In my forensic/expert witness practice I have encountered the most fascinating and intriguing cases where BPD clients have gotten their (otherwise solid and ethical) therapists to give them money, adopt them, move in with them, regularly text with them at 1 or 2 AM, do drugs with them, and, of course, have sex with them.
Without doubt, it is a therapist’s responsibility to maintain clinically appropriate boundaries with all clients. However, that is not always easy with many BPD clients. BPD clients are so desperate for attachment that their fierce need can draw a therapist in. At the same time, many BPD clients have learned not to trust those very attachments they demand and crave. Thus, therapists can find themselves caught in their BPD clients’ conflicting desires.
A growing body of research clearly indicates that BPD clients can be treated successfully and effectively with psychotherapy. Understanding the interpersonal power that BPD clients exert on the therapist is essential both for effectively treating BPD clients and for protecting psychotherapists and counselors.
What one should do to prevent boundary violations with BPD clients:
- Recognize the potential dangers/hazards when working with the BPD.
- Understand the powerful intra- and interpersonal dynamics at work in BPD therapy.
- Exercise extra caution with boundary crossings with BPD clients. As examples, boundary crossings might include gift-giving, leaving the office, communication outside of therapy, texts or e-mails, home visits, touching, etc.
- Watch out for a dangerous cognitive trap often encountered with the BPD clients: “If I only agree with this last demand he/she will settle in, let go, calm down, or finally realize that I do care.” Trying endlessly to appease or avoid the rage of BPD clients is how therapists end up violating boundaries.
- Consult, consult and…consult with peers and experts.
- Attend training, such as our online CE course on BPD.
- When appropriate, document relevant boundary crossings, non-standard procedures, unusual encounters and, when necessary, include your therapeutic rationale for such boundary crossings in your notes.
- Know and practice the common principles of effective BPD psychotherapy, which cut across virtually every therapy modality.
- Learn to navigate the narrow channel of caring, compassionate therapy without getting sucked into the BPD client’s emotional vortex.
- Learn how to keep clinically and ethically appropriate boundaries without becoming disconnected, rejecting or cold.
Additional articles on the difficulties, risks, complexities and challenges of working with BPD clients in psychotherapy and counseling:
- Legal pitfalls in treating borderline personality disorder (By J. Cooper, National Psychologist)
- The Rejection-Rage Contingency in Borderline Personality Disorder (Journal of Abnormal Psychology)
- Rejection and Rage with Borderline Personality Disorder (Dr. Todd Grande, MP3)
- Why Do Therapists Stigmatize People with Borderline? (PsychCentral)
- Therapists’ Fear of Borderline Personality Disorder Persists (by Tori Rodriguez, MA, LPC)
- Why Borderline Personality Disorder is Misdiagnosed By Alan E. Fruzzetti, Ph.D.