Q. I was recently diagnosed as BPD and the course of treatment at this particular psych clinic is group therapy. No individual therapy is ever given, unless the group leader feels there is a special need. There is a life check option, where a half hour appointment with one of the therapists is given in times of extreme suicidal tendencies. This tells me a few things. That I am not trusted one-on-one with a therapist, that the clinic doesn't trust any of their therapists to be able to treat someone with BPD, and that by only offering individual sessions at times of crisis, they are almost encouraging us BPD's to create the crises that would get them the individual sessions. Now, what I'm wanting to know, is do you think group therapy alone is productive? And, do you think medication is necessary, when all the self injurious/destructive behaviors are under control?

A. I believe medications are needed all the time, whether you are still self-injurious or not. The thoughts and actions borderlines take are biologically driven, and demand biological interventions.

I also think you are misinterpreting the group therapy idea. We offered only group therapy too, but not because of trust or cost issues. We found that borderlines did not learn much from the therapist, but from the other borderlines in the group. Sue Wagner, the therapist I worked with, figured this out. Comparing groups to individual clearly showed groups gave better outcomes. That said, every single one of our patients were on medications. Therapy is much less effective without medications.