One of the best approaches to treating people with borderline personality disorder (BPD) is to use schema therapy or an approach involving the treatment of the client’s underlying schemas and maladaptive modes and parts of self.
Mental health professionals often view clients with BPD as manipulative, selfish people. This negative view is destructive to treatment. As soon as a therapist views any client negatively, the therapist is most likely feeding into one of the client’s unhealthy “modes” (see How to treat Borderline Personality Disorder (Parts 1 and 2). Often the therapist becomes the punitive parent persona, angry with the client, critical, and rejecting. This is damaging to the client personally and also to the client-therapist relationship (Young, Klosko, Weishaar, 2003).
It is important to remember that clients with BPD will always believe and feel that they need more than the therapist can provide; this is because they feel desperate. Their emotions are overwhelming to them. Working with these types of clients can be tumultuous and intense. Often, the therapist’s own schemas are triggered (Young, Klosko, Weishaar, 2003). This is frequently referred to as counter-transference.
Therapists working with this population should take proactive measures of self-care and consultation in order to remain effective and emotionally healthy themselves.
In almost all cases, clients with BPD believe and feel that they need more than anyone in their lives can provide. Have I mentioned they feel desperate? Never underestimate the power of this desperation. Healing from borderline issues is hard work, but it is possible.
Conflict is inherent in treatment for a few reasons: one is because the client’s needs are greater than the provider can meet; the other is because the client needs to test the therapist to see if he will stick around; and a third reason is because anything hopeful of attachment is threatening to the person with these types of issues.
Remember, the goal is to re-parent this individual by providing new, inner working models of healthy relating and attachment. This will not come easily or quickly. Clients with borderline issues are always looking for a parent; a perfect parent. Because of this constant neediness it is important for the healer to understand that he (the therapist himself) needs to maintain healthy boundaries.
Remember, the therapist has rights too – rights to a private life, to be treated respectfully, to have time for himself and others, etc. The therapist cannot, nor should, give the client everything he wants or needs. Let the client understand this underlying dynamic. Reassure the client that he can learn to self-soothe and meet his own needs, separately from therapy.
The client’s progress in treatment, in some respects parallels child development. Psychologically, the patient “grows up” in therapy. Treatment takes time.
One thing to keep in mind is that during the developmental process of the BPD client, mature growth was “stunted” in a way, resulting in maladaptive coping states of being (referred to as “schema modes.”) These schema modes can also be, more currently referred to as ego states or parts of self.
The goal of therapy is to integrate the different parts of self, which is a form of developmental maturity.
American Psychiatric Association (2014). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition: DSM-V. Arlington, VA: American Psychiatric Association.
Giesen-Bloo, J., van Dyck, R. Spinhoven P.; van Tilburg, W. Dirksen, C.; Thea van Asselt, T., Kremers, I., Nadort,& Arntz, A. (2006). Outpatient Psychotherapy for Borderline Personality Disorder: a randomized trial of Schema focused therapy versus Transference focused therapy. Archives of General Psychiatry (63)6. pp. 649-658.
Schmidt, S.J. (n.d.) The Developmental Needs Meeting Strategy: What It Is and How It Works. Published by The DNMS Institute, LLC. Retrieved from: http://www.dnmsinstitute.com/therapy/wp-content/docs/aboutdnms.pdf
Young, J.E.; Klosko, J.S.; Weishaar, M.E. (2003). Schema Therapy: New York, NY. Guilford Press.