Borderline Personality Disorder

Borderline Personality Treatment

Our BPD track is designed to effectively address these domains of impairment, knitting together evidence-based practices known to be effective with BPD to help each client increase overall stability: improved self-soothing and emotional regulation tactics, the formation of a more positive sense of self that is reliable and constant, and improved interpersonal effectiveness to repair/enhance existing relationships. We focus intensely on fostering client resilience through posttraumatic growth because we recognize that individuals who bear a BPD diagnosis often carry histories of unresolved relational trauma on their backs. As an alternative to a false narrative of hopelessness, “brokenness,” and internalized shame, we focus on helping clients foster improved emotional regulation and help them see emotional distress through the lens of unmet needs. We promote and teach mindfulness techniques to help clients become better acquainted in real-time with the relationship between uncomfortable emotions and how these are signaling unmet needs (e.g. for interdependence, connection, emotional validation, connection, autonomy, etc). From those points of view, clients can then evaluate whether they themselves can get those needs met alone or whether they need to ask for help (and from whom). Effective application of this process provides a client with relief, builds confidence, and stokes hope for a better, more stable future.

Modalities We Use to Treat Borderline Personality Disorder

 We use an attachment theory lens to understand how relational trauma and attachment insecurity relate to a chronically dysregulated stress response. We also discuss this in terms of polyvagal (social engagement) theory to give clients a helpful roadmap for successfully navigating distressing mood states via self-regulation and co-regulation as a replacement for maladaptive stress responses (like self-harm, delving into suicidal thoughts, destructive interpersonal tactics, avoidance, escapism, and abuse of substances). These two lenses together provide a “normalizing” function and a more integrative narrative as to why clients who had unmet childhood needs might struggle to regulate their biological stress response as adults. Within these two approaches, we apply ample psychoeducation on interpersonal boundaries (healthy versus unhealthy), effective communication (advocating for self, assertiveness, nonviolent communication), adaptive conflict tactics, and healthy coping strategies. In this context, self-soothing, mindfulness, and interpersonal effectiveness training—integrated into Dialectical Behavioral Therapy (DBT) interventions, Nonviolent Communication (developed by Dr. Marshall Rosenberg), assertiveness training, and education on the connection between attachment insecurity and ineffective boundaries—assist our clients in establishing and practicing healthier relationships with their own fluctuating self-states and with others. We utilize mindfulness frequently to help clients improve awareness of distress in real-time and to observe the temporal nature of thoughts and distress, no matter how disturbing (“this too shall pass”). 

Our program also provides much education on the relationship between high emotional arousal and a vulnerability for distorted, negative perception that plagues individuals who suffer from BPD. Discussions on the evolutionary basis of this baked-in feature of our minds—negative bias—help clients understand where their worldview might be vulnerable to distortion in times of distress and how to challenge such thinking in decisive moments prior to reacting in an unhelpful way (“responding” instead of reacting). We apply cognitive behavioral therapy, cognitive reprocessing, and an emphasis on simultaneous self-compassion to help clients better understand and more adaptively work with negative bias while accessing love for the self as an ongoing corrective experience. We use acceptance and commitment therapy and emotionally-focused therapy approaches to help clients work with limits of the mind, and acknowledge/process emotions as they arrive instead of denying/avoiding/suppressing them (which causes them to swell and intensify, often the culprit behind impulse control issues). 

We do explore clients’ stories of “why” (e.g., history) they experience the difficulties they do; however, we quickly seek to transcend the story (“moving away from a focus on the why?”) with a more positive, more reasonable relationship to the ebb and flow of moment-to-moment experience of being alive in a biopsychosocial context as a relational human animal. We utilize narrative therapy and help clients author their own stories that help integrate discrepant experiences of pain and growth and promote overall resilience and hope. We yoke together “top-down” (cognitive, linear, left-brain, psychoeducational, and insight-oriented) and “bottom-up” (somatically focused, experiential, in the body, implicit, and nonverbal) processing simultaneously to help clients achieve an ongoing corrective experience—with their own minds, their relationship to distressing emotions, and their options for managing unmet need states. Some approaches that are particularly useful in helping clients tolerate the fluctuation of their mind and emotions, as well as effectively intervening in chronically activated stress responses, involve yoga, various meditation strategies, contemplative movement, breathwork, and soundbaths.