Personality disorders
Long-term psychotherapy for borderline and other personality disorders, in Byron Bay and by telehealth across Australia.
A personality disorder is not a character flaw. It is what happens when the sense of self that should have been built in early relationships was never given the chance, and it is treated by building it now, in a relationship that holds.
I'm a GP, so a Medicare rebate applies to every session, with no ten-session cap, for as long as the work takes.
What it is, and how it is treated
The pattern, not the label
People rarely arrive asking for treatment of a personality disorder. They arrive because relationships keep ending the same way, because feelings swing from unbearable to numb, or because they have been in and out of services for years with a string of diagnoses (depression, anxiety, bipolar, ADHD, PTSD) and nothing has quite fitted or quite worked. Some have been given the label borderline personality disorder and felt dismissed by it.
What these experiences usually share is a fragile sense of self: a self that is steadied by other people and comes apart when they are absent, critical or unpredictable. That fragility is not a flaw of character. It is the predictable result of early relationships in which a child's feelings were not reliably recognised, and often of trauma.
How I treat it
I practise the Conversational Model, a psychotherapy developed at the University of Sydney by Russell Meares and colleagues specifically for borderline personality disorder and complex trauma. In the Westmead outcome studies, people treated with it showed sustained reductions in self-harm, hospital admissions and medication use, and gains in their capacity for relationships and work.
The treatment does not use worksheets or skills modules. It is a weekly conversation, over months rather than weeks, in which I attend closely to what is alive and particular in your experience and, over time, to what happens between the two of us in the room. The aim is not to manage symptoms but to grow the sense of self that was never securely established, so that the symptoms become unnecessary.
Who it suits
Adults and older adolescents with borderline personality disorder or traits; people with complex trauma and dissociation; people with a long history of self-harm, chronic suicidal feelings or repeated crises; and people who have completed DBT or a skills program and are ready for deeper work. It also suits people who have never been diagnosed but recognise the pattern.
It is not the right treatment for someone whose drug or alcohol use currently makes reflection impossible, or who is in an acute crisis that needs a hospital setting. In those cases we can discuss what should come first.
Medicare and referral
Because I am a GP, a Medicare rebate applies to every session, with no ten-session cap. This matters for personality disorder, where treatment usually takes one to two years. You need a referral letter from your GP or psychiatrist addressed to me by name; a Mental Health Care Plan is not required. Sessions are in person in Byron Bay or by video. Telehealth rebates generally need an in-person visit in the previous 12 months.
For referrers: I welcome referrals of patients with borderline personality disorder and complex trauma from GPs and psychiatrists across the Northern Rivers, Tweed and Gold Coast, and I am happy to discuss a patient before referral. Call the practice on 0455 494 858 and I will call you back.