[mich1968]

Hello. I'm desperate for help, so I apologize in advance that I'll likely be crossposting this to other forums.

My girlfriend has quite a lot of issues, chief among them are bipolar disorder, anxiety, post-traumatic stress disorder, and (she hasn't been diagnosed with this one, but she shows the characteristics of it) borderline personality disorder.

She has tried to get help, but she has no money and no health insurance. What she has been able to get is occasional, yet non-helpful psychiatric therapy sessions and a few medications, like Paxil and Klonopin. These medications seemed to help keep her somewhat "normal" for a while, but for the past several months, she has gone downhill. She is completely miserable and wants to die. She has attempted suicide a few times before and I strongly believe she is at risk again now.

She is giving up on life. She sees no point in trying to get help because the help that seems to be available to her, like group therapy, doesn't help. I believe she really needs more serious help than that anyway, perhaps hospitalization where they will actually HELP her and not just ask her questions and then send her home.

I don't have much money either and I am in a whole different state than her, which makes helping her even harder. But I don't care if I end up with even more debt than I have already; I just want to get help for her. I'm not really sure where to turn, though. Low-cost help will only be good if it actually HELPS... so.. maybe financial assistance of some sort would be helpful separate from the psychiatric help. Can anyone point me in the right direction or give me any advice? She lives in Fort Worth, Texas and whatever help she can get would need to be gay-friendly.

I live in Orange County, California... I seriously doubt I'd be able to get her to come here for help, but if there happens to be some kind of amazing facility here, I might be able to get her to consider it.

Thank you in advance.

Hey there. I don't live in the US so I don't know anything about programs that might be running in the area.

> What she has been able to get is occasional, yet non-helpful psychiatric therapy sessions

How frequent are the occasional therapy sessions?

> She sees no point in trying to get help because the help that seems to be available to her, like group therapy, doesn't help.

What kind of group therapy is it?

I'm asking because I am a great believer in DBT (Dialectical Behaviour therapy) for post traumatic stress and for borderline personality disorder. The line between bi-polar and borderline personality can be a fine one at times, and it might be that they have diagnosed her with bi-polar in order to get an axis I diagnosis (helps with funding for treatment sometimes).

> Patients with BPD are active in finding other people who will solve their problems for them but are passive in relation to solving their own problems. On the other hand, they have learned to give the impression of being competent in response to the Invalidating Environment. In some situations they may indeed be competent but their skills do not generalise across different situations and are dependent on the mood state of the moment. This extreme mood dependency is seen as being a typical feature of patients with BPD.

http://www.priory.com/dbt.htm

This can often give the appearance of swinging between good mood and good functioning and low mood and crisis (which helps justify a diagnosis of bi-polar).

I'm wondering whether the group therapy is part of a DBT program or not. If not, I think a DBT program could be helpful.

> I believe she really needs more serious help than that anyway, perhaps hospitalization where they will actually HELP her and not just ask her questions and then send her home.

Unfortunately... Hospital is often seen as basically providing a holding environment (prevention of suicide) in the short term and the aim is to discharge people to their outpatient support team. It is unclear to me what is being offered to her (e.g., whether the group therapy is part of a DBT program or some other program) or not...

> I don't have much money either and I am in a whole different state than her, which makes helping her even harder. But I don't care if I end up with even more debt than I have already; I just want to get help for her.

Sounds like you really want to help her... This must be really hard for you. Sounds like this could be part of the 'active passivity' thing where she is being active in trying to elicit you to help her and it is unclear to me how active (as opposed to passive) she is being with respect to eliciting help from the group therapist? individual therapist? whatever outpatient service she is receiving...

this kind of condition isn't something that can be magically cured overnight by way of medication or therapy. therapy for the long haul, i'm afraid. is she attending group therapy or has she stopped going because she believes it isn't helping her? if she has stopped going then... well... it is impossible for a therapist to help a client who simply doesn't turn up!

do you know what has prompted this crisis / major stress reaction? did something happen in group therapy?

imho the best thing you could do to help her would be to try and assertain what help has been offered to her and help her work through some of her issues about utilising that help. results aren't amazing in the short term. that being said things do indeed get better over time. right now she probably most needs someone who can sympathise with her bad feeling. while it would be a wonderful thing indeed if you could ride on in on a big white horse and rescue her from the situation that isn't the most helpful long term.

i'm fairly sure (since she had the group therapy option) that there are people for her to contact. they can't make her bad feelings go away or change things over night but they might be able to help support her through this rough time.

sometimes it is about riding it through and appreciating that things WILL get better soon. hang in there.

[mich1968]

Thank you for your response.

How frequent are the occasional therapy sessions?

They have been no more than once a month, if even that. It seems when she goes to make an appointment, she can't get in to see her psychiatrist till weeks in advance. I think part of it, too, is her lack of motivation to try to see someone more frequently and distrust in seeing anyone else. I can relate to that, actually. For a long time, I tried different therapists myself and none of them were helpful, so I gave up trying for a while.

What kind of group therapy is it?

I have no idea. I don't think she's even tried it. She doesn't like the idea of talking about all her private issues in a group setting and doesn't think it would help anyway. What she really wants is something like hypno therapy or electro-shock therapy because she is at constant war with her own mind.


do you know what has prompted this crisis / major stress reaction? did something happen in group therapy?

Her current crisis is due to an accumulation of things, including never having gotten over things that happened to her in her childhood. And lately, it seems like no matter how hard she tries to move forward in a positive way, things keep blowing up in her face. And a large part of it is that she doesn't deal with things well... even the smallest setbacks can upset her greatly (which is a characteristic of bpd, I believe). Much of her current issues can be helped to some degree by talking to a good therapist, I'm sure, but there is so much constantly going on in her mind that she can't control, so I'm afraid that kind of therapy won't likely give her as much help as she needs.

[mich1968]

Okay, I am reading the link you posted and just read the line, "An 'emotionally vulnerable' person in this sense is someone whose autonomic nervous system reacts excessively to relatively low levels of stress and takes longer than normal to return to baseline once the stress is removed."

Wow... that is definitely how she is! And reading on, it's certainly describing her in other ways, too. Thank you for this link!

[Hopefull]

If she has all those "mental health diagnosis", they might want to focus on one or two at a time. I suspect that helping her on one would help on the others because some of the diagnostic chategories seem rather artificial to me. I know that it is hard to get in to see a psychiatrist if your are low-income. They tend to have a larger amount of people wanting their services. Does she have an individual T rather than just a psychiatrist? I find that psychiatrist can't do talk therapy or atleast the two that I have had so far couldn't.
How well is the group therapy targeted to her situation? I think that she could probably get some benefit out of it if it is well targeted and she can get comfortable sharing with the others. However, this can be hard for someone to do especially when you add the gay part. I think Texas is in the "Bible belt." For you non-Americans, I mean that Texas is a pretty conservative state and probably is more likely to run into anti-gay views. I am not sure on this but the state is very conservative on the death penalty and some of their other laws. This might make it even harder for her to share with a group in group therapy. However, I would hope that the T would keep the group members respectfull of the lifestyles of the other members. It sounds like you have been trying to help her. All you can do is to try to connect her with whatever options you know of, encourage her to ask her psychiatrist for a referral to any other resources that he/she thinks she can use and be a good listener for her.

hey there. once a month isn't really often enough for therapy :-( once every week would be much better. sounds like she doesn't have an individual therapist, instead a psychiatrist is kind of seeing her for meds review and the like and maybe doing some therapy because she doesn't have a therapist. but i'd agree that it is far from optimal.

> I think part of it, too, is her lack of motivation to try to see someone more frequently and distrust in seeing anyone else.

yeah. i really can relate to that too. would she be able to bring this up with her psychiatrist? it might be the case that he could fit her in more often. or it might be the case... that he can reccomend someone for her to see who she is likely to mesh with. it really is scary to see someone. but that being said... having a therapist she meshes with who can see her weekly is likely to help things considerably.

> She doesn't like the idea of talking about all her private issues in a group setting and doesn't think it would help anyway.

group therapy can be really very scarey. on the upside... everybody finds it really very scarey. usually the group therapist is very gentle and doesn't try and force the person to make big disclosures. it might be that she could go a few times and kind of observe... then see if it feels safe to disclose or not. maybe...

sometimes... the way it helps is that there are things that one struggles with and one comes to think that one really is a freak of nature for struggling with that. sometimes someone else in the group discloses something and we can go 'OMG i get that too!'. and we feel less alone in the world. because we know that other people are going through the same crap. and sometimes feeling less alone... is the most healing thing of all.

> What she really wants is something like hypno therapy or electro-shock therapy because she is at constant war with her own mind.

yeah. i understand the feeling of an internal war :-( unfortunately... hypno therapy or electro-shock therapy aren't likely to help with that (in fact hypno therapy could well make things worse). electro-shock therapy... well it is a little like being medicated into a stupor, i guess. might help for a while but the same old stuff just will keep on coming back.

the internal war can be about dyregulated emotions. feeling really really really really bad and not knowing how to feel better. feeling really hopeless... sometimes that is about a real 'war from within' where one is ones own worst critic. especially when other people have treated us like crap we can come to internalise that and keep the trauma alive by doing it to ourself, basically. because we don't know any different.

the healing thing is kindness... other people being kind and learning to internalise that and be kind to oneself. that kindness can come from sympathetic psychiatrists and therapists and other group members... but life surely is a struggle at times, it surely surely is..

> Much of her current issues can be helped to some degree by talking to a good therapist, I'm sure, but there is so much constantly going on in her mind that she can't control, so I'm afraid that kind of therapy won't likely give her as much help as she needs.

Its partly about learning to have control over those things in your mind that you can't control. Learning how to regulate intensely negative emotions. Learning how to regulate those deep feelings of depression and despair.

And... Learning how to trust. To see the world as being basically a safe and accepting place. An alright place. To be able to get out of ones head and enjoy a sunset or a bubblebath or a friend being there for us being attuned to our feelings.

Time. It is a hard road sometimes... But yeah, maybe you could try and encorage her to ask her p-doc about therapy. To give group therapy a try. To... Post to a message board (maybe) so she might be able to see some benefits to group therapy?