Interestingly, borderline personality disorder (BPD) is one of the most challenging disorders to treat, but it is also the most successfully treated personality disorder. Many mental health providers, myself included, often feel overwhelmed and stuck with our clients who fall along this complex spectrum. Below I’ve listed three perspectives and strategies to help you increase the probability of success with your clients along the BPD spectrum.
Resist the antiquated stigma that BPD is only composed of individuals who self-harm, are overtly aggressive, and resistant to change. They’re actually a treatment-seeking group that is afraid, and lack the skills to do things differently.
One of the universal components of personality disorders is impaired insight. Without insight, how can you understand your own motivations to engage in maladaptive or adaptive patterns and how they’re likely to impact the self and others? Building insight through slow cognitive and emotional introspection encourages long-term change.
Skills, skills, skills. We need to teach our clients skills in the very first session. Often, we wait until the third session, but this may be too late for many. Identify an area to focus on, such as abandonment fears, and ask your client to embrace a safety object. This is having them find an object—could be in your office, their home, or have them buy something special in a store—and sit with this object, feel connected to it, and pair it with memories and feelings of hope for change and the future. You’ll want to encourage this secure attachment to this transitional object. It can really help them feel safe and grounded when those feelings of being overwhelmed and under high stress arise.
Treating BPD is a slow process, but one that can be very professionally rewarding when change becomes evident to not only you, but to your client and their family, partners, and friends as well.
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.
