Preparing For The Search

1. Learn about BPD. While this step might not be necessary if you were looking for help for familiar mental health issues, it is required for borderline personality disorder. There's too much misinformation and out-of-date thinking among mental health professionals. Therapists who don't treat many patients with BPD might easily be unaware of the most basic BPD-specific treatment approaches. Take a look at some of the web sites and books listed at the end of my previous Psychology Today  blog post .

2. Research your insurance. Check to see if there is an approved list of providers, of whether you need a referral from your family doctor. If your insurance company will only cover services provided by one of the clinicians on its list, talk with your insurance provider and ask if they will make an exception. Point out that the right clinician may keep your family member out of the hospital and emergency room, which will save them money.

3. Create a medical history file. This might include:

• Signs and symptoms by age and any special circumstances, such as self-harm occurring after a bad break-up.

• Previous treatment (if any), including the name(s) of the clinician(s), diagnoses given, whether the treatment was beneficial, and anything else that strikes you as important. List all medications currently being taken, their dosages, what time of day they're taken, and what they're for. (It will come in handy when you fill out forms.)

• A list of the medications (and dosages) that have been tried and discontinued. Explain why, such as it wasn't effective or produced undesirable side effects. This will help during the trial and error process. Perhaps a different dosage may produce better results or fewer side effects.

• Anything else that you think a therapist should know, such as family stressors like a divorce, a move, or the loss of an important person in the BP's life. You might also talk about the impact the BP's behavior has had on family members.

Starting Your Search

You can look for help using a mixture of three approaches: searching clinician databases, obtaining a referral, or doing a grassroots search. If your family member has a serious co-occurring illness, you may want to start with a specialist in that area. Substance abuse needs to be addressed before treatment for BPD.

1. Search a Database

Try:

DBT therapists: http://behavioraltech.org/resources/crd.cfm
Psychology Today site: http://therapists.psychologytoday.com/rms/
At BPDCentral.com: http://bpdcentral.com/resources/therapist/main.php

Other databases of therapists exist on the Internet. Although they're not specifically for BPD, they can contain a great deal of information about the therapist--orientation, interests, philosophy, background--and it's easy to hone in on the ones who most interest you.

2. Obtain a referral

• Ask friends and family, and ask them to make an inquiry of their friends and family.

• Ask your other health care providers, especially your primary health physician.

• Make a phone call to the psychiatric department of the hospitals in your area and ask the nurse-manager whom she would recommend if someone close to her needed a psychiatrist or a therapist. You don't have much to lose if you also ask her whom she would not recommend.

• If you already have either a psychiatrist or a therapist, the psychiatrist should have names of therapists to recommend, and therapists should be able to recommend psychiatrists. Make sure the psychiatrist is up to date with the latest studies. Things change very quickly.

• Look up local mental health agencies. Some local mental health services are listed in the phone book in the blue government pages. In the "County Government Offices" section for the county where you live, look for a "Health Services (Dept. of)" or "Department of Health Services" section. In that section, look for listings under "Mental Health."

• Check if your company offers a employee assistance program, which may be able to provide the names of psychiatrists.

3. Perform a Grassroots Search

• Look in the Yellow Pages or do an Internet search. Mental health professionals are listed under "counseling," "psychologists," "social workers," "psychotherapists," "social and human services," and "mental health."

• Take a look at local magazines that may put together lists of top professionals in the area.
• Keep your eyes open for the names of professionals used as sources in the local media.

• After each interview with a potential candidate, ask if they can give you any names.

• Call your local state psychological association.

• Find the most respected medical clinics in town that have a behavior health department. Top clinics like to become associated with top people.

• Speak with your pastor, minister, priest, rabbi, or other religious leader.

• If you have a local university, call its department of psychiatry. These psychiatrists are often on the cutting edge of research. Also, ask for recommendations of people trained in that university's psychiatry or psychology program.

• Contact the National Alliance for the Mentally Ill (NAMI), both state and local branches, as well as any other mental health organizations.

Evaluating the Candidates

Regardless of where you get the name, you should still evaluate each candidate. An effective therapist for a lower functioning, suicidal patient may not be the right one for a higher functioning patient with a different set of problems.

Call or email the offices of the best candidates. Introduce yourself and explain the reason for the call. Leave a voicemail and suggest good times to call you back. Once you connect, ask if they have time to chat with you on the phone for a few minutes. The way the therapist answers the questions is also revealing. A good one should encourage you to shop around for the right therapist and not be offended that you're asking questions.

Consider whether you want to use the actual term borderline personality disorder, especially if your loved one hasn't been formally diagnosed. If you do, the image of lower-functioning, "conventional" BP (suicidal and self-harming) will most likely come to the clinician's mind.

If that doesn't describe your higher functioning family member, be cautious about using it. Even if you do have a lower-functioning conventional borderline family member, you may wish to just describe the traits themselves first to help the therapist keep an open mind. Experiment.

Evaluate prospective clinicians in three areas: hard factors, soft factors, and attitudes and beliefs about BPD.

Hard Factors