Borderline Personality Disorder

By Ofer Zur, Ph.D.

No other mental disorder has stirred and evoked more fascination, volatility, trepidation and dread in therapists as borderline personality disorder (BPD). We have all heard statements like the following:

“Never have more than one or two Borderlines in your practice at a time.”

“You are one Borderline away from losing your license.”

“I have one Borderline too many in my practice.”

“If you take on a BPD client, you will be swamped with late night phone calls and an all-consuming, volatile therapeutic relationship.”

The Risks

Litigation Risk: BPD clients are more likely than other clients to file complaints and initiate legal actions against their therapists.

Emotional Toll: Working with BPD can be emotionally taxing and exhausting. Learn about the nature of the disorder and carefully manage your counter-transference. Do not act impulsively. Do seek support and consultation as necessary.

The Hope

Contrary to the prevailing myths that BPD is incurable, new perspectives and new (and old) therapies have proven surprisingly effective. With the aid of this online course, it is our hope that BPD will no longer be the disorder that therapists dread. The course will discuss how BPD is eminently treatable and show how working with BPD clients can be highly rewarding.

Strategies for Risk Management:

  • Developing a deep understanding of the nature of BPD and treatment options.
  • Comprehend the actions and reactions that are often evoked.
  • Implement clearly articulated treatment plans.
  • Set clear, appropriate and compassionate (not punitive) boundaries.
  • Carefully manage your counter-transference, do not act impulsively.
  • Terminate thoughtfully.
  • Document, document, and . . . document.
  • Consult, consult, and . . . consult.
RECAP: Borderline Personality Disorder
  • The DSM captures only part of the symptoms of BPD. Research shows that most therapists use other tell-tail signs as diagnostic tools.
  • Instead of diagnosing and understanding BPD from DSM symptom checklists, it may be more accurate, and provide a richer clinical picture, to think in terms of four symptom clusters: affect, cognition, impulsivity, and interpersonal relationships.
  • BPD has diverse etiologies, including biological and psychosocial. Understanding your client’s specific etiology will help you make effective treatment choices.
  • The belief that BPD is an intractable part of personality may not be true. Many BPD clients mysteriously shed their BPD symptoms. They sometimes do so without treatment.
  • There are several different highly effective treatments for BPD. Many treatments are new, but some are traditional.
  • There is a tangled web between Axis I mood disorders and Axis II personality disorders. Understanding your client’s specific web will help you make better treatment decisions.
  • Although no medications specifically address BPD, some medications may occasionally play a valuable role in treatment.
  • Neuro-imaging studies suggest how and why BPD develops.
  • Observational studies of mothers and babies may provide insight as to how BPD is transmitted from mother to baby.
  • Dialectical behavior therapy, interpersonal psychotherapy, transference-focused (psychodynamic) therapy, emotionally supportive therapy, and mentalization-focused therapies have all proven effective with BPD. However, they each address different dimensions of the disorder.
  • Therapists are particularly prone to strong counter-transference with BPD clients, which presents a legal peril. Understanding the dynamics and taking precautions may help insulate you from legal problems.
  • Many treatment failures with BPD clients may be due more to therapists’ hesitations and defenses than to the “intractability” of BPD.
This Course Will Help Therapists to:
  • Identify the symptoms and accurately diagnose BPD.
  • Understand the diverse etiologies of BPD.
  • Identify effective therapies.
  • Learn the principles of several effective therapies.
  • Understand the limitations of DSM taxonomy in regard to BPD.
  • Learn the appropriate use of medications for BPD.
  • Learn the common ethical and legal pitfalls in treating BPD.
  • Practice ethical risk-management with BPD.
  • Access resources for therapists, clients and families.

See our 5 CE credit online course: Borderline Personality Disorder…
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