Wednesday, 16 November 2016

Letter To Carissa

Estelle Davies
Real Care Health Clinic
245 Park Street
South Melbourne
VIC 3206

Dear Carissa

From the start of our work together on the 15thSeptember this year, it was clear that you are someone with a great deal of understanding and insight in to your mental health difficulties. You started to feel what you describe as' intense emptiness and pain' from the age of 15. You were diagnosed with Borderline Personality Disorder at the age of 17. Over the last 10 years, you have worked to accept the diagnosis, you have attended therapy to learn skills to best manage the symptoms, you have expressed your pain, asked questions, given encouragement through your online blog and you have been working as a patient advocate for a suicide prevention organisation over the last year. 

However, we have agreed that there is a gap in your skill set. When you are feeling overwhelmed by intense distressing emotions you try to challenge your thinking but you find your emotions are often too strong. You can quickly start to dissociate at this point and lose touch with the present. In these circumstancesyou often will end up self-harming.You have made a number of suicide attempts in the last 10 years, some of them have been lethal and you have been admitted to hospital on several occasions.

Family History
You are the eldest of three girls and you were born and brought up in Perth. You have told me that yourfather was verbally and physically abusive towards you throughout your childhood and you now believe that he also sexually abused you. At the age of 17 you found out that your father was having an affair.This placed you in an extremely difficult position but you did the right thing and you told your mother. Your father to this day blames you for the break-up of the marriage. Contact with your father continues to be very rejecting and distressing for you.

Common triggers for your distress
Relationship conflict, relationship breakdown, interaction with your father, recurring intrusivememories from childhood that cause distress
The last year has been very difficult due to your relationship difficulties with your ex-partner It was for you the most emotionally intense and meaningful relationship you have ever experienced. You allowed yourself to be vulnerable with her and you shared some of your deepest secrets. Unfortunately, for you this trust was not reciprocated and you have been extremely hurt by any of her actions. You also feel she has projected her blame on to your BPD diagnosis and this has left you confused and at times full of self-doubt. You are starting to stand back and apply your wise mind but again your emotions have often taken over.

The future
You took the brave step in moving away from Perth to make a new start and you are now very keen to do further work in therapy. You have settled in well, and you have no difficulty finding work as a barista and waitress. You played AFL when you lived in Perth and now you are enjoying being part of an indoor soccer team. You have many supportive friends back in Perth and you are developing a network of friends here in Melbourne. 
We have agreed that a DBT approach would be the treatment of choice for you and we are currently looking into what is available in Melbourne given your financial constraints. Being able to regulate your emotions more effectively is key especially for when the time is right for you to perhaps work through the abuse from your childhood.
You have no Medicare sessions left for the remainder of 2016 but we have agreed that you will pay a reduced private fee and attend less frequently. You can then get a new MHCP in the New Year.
Further into the future you want to give back and help others who find themselves in the same position as you. You feel concern and deep compassion for people struggling with BPD but you need first to focus on reaching a more emotionally stable place yourself.

Looking forward to seeing you again soon
best regards
Estelle 
Clinical Psychologis
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