Listen to your treating physicians, is my advice... versus posting a few random words online, then getting feedback based on such limited information and time. If two treating professionals believe PE is the best method for you, then go with that and see what happens.
I agree with Anthony; trust your own Ts. I've been reading a lot of the original research from trauma specialists about PE and other exposure therapies, including research by Edna Foa (the originator of PE), Maryléne Cloitre (who developed a 2-phase approach with skill-building then exposure therapy specifically for survivors of childhood abuse), and others who have looked at whether certain factors might make PE or other exposure therapies less successful. I find these journal articles at ResearchGate, the VA's National Center for PTSD, and The National Institute of Mental Health. I believe the conclusion is that the following factors do NOT automatically exclude someone from benefitting from PE: CSA or other childhood abuse and/or multiple, complex trauma; BPD; non-suicidal self-injury (NSSI); major depressive disorder (MDD); and survivors currently being treated for substance abuse. Suicidality is definitely a basis for exclusion, as is someone who is currently in an unsafe situation (eg, domestic violence), until those physical and emotional safety factors are effectively addressed. I think that the recommendation is to
evaluate self-harm and severity of MDD/BPD, as well as time in recovery for substance abuse, to determine an individual's suitability for PE.
There is a high degree of comorbidity of BPD and PTSD (for many, due to childhood abuse and/or neglect), along with NSSI (not sure about the other factors.) Often, treatment for BPD and some of these other issues do not address underlying trauma, and vice-versa. I think it would be doing a number of people a huge disservice to simply say that PE is not appropriate due to these factors.
Mind you, I'm not a clinician (although I do have a psychology background), and I have some reservations myself about how PE is going to help me given the nature and multiplicity of my trauma history. That's why I did all this research! IMHO, I think that the two-phased approach: stabilization and skill-building,
then exposure, seems best.
That is what we've done in my case. I don't have BPD, but I do have MDD along with PTSD, and I struggle with self-harm urges. I've been attending a skills group based on DBT skills (but which is not DBT group therapy), and working with my T, for 8+ months now (my PTSD "came back" with a vengeance about 10 months ago.) That, plus meds, plus a helluva lotta hard f*cking work on my part and tremendous support from my partner has gotten me to the point of being ready for PE (starting in October.)
For me, the single biggest factor is the strength of the therapeutic alliance: I trust my T, she
sees me, she gets me, she is skillful and compassionate and insightful. She's also a post-doc, just 2 years out from getting her PhD in Counseling Psychology. All the other factors, plus my trust in the quality of the supervision and consultation she is receiving from more experienced trauma specialists, trumps everything else for me. She'll know how to push me if I'm shut down and detached, and how to pull me back and keep me from drowning in memories if I have awful flashbacks or start dissociating. I've seen a lot of therapists over the last 30+ years, including being part of 2 incest survivor support groups (4 months, then 1 year), and she is the
only person I've ever trusted enough to tell "the details" to, to speak the unspeakable. She has reassured me that "no one will get left behind" (btw, I'm not DID, but I do dissociate), that "we will get to all the memories that are now bothering you, over time." She's not approaching this like she would someone with a simple phobia, or a single, adult trauma incident. I don't have to just pick 1 worst memory. That was enough to reassure me.
That said, I'm still terrified! We are going to go on a magic trauma ride together through hell in October, twice a week! Ugh! I'm still looking to others to hear their experience, from the perspective of multiple, child sexual abuse as the primary trauma addressed. But I no longer doubt that it's the right approach at this time.
I hope this was helpful. You might want to try looking at the research on sites I mentioned yourself (just google them, it won't let me post links). Good luck!
