I've been learning about General Psychiatric Management (GPM) for BPD — Gunderson's model that emphasizes a pragmatic, stabilization-focused approach (less intensive than DBT, TFP, or MBT).

From what I've read, it’s designed for generalist clinicians to deliver effective treatment without needing specialized certification, and it has some RCT support (McMain et al., 2009), suggesting it can be comparable to DBT for many clients.

One interesting point is that Gunderson explicitly states the first intervention is unapologetically disclosing the diagnosis to the client. I'm sure this ruffles some feathers among those who emphasize non-pathologizing; my current practicum site, for example, does not believe in disclosing diagnoses to clients, something I have to navigate.

Regardless, I'm curious about the broader professional take:

What are everyone's thoughts on GPM? How does it compare to DBT, MBT, Schema Therapy, or psychodynamic approaches in your view?

EDIT: Gunderson also posits that BPD is a latent genetic component and not exclusively environmental -- I tend to agree. I recognize this perspective can be disconcerting for some.

I’m a 31 year old LCSW with my own private practice. I am also the breadwinner for my family—I make 2x to 3x what my partner does and pay for most things. That’s to say, I can’t really make less unless I sell my house and put off having children (or not have children at all).

I would LOVE to get a PhD. Not only would I enjoy the research-based word, I am very interested in getting into assessments and report writing and would love to incorporate that into my work.

What I’m gathering from my research is that unless I fall into like 5 years of salary so that I can take the time off, there’s no way forward with this (unless I just get a PhD when I retire lmao). Part time programs aren’t accredited, they don’t want you to have a job during your time in classes, and stipends are probably 25% to 30% of what I make now.

Is this true? Should I give up/move on if being the breadwinner is non-negotiable and neither is inheriting a large trust fund? lol

Edited to say: I’m not interested in other PhD programs such as Social Work—it wouldn’t change and diversify my scope of practice enough for it to be worth it.

I’m taking the exam in 10 days. This will be my third attempt. I have been studying very intensely for 4 months using AATBS. I want some advice about my readiness to take the exam Practice exam #2 study mode: 70%; #3 study mode: 71%; #4 study mode: 73% Test #7 test mode last week was 64% Test #8 test mode TODAY was 61.78%

I’m feeling incredibly confused and disappointed. Do i have a Chance of passing? Given others previous posts here it seems I’m in the ballpark but 61% with 10 days until the test feels totally defeating. For reference I got 433 on BOTH previous attempts. I’d love feedback. Thank you so much in advance!!

While I can see its connection to ACT, I find it interesting that some of it can also relate just as/perhaps even more strongly with, CBT.

For example, it talks about rules. For example "I need to be nice to people in order to not feel bad" But these rules really sound like core beliefs. So they can also be targeted via CBT. So yes, cognitive defusion for example can help in this regard, but I would argue only to a point, it seems like ultimately CBT style interventions such as cognitive restructuring would be necessary.

I also think that a lot of RFT principles are just common sense. They make certain common sense observations (such as the word fox = an actual fox = a picture of a fox) into a formal science with boxes and categories and arrows and fancy labels such as "combinatorial entailment".

I think they are trying to show that a lot of psychopathology results from A) classical conditioning B) operant conditioning C) relational conditioning. And they are trying to focus on C.

But again, in terms of practical clinical utility, I think they overdo it at times. I think practically/clinically, the biggest takeaway from RFT is that language can be exaggerated/general language can be used to exaggerate negative thoughts/feelings even when the language is not objectively that relevant/applicable/valid in terms of a specific context. And what follows from this in terms of clinical interventions is for example cognitive defusion. But if you think about it, cognitive defusion is just psychoeducation to the client: you are just explaining to them the pitfalls of language, you are not actually doing anything to change their distorted/incorrect use of language. I guess you can argue that this is done through the experiential exercises, but I don't think some metaphors about cognitive defusion for example are going to be sufficient in this regard. The metaphors will just help the person remember the concept faster, but it won't necessarily change their belief in their rules/core beliefs (see 2nd paragraph from the beginning of this post), or it won't change their distorted/incorrect/exaggerated use of language: to do this you need to address these errors using CBT. I would argue that incorrectly using language is also a form of cognitive distortion.

This is a very broad question, and I know the obvious immediate answer is that there is no definitively correct way to do it. People are different, have different issues and personalities, and therefore respond differently to varying approaches.

That said, I’m genuinely curious: is there a most legitimate or grounded method therapists use to guide treatment planning, especially when starting with a new client?

For example, to my understanding, psychiatrists often approach things through a clinical and medical lens and prioritize diagnosis and medication as a foundation. A patient might come in with symptoms of depression or anxiety, and the psychiatrist evaluates based on DSM criteria, then prescribes SSRIs or other medication as a first step in treatment.

In contrast, clinical psychologists (especially those trained in CBT) might focus on thought patterns, behavior tracking, and goal setting. They may zero in on distortions and coping mechanisms, offering structured interventions based on cognitive-behavioral models.

Psychoanalysts, from what I understand, take a very different route by diving into unconscious motivations, early childhood experiences, and deep patterns over long stretches of time. It’s more exploratory and interpretive than action-based.

The list continues on with various other therapies like humanistic therapy or other modalities like EMDR or somatic therapy.

Even now, I'm in therapy with a Christian therapist, and the things I hear are obviously very different and specific than a secular therapy program. Granted, this decision was of course deliberate, so I have the ability to appreciate and utilize what I hear because it falls in line with my personal beliefs. But, coming into it with a lot of what seems like depression and obvious anxiety, I feel like if I theoretically took my issues to a psychiatrist, I could get some sort of diagnosis within the first couple of sessions. On the contrary, with my current therapist (whom I do thoroughly like), I don't see a diagnosis coming anywhere down the line. That's not to say I want one, but it does make me wonder how different kinds of therapists view these things, like disorders, and their objectivity/concreteness.

So I guess my question is: Is there any consensus on what the most grounded or widely respected framework is for approaching psychotherapy in a general sense? Or is the answer always going to be “it depends”? Are there approaches that are more evidence-based across populations or conditions? I’m not looking to discredit any modality—just hoping to better understand the logic behind how therapists choose a direction, especially early on with a new client.

Would love to hear how professionals (or those in training) think about this. Thank you.