Q. I have been diagnosed as Bipolar II, PTSD, and Borderline. I have been in therapy for 10 years with the same therapist and he isn't helping me anymore. I feel that my treatment has gone stale. I have been hospitalized numerous times, 6 times in the past year alone. My Psychiatrist and my Therapist seem to argue over what type of treatment I need. I feel like a child caught in a custody battle. I explained this to them both and now I have to see an expert in trauma disorders for a consultation as to what type of treatment approach will be beneficial.

I am scared to do this because I feel that I am being drug along into another 10 years of therapy that won't help. I am scared that I have a lifelong sentence of being miserable and that there is no future for me. Then I am also scared of change for the better. I try to tell myself that change is good, but I feel that I am comfortable in my misery that I should stay there. This has made everyone who works with me see me as "treatment resistant." While I don't feel I am, I can't convince my team that I'm not.

What can I do to counter my own self-sabotaging behaviors in order to get the right treatment? I have tried cognitive restructuring of my thoughts but it hasn't helped. I really don't want to be stuck anymore, but I'm scared of the unknown. My Therapist doesn't help me in this area. I feel like I need to be "pushed" more, but my Therapist tells me that he won't do that since he wants the therapy to be around my agenda and not his. I've tried to tell him that it's not working but he turns it around onto me and my resistance. My Psychiatrist is helpful but her boundaries are really strict with me so I am unable to see her (or talk to her) except for 15 minutes every week. I will go see the specialist, but how do I trust that the treatment approach he recommends is right?

A. I am not sure what to tell you. Any new treatment has the risk of success or failure. If you are happy with the way things are going, then continue to do more of the same. If not, then you need to change. We have published extensively on using medications in borderlines, and there are a number of letters in the archives of this site covering their use.

Personally, I am a proponent of change if what one is doing is not working. If your doctor and therapist feel seeing another party for a consultation is indicated, it is probably in your best interest to do so. I have never met a borderline in my practice that gets better by therapy alone nor medicines alone. They need both.