How to Find Effective Treatment for Borderline Personality Disorder*
What to look for in treatment:
Occasionally I hear those old stories that those with Borderline Personality Disorder are treatment resistant or reluctant to commit to therapy. While this is certainly sometimes true, my experience shows that those with Borderline Personality Disorder typically want to get better, but aren't able to find therapists who can effectively assist them with recovery.
However, challenges often seem to arise when seeking a clinician who successfully treats Borderline Personality Disorder. This is usually due to a lack of one or more of the following on the part of the counselor:
- a skill-set that includes using both validating and soothing language
- an understanding of the basis of Borderline Personality Disorder recovery
- a belief in the effectiveness of therapy in treating Borderline Personality Disorder
Therefore, when interviewing potential therapists, bring along the previous list and ask them questions to get a feel for their competency in those areas.
It is especially important, because of our exquisite sensitivity, that we find a therapist whom we feel understood by. Our clinicians should also have a very positive belief in BPD recovery and expect good results for us. Finally, they should understand how recovery works for us.
So, how does recovery from Borderline Personality Disorder occur?
Highly simplified, recovery happens through a combination of the following:
- Our ineffective thoughts are replaced by thoughts that serve us in a healthy manner.
- Our skills in managing our emotions increase.
- We gain an ability to "put ourselves in another's shoes."
- All while learning to validate and understand our own true needs and gain a strong sense self.
There are five different types of therapies that have been proven to effectively treat BPD:
1. Dialectical behavior therapy. (DBT) is a modification of CBT, or cognitive behavioral therapy, and Zen Buddhism. It was developed initially for patients with borderline disorder, especially those who engage in frequent self-destructive and self-injurious behaviors. DBT teaches the concepts of dialectics, or thinking through many aspects of scenarios, rather than just a black or white approach.
DBT therapy consists of the combination of once a week individual psychotherapy by a DBT intensively trained therapist, a two and one-half hour skills training session conducted in a group setting, and substantial homework assignments.
DBT has been proven effective in a number of controlled research studies, especially in reducing suicidal and self-injurious behaviors, and the frequency of acute hospitalizations.
2. A lesser-used modality is Systems Training for Emotional Predictability and Problem Solving (STEPPS). STEPPS is a group outpatient treatment program developed in 1995 by Nancee Blum to supplement, but not replace, other treatment. In studies for it's effectiveness, the group receiving STEPPS demonstrated a significant reduction in emotional instability, impulsivity, perceptual disturbances and disturbed relationships. They also had fewer emergency room visits during treatment and follow-up.
There were no differences between groups for suicide attempts, acts of self-harm or for hospitalizations, differences that appear to distinguish it from reported results of DBT.
3. Schema-Focused Therapy (SFT) was also specifically developed for treating borderline disorder. SFT groups the behaviors that the borderline patient "flips" through to attempt to cope with their difficulties into five modes, or schemas. These five borderline modes are: a) the abandoned and confused child; b) the angry and impulsive child; c) the detached protector; d) the punitive parent and e) the healthy adult.
The number of therapists specifically trained in this technique are also very limited.
4. Mentalization Based Therapy, MBT was developed by Professors Bateman and Fonagy as a specific treatment for Borderline Disorder. With MBT: a) the therapist focuses exclusively on the patient's current thoughts, feelings, wishes and desires; b) the therapist avoids discussions that are not linked to subjectively felt reality, thus emphasizing more conscious information (the aim of therapy is not insight but increased mentalization); c) the creation in therapy of a climate in which thoughts and feelings can be considered and "played with;" d) the enhanced understanding of the feelings and thoughts of situations prior to their enactments, not their unconscious meanings.
5. Transference Focus Therapy. This treatment focuses on transference -- the patient's moment-to-moment experience with the therapist. It is believed that the information that unfolds during the patient-therapist interaction provides the most direct access to understanding the make-up of the patient's internal world for two reasons. First, it has immediacy and is observable by both therapist and patient simultaneously so that differing perceptions of the shared reality can be discussed in the moment. Second, it includes the affect that accompanies the perceptions, in contrast to discussion of historical material that can have an intellectualized quality.
I would like to add a personal note about TFP. Once you learn to stabalize your emotions, true, long lasting happiness comes from the ability to strengthen the identity and relationships and to sort out internal representation issues. I have spoken recently both with Dr. John Gunderson and Dr. Frank Yeomans and they have helped me understand how TFP helps with this most important part of recovery.
Where to find therapists.
Now that you understand what kind of therapist you are looking for, be prepared to search for a while before you find the right fit. So, where do you find them? Here is a listing of organizations that can help:
Behavioral Tech, LLC, founded by Dr. Linehan, www.behavioraltech.org, lists DBT trained clinicians by location. This list does not include all DBT trained clinicians.
National Alliance for the Mentally Ill (NAMI). www.nami.org Once on the site, locate and visit your local support and education groups for family members or consumers and ask for their referrals.
National Education Alliance for Borderline Personality Disorder www.neabpd.com If they happen to offer a Family Connections class in your area, ask for their referrals (and go to the class if you can!)
Borderline Personality Disorder Resource Center www.bpdresourcecenter.org This organization is dedicated to finding doctors who treat BPD.
American Psychiatric Association (APA) www.psych.org Contact your local branch and inquire about doctors who treat BPD.
Association for Behavioral and Cognitive Therapies www.aabt.org
Also, contact your local university's psychology or psychiatry department and inquire about clinicians trained in either DBT or Cognitive Behavioral Therapy. Or, look over the faculty profiles and see who is interested in researching or treating personality or mood disorders.
Remember to find someone YOU feel comfortable with and trust. They are working for you and are to become a big part of your recovery team. Ask yourself if you are feeling better than you did before you went in. Do they help you feel more relaxed or skillful? It takes some time to really be able to get a good feel for a therapeutic relationship, so give it a few sessions before you make up your mind about a particular clinician.
It is not your fault you have Borderline Personality Disorder, but it is up to you to get better. By taking that important step to find and stick with effective treatment, you are taking very, very good care of yourself and you can turn your life around in ways you never could have dreamed possible!
I'm cheering for you! I did it. So can you
*Thank you to Diane C. Hall, MA, Board of Directors and NAMI Liaison, National Education Alliance for Borderline Personality Disorder, for the information she provided me in writing this article.
