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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 35 to 59 of 71. Go back in thread:
Posted by TofuEmmy on December 13, 2004, at 2:53:03
In reply to Re: That's ok. There's no need for you to get it. » littleone, posted by fires on December 12, 2004, at 22:52:26
>Are you aware of the current prognosis for those with moderate to severe BPD? Yes they deserve treatment, but don't expect a great outcome.
>http://health.allrefer.com/health/borderline-personality-disorder-prognosis.html
-------------------------------------------
The current treatment for BPD is CBT which has shown very good results and is close to receiving funding in many states as an "evidence based practice".Published in July 2004 in Psychiatric Times:
"Great strides have been made in understanding the etiologies, neurobiology and longitudinal course of BPD. An evidence-based practice guideline has been developed for the disorder, and a growing number of studies demonstrate that carefully planned and administered treatment can be effective for many patients with BPD."
To post that url with one simple sentence saying, "Borderline personality disorder has a poor outlook because noncompliance with treatment is common" sounds to me to be to be very unsupportive of the many posters here with BPD. It's also an outdated perspective in the field of BPD treatment. I feel that your additional comment, "don't expect a great oucome" would certainly be disheartening for a poster with BPD.
The nature of this forum is education and support. I feel your post lacked these components.
Emmy
Posted by Dinah on December 13, 2004, at 5:34:35
In reply to Re: That's ok. There's no need for you to get it. » littleone, posted by fires on December 12, 2004, at 22:52:26
No easy task...
Posted by fallsfall on December 13, 2004, at 7:11:37
In reply to I don't get it, posted by fires on December 12, 2004, at 15:39:01
> I keep reading posts in which people here talk about calling their therapist between visits, worrying about their therapists, being in love with their Ts, ... What are "these people" (or you) in T for?
Perhaps "these people" are in therapy because they tend to establish "unhelpful" relationship patterns and they are seeking to understand how to change that.
>
> Borderline Personality Disorder. I'm baffled as to what else it could be. Thanks.I was diagnosed with BPD, though my current therapist disagrees. I never was a "Typical" BPD patient, anyway. I have a strong attachment (you could call it a "dependency" - others have) to my therapist - probably due to emotional neglect while I was growing up. You say that you are baffled as to what else it could be - If you are interested in an answer as to what else it could be, then I suggest Emotional Neglect.
For those (of us) who have BPD, it is a sign of strength that we have sought therapy for our issues. Since your retired MD did not feel able to deal with these patients, I think it was a good choice for him (and his patients) for him to choose not to pursue a Pdoc career. I also did not choose to pursue a Pdoc career, and I would guess that you made that same choice.
Isn't it wonderful that there are so many kind of people and so many career choices, so that people can choose a career that suits them and that they are well suited for?
Posted by Joslynn on December 13, 2004, at 9:49:15
In reply to I don't get it, posted by fires on December 12, 2004, at 15:39:01
You don't understand why people have transference with their therapsists, yet you have just spent a lot of time and typing discussing your former MD on an internet board.
Do you see the irony in this? Perhaps you relate to us more than you realize. Clearly that doctor had a huge impact on you, since you are now talking about his career, quoting his book, criticizing the types of people he couldn't handle, etc.
I wonder, what is the real problem here? Do you miss him and resent the types of cases that you think drove him away from you?
I think there is more to the story than you are telling us.
Posted by Joslynn on December 13, 2004, at 9:54:24
In reply to I think you DO get it, posted by Joslynn on December 13, 2004, at 9:49:15
Posted by gardenergirl on December 13, 2004, at 10:18:54
In reply to Re: Please be Supportive » fires, posted by TofuEmmy on December 13, 2004, at 2:53:03
Lovely post, Emmy.
You said what I wanted to but couldn't because I found myself much like Dinah after reading the latest.
gg
Posted by fires on December 13, 2004, at 10:40:17
In reply to I am struck dumb. » fires, posted by Dinah on December 13, 2004, at 5:34:35
> No easy task...
I don't "get" your cryptic messages.
Posted by fires on December 13, 2004, at 10:54:24
In reply to Re: I don't get it » fires, posted by fallsfall on December 13, 2004, at 7:11:37
You misunderstood. My Dr. knew more about psychiatry than most psychiatrists. He taught psychopharmacology and other courses to med students at several major universities.
He took on treatment resistant patients. Few Drs. will do that! He was known to say that no Dr. should have more than one BPD patient at a time, unless they can handle the frequent late night/early AM "emergency" phone calls from them.
He married a psychologist.
Posted by fires on December 13, 2004, at 10:59:29
In reply to I think you DO get it, posted by Joslynn on December 13, 2004, at 9:49:15
Your info. is wrong. He had to retire due to an injury. No type of patient drove him away from me.
What gave you that idea?
There is not any more to this story than what I'm telling you, but I doubt if you will beleive me. ;)
Posted by TofuEmmy on December 13, 2004, at 11:05:35
In reply to Re: Please be Supportive » TofuEmmy, posted by gardenergirl on December 13, 2004, at 10:18:54
Except for the typo....CBT should be DBT. But you knew that. D'oh, it was late.
Posted by Joslynn on December 13, 2004, at 12:52:05
In reply to Re: I think you DO get it » Joslynn, posted by fires on December 13, 2004, at 10:59:29
I may have surmised the details incorrectly, but my overall point was, it was ironic to me that you said you didn't get transference to a T, yet you are so interested in your former doctor. You have taken on his opinions, quoted him, supported his side on this board, are still thinking of him even though he is no longer your doc, etc. That could be considered as transference, something you say you do not "get."
Also, it sounds like you have some anger and resentment towards people with BPD (which I don't have, by the way) and it seems like that must come from somewhere.
Unless you really do just want to hurt sensitive people who come on here for support?
Posted by Joslynn on December 13, 2004, at 12:54:35
In reply to Re: I think you DO get it, posted by Joslynn on December 13, 2004, at 12:52:05
I'm just adding to the problem by responding, never mind. I should have just kept scrolling.
Posted by fallsfall on December 13, 2004, at 12:55:12
In reply to Re: I don't get it » fallsfall, posted by fires on December 13, 2004, at 10:54:24
OK... I am easily confused these days.
I did also answer your original question, however, if you would be interested in discussing that...
Posted by littleone on December 13, 2004, at 14:20:40
In reply to Re: That's ok. There's no need for you to get it. » littleone, posted by fires on December 12, 2004, at 22:52:26
> Are you aware of the current prognosis for those with moderate to severe BPD? Yes they deserve treatment, but don't expect a great outcome.
Fires, you made me laugh with this. You've fallen into your own trap of believing everything you read on the internet :)You can have a prognosis in relation to a liver transplant. You can have a prognosis in relation to open heart surgery. It denotes the chances of success or failure.
I think you will find that the website you quoted uses a standard template of symptoms, treatment, prognosis, etc for a very wide range of conditions.
But with psychological problems, there are no successes or failures. There is a continum of growth that continues throughout the individual's lifetime. Therapy is not a cure. It is a tool that can be utilised to assist in this growth journey.
I would hazard a guess that the website was referring to the fact that due to the traits of impulsiveness and vilification that some people with BPD exhibit, there is a high drop out rate from treatment by these people.
However it would be grossly inaccurate to say there is a poor prognosis. In my opinion, with a strong committment from the individual and the assistance of a skilled T, I believe there is an excellent "prognosis" for growth.
Also, you need to remember that even if a person drops out of treatment, it could still be argued that it was successful to a degree. In all likelihood, the person has walked away with an awareness of some of their issues. Even just an awareness can sometimes assist in everyday life.
Posted by fires on December 13, 2004, at 16:15:48
In reply to Re: I think you DO get it, posted by Joslynn on December 13, 2004, at 12:52:05
I don't recall ever using the word transference in a post. Please define what you mean by transference.
I think we might want to concentrate on what is known, rather than what things seem or sound like.
You stated: "Unless you really do just want to hurt sensitive people who come on here for support?"
What? Where did that come from?
Posted by 10derheart on December 13, 2004, at 16:16:01
In reply to Prognosis » fires, posted by littleone on December 13, 2004, at 14:20:40
Posted by fires on December 13, 2004, at 16:52:47
In reply to Prognosis » fires, posted by littleone on December 13, 2004, at 14:20:40
No. Many sites made the same prognostic statement.
If psychotherapy can't offer any more than "growth", I'd sugggest the BPDs take a look at pharmacologic treatments. Here's just one:
Posted by pegasus on December 13, 2004, at 17:04:50
In reply to Re: Prognosis » littleone, posted by fires on December 13, 2004, at 16:52:47
You don't value growth? That would explain a lot.
This is sounding like a false dichotomy to me. A person could surely use pharmacotherapy for relief of symptoms as well as psychotherapy for growth. In fact, that's what I'm doing, and both parts of my treatment are doing wonders. It would be sad to me to miss the growth part of the equation, but of course, everyone gets to choose what their own goals are.
pegasus
Posted by fires on December 13, 2004, at 19:26:21
In reply to Re: Prognosis » fires, posted by pegasus on December 13, 2004, at 17:04:50
> You don't value growth? That would explain a lot.
>
> This is sounding like a false dichotomy to me. A person could surely use pharmacotherapy for relief of symptoms as well as psychotherapy for growth. In fact, that's what I'm doing, and both parts of my treatment are doing wonders. It would be sad to me to miss the growth part of the equation, but of course, everyone gets to choose what their own goals are.
>
> pegasus
>
>
First, I feel that your rhetorical question is quite offensive. I feel that it is a thinly veiled sarcastic putdown.I tried the growth part of the equation and found it akin to malpractice. For a patient to have to endure psychotherapy for physical problems due to a Ts lack of medical knowledge is inexcusable. I'm sure that you are aware that T is continually having to psychologize problems of living because meds have made such a signicant inroad into "emotional" disorders.
In my state, CA, it got so bad a few years back that Ts (non MD types) lobbied to try to get laws to allow them to prescribe!! Wanting for patients? You bet.
Then came Oprah, Dr. Phil, and other pop psych personalities to save the day.
They even have succeeded in getting people to believe that they primarily over-eat for "emotional" reasons - imagine that-- and they are both over weight!
Posted by gardenergirl on December 13, 2004, at 19:43:19
In reply to Re: Prognosis » pegasus, posted by fires on December 13, 2004, at 19:26:21
> First, I feel that your rhetorical question is quite offensive. I feel that it is a thinly veiled sarcastic putdown.
Fires,
In the spirit of equal time, I just wanted to let you know you might want to consider rephrasing this. Merely adding "I feel" to what you are saying does not an "I" statement make. If you wish to consult the FAQ for more information you can find it at http://www.dr-bob.org/babble/faq.html#civilregards,
gg
Posted by Gabbix2 on December 13, 2004, at 19:51:18
In reply to Re: Prognosis » littleone, posted by fires on December 13, 2004, at 16:52:47
> No. Many sites made the same prognostic statement.
How many is many? Do they all agree on the definition of borderline personality disorder? Could you provide the links to the many sites please?
Posted by gardenergirl on December 13, 2004, at 19:54:26
In reply to Re: Prognosis » pegasus, posted by fires on December 13, 2004, at 19:26:21
> I tried the growth part of the equation and found it akin to malpractice. For a patient to have to endure psychotherapy for physical problems due to a Ts lack of medical knowledge is inexcusable.
Just curious, but wouldn't an MD be a better professional to consult for physical problems? I'm not sure how a T's medical knowledge could supercede the diagnosing physician.
And your use of the word "endure" is interesting. Why couldn't you get out of it?
>
> In my state, CA, it got so bad a few years back that Ts (non MD types) lobbied to try to get laws to allow them to prescribe!! Wanting for patients? You bet.I'm not sure how much you have read about this new trend, but wanting for patients is not a driving force behind it. Increased access to care, particularly in more rural or underserved areas and a better ability to monitor the effects of the medication, as clients are usually seen weekly for therapy, are the primary reasons for the push. Thus, the two states to enact such laws to date: New Mexico and Louisiana are two states that acted in order to provide their residents with improved access to mental health prescribing providers, as they both have significant rural and underserved populations.
> They even have succeeded in getting people to believe that they primarily over-eat for "emotional" reasons - imagine that-- and they are both over weight!
Hmmm, anyone care to lay odds on what the topic du jour of the next public service announcement might be?
gg
Posted by TofuEmmy on December 13, 2004, at 20:25:04
In reply to Re: Prognosis » fires, posted by gardenergirl on December 13, 2004, at 19:54:26
>Hmmm, anyone care to lay odds on what the topic du jour of the next public service announcement might be?
gg
Dang it all gg.... I just polished off those chips. And I was all comfy cozy and happy, and then .....poof....it all vanished!!
Emsky hanging her head in anticipatory shame
Posted by littleone on December 13, 2004, at 20:46:25
In reply to Re: Prognosis » littleone, posted by fires on December 13, 2004, at 16:52:47
> No. Many sites made the same prognostic statement.
Of course they have. Many of these sites are medical based sites with the same symptoms/treatment/prognosis format.There are some excellent mental health sites out there and generally speaking you will find that they give a more thorough description of how treatment can or can't assist. One such site is at the below link (although I never seem to be able to make those rotten links work).
http://mentalhelp.net/poc/view_doc.php?type=doc&id=476&cn=8
> If psychotherapy can't offer any more than "growth", I'd sugggest the BPDs take a look at pharmacologic treatments.
Quoted from the above site. I think it says it all:
"Like with all personality disorders, psychotherapy is the treatment of choice in helping people overcome this problem. While medications can usually help some symptoms of the disorder, they cannot help the patient learn new coping skills, emotion regulation, or any of the other important changes in a person's life."
Don't underestimate the value of growth Fires.
Posted by Gabbix2 on December 13, 2004, at 21:26:36
In reply to Re: Prognosis » fires, posted by littleone on December 13, 2004, at 20:46:25
New Knowledge & New Conceptions.(Borderline personality disorder)
Psychiatric Times, July, 2004 by Gunderson, JohnByline: John Gunderson, M.D.
Our evolving understanding of borderline personality disorder (BPD) and its treatment is reflected in each of the contributions to this Special Report of Psychiatric Times. This evolution includes the surprising evidence that this disorder has more significant genetic determinants and many patients have a far better prognosis than had previously been thought.
<snip>
John M. Oldham, M.D.
article for Primary Care Physicians)THE BORDERLINE PERSONALITY DISORDER
NEW MANAGEMENT CONCEPTS
The Borderline Personality Disorder (BPD), a psychoneurological disorder affecting tens of millions [1,2] is now treatable with a combination of medication and other therapies. Fortunately fluoxetine (Prozac) [3] and low dose intermittent neuroleptics [4] can stop most of the mood swings, and many of the irrational behaviors.
Treatments: Medications:
<snip>
Psychological Counseling: Borderlines need a multidisciplinary approach. A good therapist is necessary, and borderlines should be strongly encouraged to get into counseling. For some, a psychologist/family physician team is very effective. Referral to a psychiatrist may be necessary. Psychiatric hospitalization is occasionally required, especially for strong suicidal ideation.
<snip>
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