Psychotherapy, or talk therapy, is the main treatment for borderline personality disorder (BPD). Several types of therapy may benefit people with BPD, and each type takes a different approach.
This article explores the potential benefits of five types of therapy for people with BPD:
- dialectical behavior therapy (DBT)
- mentalization-based therapy (MBT)
- schema therapy (ST)
- transference-focused therapy (TFP)
- systems training for emotional predictability and problem solving (STEPPS)
Below, we also list self-help strategies and signs that it may be time to reach out to a professional.
BPD is a long-term condition that affects around 1.6% of people in the United States. Its main treatment is psychotherapy, otherwise known as talk therapy.
Talk therapy teaches people vital skills for managing their thoughts and emotions. There are many types, and each has its own aims and methods.
Sometimes, a person has to try several types of therapy before finding one that helps.
A person with BPD may also find certain medications beneficial. The Food and Drug Administration (FDA) have not yet approved a medication to treat BPD specifically, but mood-stabilizing, antidepressant, or antipsychotic medications may help with anxiety, hostility, or depression.
A person may attend therapy for BPD one-on-one or as part of a therapist-led group session. Also, some therapists offer phone contact between sessions.
Group sessions can help people with BPD learn to express themselves effectively and improve interpersonal relationships.
DBT uses individual and group sessions to help people manage difficult emotions. The aim is to teach skills that enhance mindfulness, help tolerate distress, regulate emotions, and manage relationships.
Clinical psychologist Dr. Marsha Linehan developed DBT for people with BPD and suicidal thoughts. It is similar to cognitive behavioral therapy, but DBT focuses more on emotions and relationships.
DBT usually includes weekly individual therapy, a group training session, homework tasks, and telephone support from the therapist, if needed.
According to a 2016 review, DBT is the only empirically supported therapy for BPD. Older studies confirm that DBT helps reduce self-harm and hospitalizations and helps people stay in treatment.
The aim of MBT is to help people with BPD understand their mental states and those of other people. The underlying theory is that difficulty understanding others is the main symptom of BPD and that this prevents the formation of stable relationships.
MBT teaches people that they may be interpreting the thoughts, feelings, and emotions of others incorrectly. It encourages them to step back and assess whether their thoughts and beliefs are useful and realistic.
A 2019 review found evidence that MBT could be just as effective as other therapies for BPD. However, the researchers acknowledge that many of the studies that they analyzed were not of high quality and were possibly biased.
To better understand the potential benefits of MBT, researchers need to carry out more studies.
Schemas are deeply ingrained patterns of thinking and behavior that form as the brain develops during childhood and adolescence. They can be affected by a person’s environment and experiences and are closely related to how the person views themselves and the world.
Proponents of ST believe that events can trigger certain schemas that then lead to the development of unhelpful thoughts and behaviors.
ST aims to reshape a person’s schemas by revisiting situations in earlier life that had a negative impact. Through ST, a person can develop healthier alternatives to harmful patterns of thinking, feeling, and behaving.
Some pilot studies suggest that group ST has promise as a therapy for BPD. However, the number of participants in these studies is often small, so further research is needed.
In psychotherapy, transference occurs when a person projects their own emotions or expectations onto someone else, such as their therapist. In TFP, therapists draw attention to this unconscious process during sessions to challenge unhelpful patterns of behavior.
The therapist helps the person see how they are responding to matters that arise throughout each session, and together, the client and therapist recognize and develop positive alternatives to these behaviors as they occur.
STEPPS therapy is is a skills-based group program that people attend alongside other types of therapy. It frames BPD as an “emotional intensity disorder” and helps people regulate their emotions and behaviors.
STEPPS also helps friends, family members, and others in a person’s support network understand BPD. The aim is to help form healthier relationships with people who reinforce the new skills that the individual with BPD is learning.
Additionally, STEPPS teaches self-care skills, such as guidance about healthful eating, sleep patterns, and ways to prevent self-harm.
A small, nonrandomized trial comparing STEPPS with DBT showed that both were effective at significantly reducing BPD symptoms over 6 months, but that DBT was more effective at reducing behavioral symptoms.
Therapy can help people with BPD experience long-term remission. This means that a person has sustained periods of drastic or complete improvement of their symptoms.
A 2019 review suggests that the prognosis for people with BPD who receive treatment is good. During a 16-year period, a longitudinal study including 290 people with BPD found that:
- 35% went into remission after 2 years
- 91% went into remission after 10 years
- 99% were in remission after 16 years
In this study, 75% of participants experienced remission for at least 8 years.
However, therapy does not cure BPD — the symptoms can come and go throughout a person’s life. It is also important to note that avoiding certain social situations and relationships can give a false impression of remission.
Staying in contact with a therapist and having regular check-ins may help with monitoring symptoms.
The mental health organization Mind, in the United Kingdom, provide a list of strategies that may help when a person with BPD feels overwhelmed by specific emotions:
- For anger, frustration, or restlessness: Do some vigorous exercise, hit a pillow, listen to loud music, or do something practical, such as gardening or cleaning.
- For depression or sadness: Write a comforting letter to yourself, watch a favorite TV show or film, or listen to uplifting music.
- For anxiety or tension: Take a warm bath or shower, take 10 deep breaths and count them out loud.
- For dissociation: Try chewing ginger or chili, drinking ice water, or clapping the hands and noticing the sensation.
If a person thinks that they may have BPD or has received the diagnosis and wants to start treatment, it is a good idea to contact a therapist with experience in this area.
For anyone who is finding it difficult to cope, and especially for people thinking of self-harm or suicide, it is crucial to seek help. Many resources provide support at any hour of the day. Also, some therapists offer phone appointments.
The organization BPD World provide this list of helplines for people in the U.S.
If you know someone at immediate risk of self-harm, suicide, or hurting another person:
- Ask the tough question: “Are you considering suicide?”
- Listen to the person without judgment.
- Call 911 or the local emergency number, or text TALK to 741741 to communicate with a trained crisis counselor.
- Stay with the person until professional help arrives.
- Try to remove any weapons, medications, or other potentially harmful objects.
If you or someone you know is having thoughts of suicide, a prevention hotline can help. The National Suicide Prevention Lifeline is available 24 hours per day at 800-273-8255. During a crisis, people who are hard of hearing can call 800-799-4889.
Several types of therapy can benefit people with BPD, and some of the strongest scientific evidence supports the effectiveness of DBT. Meanwhile, early evidence suggests that MBT and ST may also help.
Therapy can lead to long-term remission, in which BPD symptoms are very significantly or completely improved. While achieving remission can take time and dedication, many find that therapy makes a significant difference to their symptoms in the meantime.
Overall, a strong and trusting therapeutic relationship is most strongly associated with a positive outcome.