For just under a year now, I’ve been receiving SCM (Structured Clinical Management) for my EUPD (Emotionally Unstable Personality Disorder), and I’d like to explain, in detail, what it entails – especially for anyone just beginning their journey and feeling apprehensive.
🧠 What Is SCM?
Structured Clinical Management (SCM) is an evidence-based treatment approach for people with BPD (Borderline Personality Disorder), also known as EUPD. It draws upon techniques from:
DBT (Dialectical Behaviour Therapy)
MBT (Mentalisation-Based Therapy)
CBT (Cognitive Behavioural Therapy)
It’s structured but flexible, deeply personalised yet broad enough to be effective for many.
🧍♀️ What Does It Entail?
🤝 1–2–1 Sessions with a Keyworker
Therapeutic Relationship
A key focus of SCM is building a strong therapeutic relationship. You’re usually assigned a keyworker who sees you at regular intervals — typically once a week for a 1:1 session lasting around an hour.
Psychotherapy
These sessions are where the core therapeutic work happens. You’ll begin to understand:
The symptoms and presentations of EUPD
Interpersonal challenges like unstable relationships, fear of abandonment, and self-image issues
Patterns of emotional reactivity, self-sabotage, and low self-worth
Crisis Management
When you’re ready, your keyworker will help you create a crisis (or safety) plan. This might take a few sessions and includes:
What calms you down
Who can support you
Coping tools and resources
Step-by-step actions from early warning signs to full crisis
🧠 Personally, this plan was essential during my first six months. It helped me recognise different stages of emotional distress and respond more effectively. For example, mindfulness wasn’t helpful during crisis but using TIPP skills was. Having everything laid out like a ladder helped me jump to the right strategy faster.
The aim? To reduce self-harm and suicidal ideation, and to help you feel in control of your responses.
Problem-Solving Skills
Current problems are broken into manageable parts and worked through over one or more sessions. You learn to evaluate options and make clear, rational decisions.
This helped me become less reactive and more objective. Passion should be fuelled by the heart — but driven by the mind.
Goal Setting & Day-to-Day Functioning
Living with EUPD can drain your motivation and blur your sense of direction. SCM supports you in:
Rediscovering goals
Rebuilding identity
Creating realistic, achievable steps toward a better quality of life
Emotion Regulation
You’ll explore:
Triggers and early warning signs
How to label and understand emotions
The function and need behind each emotion
The link between emotions and behaviours
You’ll also learn distress tolerance skills, such as:
Distraction
Self-soothing
Delaying impulsive actions
Safer alternatives to maladaptive coping strategies
This helps reduce the confusion and guilt that can follow emotional overwhelm.
🧑🤝🧑 Group Sessions
Once you’ve had time to build rapport with your keyworker, you may be invited to attend group sessions (depending on your readiness and suitability). These are usually:
Weekly and during term times.
Last a little longer than 1:1s
Offered alongside individual therapy
Group Work Covers:
The same topics as 1:1 sessions, but in more depth
Delivered in modules (some lasting weeks or months)
Led by trained SCM practitioners with handouts, exercises, and take-home materials
Why Groups Matter:
Group work increases your visibility, validation, and peer connection.
Personally, it was life-changing to realise I wasn’t this “three-headed, eight-eyed alien.” Being in a room with people from all walks of life who shared similar experiences helped me accept my diagnosis. I wasn’t weird, I was just human. And in that space, I felt seen in a way I never had before.Everything that I was previously ashamed of and hiding regarding my mental health was now seen and validated.
🩺 Consultant Reviews
Alongside therapy, you’ll also have consultant reviews for:
Diagnosis (if not already confirmed)
Medication reviews, typically every six months (but more frequent if needed)
🧪 Healthcare Monitoring
Depending on your medication, you may receive routine health checks, including:
Blood tests
ECGs (electrocardiograms)
These are usually organised by the SCM team to safeguard your physical health alongside your mental wellbeing.
The Discharge Period
Going from twice-a-week contact to nothing at all would terrify most people in recovery; that’s why the discharge period is so gentle. Once groups are finished, you will go back to just 1:1 sessions with your keyworker, and then gradually drop down to bi-weekly sessions, and then monthly. Again, all at your pace. If you’re not ready, you’re given more time. You can even do groups again, if you want. It’s an empowering discharge, not a scary one. The whole journey for SCM lasts approximately two years.
🌿 My SCM Journey
When I began, I’d already had CBT and felt very closed off to therapy. I saw SCM as a stepping stone — just something I had to “get through” to reach what I thought would be the real help.
But within three months, I started looking forward to my sessions. I noticed I was using the skills subconsciously, even outside of crisis moments.
My keyworker’s constant positivity annoyed me at first because as she always says, ’emotions love themselves’ and I just wanted to wallow in my pain. But slowly, I started thinking like her. I’d look for the positive even in my most challenging situations. I wasn’t just learning skills; I was living them. And that changed everything.
Now, nearly a year in, I’m:
Reducing my medication (Venlafaxine down from 187.5 mg to 150 mg; Aripiprazole from 10 mg to 5 mg with another review in 3 weeks)
Genuinely considering a future without medication — something I never thought I’d say
Living with better emotional awareness, much fewer crises, and more trust in myself
🏥 How to Access SCM in the UK
SCM is usually offered by the Community Mental Health Team (CMHT), a secondary care service within the NHS.
How to Get Referred:
Your GP can refer you, but this isn’t always straightforward.
It took me over two years of persistence.
Many GPs will suggest SSRIs/SNRIs or talking therapies first.
If you believe you may have EUPD and feel SCM could help you, please talk to your doctor and advocate for yourself.
💬 Final Thoughts
This process may sound overwhelming but I am much more overwhelmed, positively, about my progress in recovery and I’d like to assure you that every step is taken at your pace, with your input, and within your boundaries. Trust takes time — but healing is possible.
You deserve help. You deserve to feel better. You deserve to feel happy. And I truly believe SCM is an incredible chance at a new lease of life. I have gone from thinking therapy was useless and a waste of time to now not being able to imagine a life without therapy. Good luck, no matter where you are in the journey. 🤍
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