Effective Therapy for Clients With Borderline Personality Disorder
By Christy Pennington, MA, LPC, Admissions Manager

The title says it all, I Hate You, Don't Leave Me by Jerold J. Kreisman and Hal Strauss; It's an old book, but a good one in understanding borderline personality disorder. When you have a client that creates that push, pull in relationships, continues to think in black and white, and acts impulsively, dialectic behavior therapy (DBT) can help.

Originally, this was a therapy designed to address the specific needs of those struggling with borderline personality disorder (BPD) who experienced difficulty with treatment as usual in the past. Since this time, studies have shown DBT to be helpful not only with BPD, but with other issues such as eating disorders, bipolar disorders and substance abuse.

DBT is a behavioral system of both individual and group therapy, whereby the client is taught to identify thinking patterns and work through dialectical issues so as they can make more "effective" decisions for themselves.

DBT Group Skills Training is the therapy group portion of the therapy during which skills are taught in four areas that those with BPD specifically struggle with: distress tolerance, emotion regulation, interpersonal effectiveness and mindfulness.

Individual therapy - Those who struggle with BPD and like disorders see the world from extremes - black and white thinking. Individual therapy is used to help clients identify when they are employing black and white thinking, and how to challenge themselves to avoid this. For example, a client who has been a dangerous cutter for years may need to see that her family can love and miss her very much (with the daughter being in placement), and still feel great relief that she is not in the home. These feelings can and do coexist, and are not mutually exclusive. Dialectics such as acceptance vs. change, and willingness vs. willfulness are continually discussed.

The final arm of this therapy is having a support system for therapists and counselors who work with these difficult clients. BPD has been considered the most difficult disorder to work with due to the fact that clients struggle so much with sabotaging all relationships, including that with their therapist. Therapists and counselors must therefore approach these difficult clients with a very open and validating perspective. At Excelsior, our Treatment Team model provides the support needed to each other while continuing to provide nonjudgmental services to the client on a consistent basis.