Specialised BPD Therapy
For most of my career as a social worker/ therapist, I have specialised in working with people affected by traits of emotionally unstable/borderline personality disorder.
I emphasis ‘traits of’ because we believe that psychological disorders are often extreme expressions of a continuum of normality.
My approach to working with BPD is to blend evidence-based methods designed for attachment trauma such as Schema Therapy, Dialectical Behavioral Therapy, Mentalisation-based Therapy, EMDR with other more intuitive models such as Sandtray Therapy and Art Therapy. On top of 'fire-fighting' with the imminent issues, we aim to make changes to the deep-seated life patterns that cause similar issues to come up again and again in your life. This process can create lasting changes because it looks beyond the surface and addresses the core emotional roots.
I bring together scientific research and clinical knowledge that were particularly effective in tackling the following issues: difficulties in regulating emotions, interpersonal relationships (e.g. standing up for yourself or asking for what you want), managing anger outbursts, impulsive behaviours and compulsive urges, or having suicidal thoughts and urges to self-harm.
BPD therapist- what to look for?
Due to one reason or another, we may not be able to work together. Although there remains many misunderstandings and ignorance around BPD traits, there are also good resources and therapists who can help. Here are some further thoughts on what to look for when seeking to work with someone regarding BPD- related difficulties.
Given the variety of therapeutic approaches, knowing what to look for in a therapist can be difficult. Existing research and literature into the essential therapeutic elements in successful treatment with BPD may be able to provide some guidance.
Responsive to your individual needs
Although it can be tempting to paint people with BPD with a single brush, considerable evidence suggests that the BPD diagnosis is highly heterogeneous. People with the same diagnosis may have different presenting issues, and therefore want different things from therapy. Real therapeutic work comes from working collaboratively, honoring both your goal and your therapist’s knowledge.
Either across individuals or within one person, therapeutic goals should not be reducible to one theory-driven meta-goal. For instance, we cannot assume that it is ‘all about’ correcting dysfunctional cognitions or ‘all down to’ aligning self-concept.
It is also likely that a person with BPD would have very different needs at different times. It is particularly crucial for your therapist to be flexible enough to tailor each session based on your affective state and arousal level. They need to be able to ‘meet’ you in terms of the intensity of feelings, whilst remaining centered and grounded.
This can be a real challenge, but is fundamental to a working relationship. For instance, when you reach out to your therapist in crisis, or in a heightened emotional state, they being cold and distant might leave you feeling rejected and abandoned. Yet, on the flip side, you don’t want your therapist to be so drawn into your emotional turmoil that they becomes just as lost.
On revision of the existing treatment protocol for BPD, client involvement is one of the most important factors for creating changes. Essentially, treatment for BPD would not succeed unless the therapeutic alliance is built on the agreement of therapeutic goals and strategies.
There should be a ‘shared understanding’ of the origin and nature of the presenting problems. It is not something that the therapist alone decide on, but an ongoing thread of discussion and negotiation.
Hope and faith
The BPD journey is a painful one, and there may be times when you feel hopeless; this is when your therapist can offer an alternative perspective, teach skills or provide a temporary holding environment. Your therapist may be more directive in offering guidance and advice in the beginning, especially if you did not have relevant containing parenting experience in early life. However, just like a good parent, your therapist’s ultimate goal is to help you recognise your own strength and agency rather than fostering dependency. Your therapist is also there to help you recognise your uniqueness and abilities, and eventually make use of them. Eventually, you will be able to internalise the hope your therapist holds in recovery, and the faith your therapist has in you.
Validation of your emotions is a central component for therapeutic alliance in all the empirically effective individual therapies for BPD. A therapist’s ability to resonate with your painful emotions and to tolerate the intensity of them can be transformative. The therapist must show a willingness to mindfully explore the process and content within the therapeutic relationship, and demonstrate acceptance of a wide array of experiences, including the unpleasant ones. This does not mean agreeing with all that you do, especially when it comes to behaviors such as self harming or disordered eating. However, this does not take away the validity of the painful emotions behind these coping behaviours. By experiencing and learning that your feelings are tolerable within the relationship, you may gradually be able to develop the capacity to self-regulate in a healthy fashion.
Owing to the unique nature of BPD, effective treatments call for high level of responsivity/flexibility from the therapist, a collaborative stance, trust and shared authority. These are perhaps essential qualities in all therapies, but are particularly important for BPD clients. Psychotherapy for BPD should only be delivered by a trained professional. Do not be afraid to ask about their experience. It is within your right to look around before you decide!