Therapies


Treatment for BPD is complex and dependent on the individual — what works for one person may not work for another. Therapists and treatment facilities often specialize in the types of treatments offered.


A Treatable Disorder

Diagnosis is often a relief when people with BPD realize others understand their experience and treatment options exist.

Transference-Focused Psychotherapy

Transference-Focused Psychotherapy (TFP)

Dialectical Behavior Therapy (DBT)

Dialectical Behavior Therapy (DBT)


Behavior Modification

The process of working to directly alter a patient’s behavior patterns in order to minimize self-defeating trends and heighten productivity and self-satisfaction.


Psychodynamic or Psychoanalytic Psychotherapy

A form of therapy centered on the interaction of various conscious and unconscious mental or emotional processes involved in the patient’s interpersonal difficulties, especially its influences on personality, behavior, and attitudes.


Transference-Focused Psychotherapy (TFP)

A structured psychodynamic psychotherapy that utilizes the phenomenon of transference (unconscious reassignment of extreme positive or negative images associated with one person to another person, such as a therapist) as a key to go beyond behavioral change to underlying structural personality change. The premise is that the symptoms of BPD are rooted in a patient’s confused and contradictory sense of identity that is related to these extreme and emotionally intense mental images of the self and others. TFP involves the recognition of transference the moment it occurs within the context of the patient-therapist relationship, then the exploration of patient’s implicit images of self and others related to that moment. Therapy addresses the intense shifts in emotions, such as to aggression or love, as patients learn to reflect and verbalize, rather than impulsively act out, these emotions.


Cognitive Behavior Therapy (CBT)

A type of psychotherapy in which the therapist teaches the patient to restructure his or her cognitive beliefs (i.e., negative, dysfunctional thought patterns) to change unwanted behavior. CBT focuses on the immediate present: what and how a person thinks more than why a person thinks that way.


Dialectical Behavior Therapy (DBT)

A form of CBT that teaches skills to reverse negative thoughts and behaviors. It emphasizes balance between acceptance and change in helping to relieve psychiatric symptoms and improve the quality of life. This type of therapy focuses on the concept of mindfulness (being aware of and attentive to the current situation). There are two components: an individual component in which the therapist and patient discuss issues following a hierarchy (self-injurious and suicidal behaviors take first priority, followed by therapy interfering behaviors, quality of life issues, and, finally, working towards improving one’s life) and a group component, in which clients learn to use specific skills that are broken down into four modules: core mindfulness skills, emotion regulation skills, interpersonal effectiveness skills and distress tolerance skills.


Dynamic Deconstructive Therapy (DDT)

The focus of treatment consists of helping patients identify and verbally express their emotions, construct coherent narratives of their interpersonal experiences, and integrate polarized attributions about self and others. Patients are encouraged to express and think about their emotions and interpersonal experiences without resorting to compensatory maladaptive behaviors. The therapy involves four distinct phases: therapeutic alliance, identification and integration of distorted attributions, acceptance of limitations of self and others, and differentiation from the therapist.


Mentalization-Based Therapy (MBT)

Mentalization refers to the ability to focus and reflect on mental states – beliefs, intentions, feelings, and thoughts – in the self and in others. This ability is thought to be compromised among people with BPD in that the capacity to mentalize is highly prone to fluctuation and impairment under stress, particularly the stress of rejection or disappointing interpersonal experiences. Impaired mentalization is thought to contribute to affect dysregulation, the misreading of interpersonal cues, and impulsive behavior.


Schema-Focused Therapy

A type of therapy that combines elements of CBT with other forms of psychotherapy that focus on reframing schemas (i.e., the ways people view themselves). This approach is based on the idea that BPD stems from a dysfunctional self-image (possibly brought on by negative childhood experiences) that affects how one reacts to their environment, interacts with others, and copes with problems or stress.


Supportive Psychotherapy

A form of psychotherapy in which consistency, support from others, and a hopeful attitude are used to sustain the patient through crisis periods and encourage small gains over time. This approach focuses on encouraging the transformation from acting out to verbalizing psychological conflicts and developing adaptive outlets for emotions.


Systems Training for Emotional Predictability and Problem Solving (STEPPS)

A relatively brief treatment consisting of 20 two-hour sessions led by an experienced social worker. Emotion and behavior regulation skills are the primary goals of treatment. In addition, family members and close friends are taught methods of reinforcing and supporting new regulation skills, reducing the likelihood that the patient will practice splitting (a mental mechanism in which the self or another is viewed as “all good” or “all bad”, indicating the failure to integrate both positive and negative qualities) with those in their social support system.