I wonder whether it is worth taking on the commissioner. To argue that ‘personality disorders’ (for there are many!) can be treated using EMDR is quite extraordinary. EMDR is a treatment for trauma. Its link with BPD is indirect at best- having had a quick look at the evidence base in the literature, Brown and Shapiro in the journal Clinical Case Studies (2006, volume 5, pages 203-420) argue that ‘Given the significance of childhood abuse and trauma, eye movement desensitization and reprocessing (EMDR), a recognized trauma therapy, may be a reasonable treatment option for BPD’. EMDR is therefore only indicated for your daughter if she has a history of childhood abuse and trauma.

In the field where I work, we use a ‘response to intervention model’. Which basically means, the client gets whatever treatment is provided, and only if they do improve, do we then go to the next level. So another line of argument is to consider whether you daughter has shown any improvement following her 10 CBT sessions, or during her time in the crisis unit. What do the professionals treating her say? It may be that she should take up the offer of EMDR, so that it can be established that this isn’t effective for her. The downside of this is that we are effectively ‘waiting’ for clients to ‘fail’. losing time and hope in the process, and putting clients through treatments which are likely to be ineffective. But showing that the existing provision has not helped your daughter may work?

I too looked at self-funded treatment in a clinic programme, and could not possibly have afforded. When you ask who can, well- one private clinic told me that all their patients were NHS patients, sectioned under the mental health act. So it would seem the NHS is the only ‘client’ who can afford private clinic treatment! There are private therapists listed on this page who offer individual therapy and skills training, which is what I did. One, for example, offers a 16 week DBT skills group (2.5 hours a week) for £900, and weekly individual therapy plus skills coaching for £60. I don’t know whether this is more within your means (and I wholeheartedly agree that you shouldn’t have to pay!) but it might be a better option?

Happy to help further if I can. Your daughter is fortunate to have a supportive family member fighting her corner. Best wishes to you and her.

I’ve just finished reading your blog (from the beginning), you sound like such a strong and brave person coping with what you’ve been through. DBT sounds like it can really help and work, it’s such a shame the are so few therapists in the UK. Reading your latest entry was so sad, I hope you’re managing to cope and are doing ok.

If you do have to stick with your current therapist, you could use the same skills to describe the difficulties you’re experiencing in your relationship. The therapist should work hard with you to problem solve these difficulties, since they’re interfering so badly with therapy. The therapist should also reinforce your practice of the skills, by being willing to hear what you’re saying, rather than punishing you for bringing up a difficult issue.

Good luck! Let us know how you get on…

CBT would be the polar opposite, in terms of being very focused on the present, and on your current thoughts, feelings and behaviours, and the factors that maintain the cycles you are trapped in. It sounds like CBT would be more in line with your goals than the therapy you’re currently experiencing. CBT is also quite amenable to working towards the goal that’s important to you (e.g. ‘building a life worth living’). The major limitation is that it is so time limited (6 weeks), but it may be a very good kick start to being able to use DBT skills on your own (using the resources linked to on these pages) to being able to build a life more broadly. There are thousands of people online doing what they can with what’s available online, and they can be very good allies in building a life. Good luck, and do let me know how you get on…

I’ve been unable to find a link for this so haven’t yet added it. Can you point me in the right direction?

I’m not an expert by any means in accessing treatment on the NHS, but a few ideas come to mind:

1. Can you fight the NHS Trust? This would probably involve going through a systematic complaints system, beginning with PALS (Patient Advice and Liaison Service). This could take considerable time. You would need to be clear about whether your priority was to complain about the confusion and false promises, or to access DBT. If you wanted to access DBT you would need to wave the recommendation from the psychiatrist, and the NICE guidelines. It’s not clear from your post whether there *is* DBT provision in your area but you’re not yet at a high enough tier to access it (i.e. you have to go through group therapy and this has to be unsuccessful to be allowed to progress to DBT) or whether there simply isn’t any provision, and group therapy is all they have to offer; in this case you would be fighting them to fund you to have DBT under another NHS Trust. I do think it would be a good idea to get written documentation from the psychiatrist to say that group therapy is contraindicated for you. Or you could ‘comply’, go to the wretched group therapy, and see if they’ll give you DBT after that? I suggest you contact Fenella Lemonsky (link on this page) as she will be much more knowledgeable than I am about how NHS provision works.

2. Can you use your own resources to do DBT? This blog has links to workbooks, websites, skills groups and forums. Apart from the books, these are all free. If your supportive GP agrees, you could even suggest that you have a weekly appointment and look at one skill together, and you then go off and work on the skill for the week. It requires motivation, which is hard to find when you’re at your lowest ebb, but there are thousands of people online teaching themselves the skills and supporting each other.

3. DBT is not the only hope for people with BPD. Does your NHS Trust offer schema therapy or transference focused therapy? Both of these also have good evidence of effectiveness…

I’m sorry you feel so let down. I know what it’s like to feel hopeless and desperate. I hope so much that you can find a way to go forward. Do let me know how you get on.

Very best wishes