Posted 6/4/2011 10:15 PM (GMT 0)
I've done DBT and swear by it. It was poorly administered but I still got a lot out of the theory and put it into practice each and every day and I am in a much better spot than I was prior to DBT. I only had a BPD diagnosis at the time I did the course - and because the course I did was poorly administered I was driven to exhaustion by the DBT team for my undiagnosed bipolar - being accused I wasn't using my skills well enough. In reality, what skills that are sometimes required by BP are different to BPD. (Please don't use BP as a reason not to apply DBT fully though - it is up to you to negotiate what works best for you). Also try to get the most skilled member on the team that can deal with the complexity of a dual diagnosis. My first worker was 20 years younger than me and straight out of uni, with only a similar degree to me. I negotiated that I get a far more experienced, far higher qualified person and things were much better. They were my issues and will have your own unique issues. It is a challenging course but well worth the effort. Also, given you will be going in with the double diagnosis the team won't drive you to exhaustion, making your BP worse.
It usually takes time to get into DBT. I found an ACT Mindfully Course which I did prior to DBT. It is important you don't do any other therapies while you do DBT but ACT is one therapy which is a compatible predecessor to DBT. ACT doesn't have the same behavioural management components in it that DBT does, at least I don't think so. DBT is much more streamlined in managing your physical health - eating, sleeping, meditating, exercising; managing your interactions with others despite how my may feel inside; giving specific techniques on how to soothe extreme emotions ourselves. ACT and DBT both work on the principles of accepting reality as it is and making room for painful feelings as a way of both reducing and tolerating pain.
You may have read I don't metabolise medications all that well. I take 75mg of Efexor, 100mg Tegretol and recently we have added Agomelatine (dose is still being established) - and Microleut to even out the hormonal swings. My medication doesn't come close to stabilising me but these are the only drugs that help me a little and don't make me worse. Other people here are better placed to give you info about what drugs have worked for them. Of course everybody's different and there is rarely anyway to shortcut your own journey through the med labyrinth, but it does help to research what treatments are available and have an active role in managing your own heath. Well done :)
(My pdoc and I are considering ECT for me given that I've been trialling meds for 21 years and haven't been stabilised via that route. ECT terrified me 20 years ago, but now I'm putting some degree of hope into it. This is not an option for you to consider though - you have heaps of elasticity left on the medication route - be grateful that your body can metabolise them!).
You are unique, your illness is unique, your therapy will be unique, your medication regime will be unique. You will find what works best for you over time, especially when you are so open to what options might be most effective for you :).