Therapies & Medications
Behavioral symptoms are a major part of Borderline Disorder that cause disruptions in normal development of effective patterns of behavior and in relationships. It is imperative that you have a safe, supportive, and effective relationship with a therapist who is able to help you learn about your illness, what it means to you, and how you can use psychotherapy to help you gain optimal control over your symptoms.
Researchers and medical experts have identified a range of therapies that have been shown to help people who have Borderline Disorder. Finding the right therapy for you will depend in part upon the relationship you create with both your therapist and the support group you build around yourself. Those lasting, trusting relationships will be as important to you in your effort to build a successful life as the therapy you engage in. Working with a therapist to understand how effective a therapy can be for you is a critical part of beginning your journey onto your treatment path.
Engaging in therapy requires emotional work. Know that you will have to be patient with yourself in the process, that the results will not be instant, and that there may be times when you are uncomfortable with the direction the therapy is taking you. Continue to invest in yourself. As therapy progresses, you will learn a tremendous amount about yourself, the people that you love, your relationships, and about how Borderline Disorder impacts your life. Think of therapy as the exciting and revelatory process that it is. Through this process you have the amazing opportunity to begin to change the course of your life.
Types of Therapy
Eclectic Combination Therapy: A therapeutic approach that incorporates a variety of therapeutic principles and philosophies in order to create the ideal treatment program for a person’s needs.
Good Psychiatric Management (GPM): Developed by John Gunderson with Paul Links, GPM is symptom targeted and integrates psychodynamic psychotherapy, case management and pharmacotherapy in treating Borderline Disorder. GPM concentrates on treating spontaneous and unstable moods, impulsivity and aggressiveness.
Psychodynamic Therapy: Involves close collaboration between you and the therapist by exploring your underlying thoughts, feelings and motivations. Based on the theories of psychoanalysis therapy, but different in that it balances the therapist/client relationship with the relationship the client has with their external world.
- Mentalization-Based Therapy: A form of Psychodynamic Therapy that focuses on an individual's emotions and the emotions of others, how to identify those emotions correctly, and respond in appropriate ways to those emotions. While most people develop these attachments and learn to understand emotions in early childhood, Mentalization-Based Therapy for the treatment of Borderline Disorder is helpful in establishing those skills later in life.
- Transference-Focused Therapy (TFT): This is another form of Psychodynamic Therapy for individuals, which is like psychoanalysis in its analysis and in reframing an individual’s understanding of their emotions. Through TFT, individuals work with their clinician to identify and correct perceptions that may have become distorted.
Cognitive Behavioral Therapy (CBT): A short-term, evidenced-based and goal-oriented therapy where you work with a clinician to identify, understand, and change unhelpful and negative thoughts and behavior patterns, exchanging them for more positive ones through a series of homework tasks or exercises, reinforcing new attitudes and behaviors. Cognitive Behavior Therapy involves work in these four steps:
- Identifying difficult situations and problems in your life and establishing goals to work on to remedy those problems or conditions.
- Awareness of your thoughts, feelings and beliefs about the situations and problems you identified.
- Identifying inaccurate or negative thinking. In learning to recognize negative or false patterns of thinking that may be making your problems more complex, you and your therapist will work together to understand your behavioral and emotional responses.
- Reshaping inaccurate or negative thinking. Your therapist will help you understand if your beliefs about a given situation are based on fact or perception, and help you evaluate old patterns of thinking.
Grounded in these four principles, Cognitive Behavior Therapy requires that the client is committed to work with the therapist and be open to changing their negative behavior patterns. Cognitive Behavior Therapy is usually a short-term therapy, ranging from 10 to 20 sessions. You and your therapist will work together to decide the correct length of treatment for you depending on your symptoms, how you progress, the stresses in your life and your support system.
Dialectical Behavior Therapy (DBT): Created by Dr. Marsha Linehan in the 1980’s using Buddhist mindfulness techniques, Dialectical Behavior Therapy (DBT) is a comprehensive, evidence-based treatment therapy that focuses on problem-solving and acceptance-based strategies designed to help clients understand and process opposite concepts of change and acceptance. Originally created to treat Borderline Disorder, it is now utilized to treat other disorders as well. Research indicated that DBT strengthens an individual's tolerance for stress and their ability to handle stress without acting out. Dialectical Behavior Therapy focuses on helping you develop four basic skill sets that will help you to not be overwhelmed by your emotions:
- Distress Tolerance: Skills to help soften upsetting circumstances and help you cope with difficult events by building your tolerance and resiliency.
- Mindfulness: Skills to help you be more present, to focus less on the past and future and their painful circumstances. Mindfulness gives you tools to create new patterns and to stop judging yourself and others.
- Emotional Regulation: Skills to help you recognize, name and observe your feelings without beings overwhelmed by them. New skills are learned to help you moderate your feelings without being reactive to them in patterned responses or destructive ways.
- Interpersonal Effectiveness: Skills to help you express your needs and beliefs, create boundaries and solve problems, all while being respectful and protective of your relationships.
Between weekly sessions, you will work on homework assignments to help you build your skill set and to practice the skills you have learned. Dialectical Behavior Therapy can be provided in one-on-one sessions or through group therapy sessions.
Systems Training for Emotional Predictability and Problem Solving (STEPPS) Therapy: A manual-driven class, STEPPS Therapy is usually delivered in a group setting that helps you become aware of the feelings and behaviors that both describe the impact the Disorder has upon you and teaches you the skills to change and manage those feelings and behaviors. Participants in groups of six to ten usually meet for two hours weekly for a total of 20 weeks. After each session, participants typically engage in homework assignments based on cognitive behavioral techniques, helping them learn coping skills to replace destructive old patterns of behavior and to focus on developing new skills to manage behavior and emotional regulation. Family members also receive skills training to learn how to support their loved ones in times of crisis and stress.
Group Therapy: A method of psychotherapy where a group of people meet to discuss their problems and identify new strategies for overcoming behaviors under the direction of a qualified clinician. These groups can be either Interpersonal, for just the client, or Family Programs, for clients and their families. While neither Interpersonal Group Therapy, DBT skills groups or Family Group Therapy are replacements for individual therapy, they are a valuable addition to a comprehensive treatment plan. Progress has been noted when groups are led by one or two skilled facilitators or therapists.
It is often very reassuring for those with Borderline Disorder to share their experiences and help each other deal with the effects of the Disorder. Group therapy sometimes speeds the learning process of individual therapy and provides significant motivation for its participants.
Family Programs and Family Group Therapies exist to help families work better as a unit, learning coping skills and self-care around the emotions and behaviors exhibited by their loved one with Borderline Disorder. Group therapy also provides an important network of families and loved ones with shared experiences around the Disorder, building compassion, support and understanding.
Schema Therapy: A combination model of psychotherapy that integrates the qualities of four therapy types into a single approach:
- Experiential: Clients identify subconscious or hidden issues through activities or active experiences.
- Interpersonal: Attachment focused therapy centered on mastering interpersonal symptoms and problems.
- Psychoanalytic: Using free association, dream interpretation and resistance and transference analysis to explore repressed and unconscious impulses and internal conflicts and anxieties to free psychic energy for work towards mature love.
- Cognitive behavioral therapies: Goal oriented psychotherapeutic approach based in problem solving to change behaviors.
Dr. Jeffrey E. Young developed Schema Therapy in the 1980’s, basing it on a core systematic approach that we all have certain life themes and patterns (or “schemas”). These schemas develop in childhood and then repeat themselves throughout our lives unless we become conscious of them and do the important work to change them. We create these patterns as coping mechanisms in our childhood and they exist because our needs were not met as children. For example, an abandonment schema could represent the unmet need of being safe and cared for. With Schema Therapy, we learn to change these patterns through the experience of having those needs finally met as adults, helping us to heal, to stop harmful behaviors, and to understand our emotional needs.
- Mayo Clinic. “Cognitive Behavioral Therapy.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 29 Dec. 2017, www.mayoclinic.org/tests-procedures/cognitive-behavioral-therapy/about/pac-20384610.
- Psychology Today. “Dialectical Behavior Therapy.” Psychology Today, Sussex Publishers, www.psychologytoday.com/therapy-types/dialectical-behavior-therapy.
- Mayo Clinic. “Borderline Personality Disorder.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 30 July 2015, www.mayoclinic.org/diseases-conditions/borderline-personality-disorder/diagnosis-treatment/drc-20370242.
- McKay, Matthew, et al. The Dialectical Behavior Therapy Skills Workbook: Practical DBT Exercises for Learning Mindfulness, Interpersonal Effectiveness, Emotion Regulation & Distress Tolerance. New Harbinger Publ., 2010.
- Friedel, Robert O. “Borderline Personality Disorder Demystified |.” Borderline Personality Disorder Demystified, 10 Feb. 2018, www.bpddemystified.com/.
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-5. American Psychiatric Publishing, 2014.
- Harley Therapy. “What Is Schema Therapy, and Can It Help You Break Your Patterns?” Harley Therapy™ Blog, 30 Dec. 2017, www.harleytherapy.co.uk/counselling/what-is-schema-therapy.htm.
- U.S. Department of Health and Human Services: Substance Abuse and Mental Health Services Administration. Report to Congress on Borderline Personality Disorder. May 2011.