Borderline Personality Disorder (BPD): Symptoms, Etiology, Treatments and Legal/Ethical Challenges

Probably no other mental disorder has stirred up more emotions and evoked more fascination and trepidation in therapists as the treatment of borderline personality disorder (BPD). In the past, it has been considered to be untreatable and hazardous to therapists who attempt treatment. Defense attorneys have warned therapists, “You’re one borderline away from losing your license.” However the BPD has undergone a significant re-conceptualization in the last decade in terms of understanding its symptoms and causes, and getting better clarity in regard to prognosis and treatment. Once considered an intractable condition, it is actually amenable to several treatments, which have gained empirical support. Research shows that some of the most traditional therapeutic techniques can also be effective with some BPD clients.

Due to the intense transference and the counter-transference, BPD treatment can be very volatile, unpredictable, intriguing and stressful. Taking into consideration that clients who have been diagnosed with BPD, more than any other group, are likely to file lawsuits and complaints with licensing boards, this course will help insulate therapists against the legal actions by people with BPD. Understanding the nature of BPD, the likely actions and reactions that are common during therapy, the course outlines simple therapeutic, consultations and record-keeping steps that therapists can take to reduce the risk. This intermediate level course introduces students to treatment principles and techniques, the latest theories and understanding of BPD so therapists who have shied away from treating BPD clients in the past need no longer automatically fear volatile therapy relationships and treatment failures.

This course covers the diverse symptoms of BPD, explores its etiologies from several perspectives, including cognitive, behavioral and psychodynamic. It reviews the important work of John G. Gunderson, MD and Marsha Linehan, Ph.D. and explains several of the effective treatments, including Cognitive behavioral: Dialectical behavior therapy; Psychodynamic and psychoanalytically-based therapies; Interpersonal psychotherapy: Principles and applications; and Mentalization-focused therapies. It covers the complicated comorbidity between BPD and Axis I mood disorders and how that affects treatment decisions. The strange phenomenon of “vanishing” BPD is explored in depth-clients who, sometimes even without treatment, eventually no longer meet DSM criteria for BPD. The common antidepressants and anti-anxiety medications used for addressing the comorbid Axis I symptoms of BPD are explained in depth. Two articles look at the potential legal and ethical pitfalls of working with BPD clients and explain how those situations can arise and how to avoid these pitfalls while still doing effective therapy. Additional resources and references are provided for further study, but they are not part of the course.