Has your T ever advised you against going to the hospital?

Thank you so much, everyone, for your perspectives and advice. I decided to just do it last night and am now in the hospital. I’m not sure if I feel any better but at least I’m safe.

Now that I’m actually admitted, my therapist is being supportive about it, which I really appreciate—I was a little afraid he’d be petulant about it.

I think I can explain the theory behind a person with borderline personality disorder or for that matter anyone with emotional regulation problems not going to the hospital according to the DBT modality anyway. DBT recommends against hospitalization whenever possible, even in emergency situations.

First, it's not that DBT therapists think that the person with BPD is doing it on purpose or is being manipulative or wants to get attention. Reinforcement in behavior theory is anything that increases a behavior. So this can be adding something pleasant or removing something unpleasant. And this is universal. It works in animals, children, adults, clients, therapists. It can happen on purpose or by accident.

Being emotionally dysregulated is extremely unpleasant. It's a negative stimulus. Whatever behavior removes the negative stimulus (or makes us feel better) will be reinforced. So if you feel really horrible for whatever reason, and you go to the hospital and then you feel better, the next time you feel really horrible you'll want to go to the hospital again.

It isn't that going to the hospital is a horrible thing, but DBT theory says that if you go to the hospital to regulate emotions, you are less likely to regulate them other ways. And they think that it is better to learn the other ways of regulating emotions in your own environment with all the stresses present rather than removing you from the environment. DBT does say that the therapist should be available though to help coach you through the skills.

I'm not saying that this is right for everyone or anything. I just wanted to explain the theory and say that it is possible your therapist is thinking of "reinforcement" this way rather than the hospital being some kind of prize or that you are becoming dysregulated in order to get attention or anything.