Borderline Personality Disorder in Psychotherapy and Counseling
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Borderline Personality Disorder in Psychotherapy and Counseling.
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Updates Regarding Borderline Personality Disorder
6-23-11: Founder Marcia Linehan tells her own story of triumph and challenge with BPD.
2009 Study: "A randomized trial of dialectical behavior therapy versus general psychiatric management for borderline personality disorder" finds that the new psychodynamically oriented treatment for borderline personality disorder is as effective as Dialectical Behavior Therapy on even the most serious symptoms such as suicidal and self-harming effects. The treatment, General Psychiatric Management, is based on the treatment guidelines of the American Psychiatric Association and has some similarities and differences with DBT. Unlike DBT, it specifically addresses the negative transference in session between the therapist and client. The study, by McMain, S., et. al., is in the American Journal of Psychiatry, 2009;166(12):1365-1374.
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Resources for Clients and Their Families
The National Education Alliance for Borderline Personality Disorders is an excellent place to start for therapists, clients, and their families. In addition to the following resources, it also lists occasional clinical trials for people with BPD.
Families: Engaging families in treatment is an often overlooked component of treating people with BPD. As with serious disorders such as schizophrenia and bipolar disorder, growing research indicates that a systems approach that includes psychoeducation for family members about a client's condition significantly reduces hospitalizations and relapses. The NEABPD runs a Family Connections program in cities around the United States. It's a 12-week program with a minimal charge that uses principles of dialectical behavior therapy to help family member relate to a member with BPD. Through informational sessions and role plays, it addresses topics such as:
- Education on BPD
- Research on BPD
- Family Perspectives and Experiences
- Relationship Mindfulness Skills
- Emotion Regulation Skills
- Effective Communication Skills
- Validation Skills
- Problem Management Skills
In addition to information on the Family Connections program, clients and families can also download for free a 16-page booklet, Family Guidelines, by John Gunderson and Cynthia Berkowitz that offers dozens of specific tips for helping to manage the home environment.
Although it's not part of the NEABPD site, families and therapists may also be interested in the STEPP program (Systems Training for Emotional Predictability and Problem Solving), a promising program to help families with someone who has BPD. The program offers a DVD for about $50 (including shipping) which walks family members through the STEPP program. (For a research article on STEPPS, see Blum, N, St. John, D, Pfohl, B, Stuart, S, McCormick, J, Allen, J, Arndt, S, and Black, DW (2008), Systems Training for Emotional Predictability and Problem Solving (STEPPS) for Outpatients With Borderline Personality Disorder: A Randomized Controlled Trial and 1-Year Follow-Up, American Journal of Psychiatry, 165: 468 - 478).
Also not part of the NEABPD website, but an online support group for family members of people with BPD
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Resources for Therapists
Borderline Personality Disorder Demystified. A good site for overviews of the signs and treatments for BPD, geared primarily toward clients and families but also for therapists.
Interpersonal Psychotherapy. Therapists looking for more information about and training in IPT, an empirically supported therapy, can visit their website.
Dialectical Behavior Therapy. Perhaps the therapy with the strongest empirical support for BPD. Therapists can order materials and receive information on DBT and on training.
Middle Path. A New England-based advocacy and resource center for BPD that presents causes, symptoms and treatments in a straightforward manner, well-suited for clients. It looks at BPD from both an object-relations and biopsychosocial perspective and believes that treatments that utilize both perspectives, such as mentalization and DBT, are the most effective.
Online support groups. A list of several online and in-person support groups for people with personality disorders
BPD World. This U.K. support center for people with BPD is founded by Joshua Cole, who himself has BPD. BPD World offers online support groups, blogs and chat rooms. In addition, the section for professionals has a list of advice for professionals that bears repeating and speaks to the informed and humane quality of the website:
"Working with people who have a diagnosis of personality disorder can be both rewarding and challenging. We have put together a list of do's and don'ts for you. As well as this you may wish to download some information from our online shop."
- Do be non-judgmental and validating.
- Do show respect.
- Do recognize that the distress felt is very real.
- Do seek your own support, from supervision and peers.
- Do remain consistent.
- Do recognize that they are a difficult client group, and it is easy to feel demoralized.
- Do ask for training- it's VITAL.
- Do recognize there may be other, Axis I disorders, which may be more treatable.
- Do recognize that BPD patients are among the most creative people.
- Do look after yourself. If you find it hard to look after yourself when working with this client group, you aren't going to find it any easier to work with them!
- Don't think their behavior is a personal attack.
- Be careful with managing professional boundaries, such as accepting gifts, self-disclosure, out-of-office experiences, meals, texting, home visits, etc.
- Don't let yourself become burnt-out by not seeking support.
- Don't feel guilty for strong emotional responses to clients.
- Don't act on the emotional responses-that's what supervision is for.
- Don't underestimate risk-it is easy to become complacent with someone who has a long history of self-harm.
- Don't be afraid to challenge the patient, let them know how their behavior is affecting you!
- Don't be tempted to collude with the patient, even if you secretly agree with them!
- Don't treat the patient like a child-they may behave like one at times, but this will not help!
- Don't put yourself at risk-if you feel out of your depth, seek support from the appropriate place.
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Risk Management with Borderline Personality Disorder
Critique of BPD Diagnosis
Should We Abolish the Diagnosis of Borderline Personality?