broad subject and thousands of books have been written about the different topics. Here are a few practical things to bear in mind when considering going for psychotherapy:
- There are many types of psychologists and therapists, and many types of psychotherapies. It is the responsibility of the psychologists/therapist to practice within their Scope of Practice as stipulated by the HPCSA, be knowledgeable about the therapies they are offering, and of course to keep the patient’s best interest at heart. But it is the patient’s responsibility to commit to the process.
- Psychotherapy can be useful for every person at some stage in their lives, but psychotherapy is not indicated for every person with a psychiatric problem.
- In general, for patients with BPD a team approach works best. This means that all the professionals (psychiatrist, psychologist, GP etc) must work together and be in contact. This not only ensures the best clinical results, but also that the funding (whether from a medical aid or the patients’ own funds) is applied most effectively.
- Ask your psychologist/ psychiatrist about whether you can apply for Prescribed Minimum Benefit (PMB) privileges. If you do not belong to a medical aid you should also negotiate with your therapist.
- The goals of psychotherapy should be discussed. Psychotherapy is not a never- ending story where results are not clear. The psychotherapist and the patient should agree at the outset what are the goals they want to reach with the therapy.
Psychotherapy options: Dialectical Behaviour Therapy (DBT) and other therapies
“Going for a life worth living” Marsha Linehan (founder of DBT)
DBT is the therapy that is most easily available to patients in South Africa. Other psychotherapies include mentalization-based therapy, transference focused therapy and cognitive and behavioural therapies.
DBT can be offered to patients on an individual as well as group basis. The COVID-19 pandemic has made online group DBT sessions a reality, which is an extremely exciting treatment option.
In the individual setting (meaning the patient consults a psychologist or psychiatrist) we usually do a chain analysis. This is an exercise where we look at a difficult situation and pinpoint exactly where things went ‘wrong’. We then look at specific skills that can help with that type of situation in the future.
In the next article we will have a closer look at DBT.