Borderline personality disorder (BPD) content can be overwhelming for therapists and clients due to emotional reactions based upon distorted perceptions. It’s common for those with BPD to perceive mild or moderate—or even neutral—stressful situations as intense restricting circumstances. This often leads to them feeling trapped and overwhelmed, followed by extreme maladaptive behavioral expressions of BPD patterns. When this happens, the best intervention is not to get lost in overt content, but focus on the theme that’s driving it.
To achieve this, we have to align with our clients to make the connection between the underlying content that feeds the distortion that’s encouraging the impulsive maladaptive BPD symptoms expression.
The practical steps to managing extreme maladaptive BPD content include:
1. Initially work backward, link overt symptom expression to underlying driving theme (e.g., abandonment, emptiness, low self-worth).
2. Express empathy clearly as to how it makes sense that the client developed this symptom expression pattern based upon their past experiences that helped create the underlying driving theme.
3. Don’t get lost in comorbidity. BPD is a complex condition and it’s highly likely that you’re contending with more than just BPD, so be on the lookout for complex borderline personality disorder (CBPD).
4. Catch and challenge those extreme self-defaming descriptors that encourage and justify maladaptive symptoms aimed at strengthening underlying themes.
5. Openly, clearly, and consistently encourage your client to try adaptive strategies instead of falling into old BPD maladaptive patterns, such as cutting, acting out, and age regression behaviors.
a. Adaptive strategies can include freezing in place, processing triggering underlying themes, and replacing extreme maladaptive behaviors to increase positive outcomes.
6. Practice and encourage this sequence every session.
These are tough therapeutic processes to identify, work through, and change for clients with BPD. Sticking with it will help you, and them, build insight, feel empowered, and make changes that last over time.
Daniel J. Fox, PhD, is a licensed psychologist in Texas, international speaker, and award-winning author. He has been specializing in the treatment and assessment of individuals with personality disorders for more than twenty years in the state and federal prison system, universities, and in private practice. His specialty areas include personality disorders, ethics, burnout prevention, and emotional intelligence. He has published several articles in these areas, and is author of The Borderline Personality Disorder Workbook and The Clinician’s Guide to Diagnosis and Treatment of Personality Disorders; along with the award-winning The Narcissistic Personality Disorder Toolbox; and the award-winning Antisocial, Borderline, Narcissistic and Histrionic Workbook.