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Borderline Personality Disorder in Psychotherapy and Counseling

Resources

This resource page is part of an Online Course
Borderline Personality Disorder in Psychotherapy and Counseling.

CE Credits for Psychologists. CE Credits (CEUs) for LMFTs, Social Workers, Counselors and Nurses.
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Zur Institute is approved by the American Psychological Association to sponsor continuing education for psychologists. Zur Institute maintains responsibility for this program and its content.

 

 

Updates Regarding Borderline Personality Disorder

6-23-11: Founder Marcia Linehan tells her own story of triumph and challenge with BPD.

2012: In a head-to-head clinical trial of dialectical behavioral therapy and a treatment following the American Psychiatric Association's general clinical guidelines for treating borderline personality disorder, both treatments were equally effective:
Dialectical behavior therapy compared with general psychiatric management for borderline personality disorder: clinical outcomes and functioning over a 2-year follow-up.
McMain SF, Guimond T, Streiner DL, Cardish RJ, Links, PS. American Journal of Psychiatry. 2012 Jun;169(6):650-61.

2016: Between Verbalization and Reflection: Referential Activity and Narrative Processes in Borderline Personality Organization. Psychoanalytic Psychology, Górska, Dominika; Soroko, Emilia. Oct 31, 2016, http://dx.doi.org/10.1037/pap0000117

 

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Resources for Clients and Their Families

National Alliance on Mental Illness (NAMI)

The National Education Alliance for Borderline Personality Disorders is an excellent place to start for therapists, clients, and their families. In addition to the following resources, it also lists occasional clinical trials for people with BPD.

Families: Engaging families in treatment is an often overlooked component of treating people with BPD. As with serious disorders such as schizophrenia and bipolar disorder, growing research indicates that a systems approach that includes psychoeducation for family members about a client's condition significantly reduces hospitalizations and relapses. The NEABPD runs a Family Connections program in cities around the United States. It's a 12-week program with a minimal charge that uses principles of dialectical behavior therapy to help family member relate to a member with BPD. Through informational sessions and role plays, it addresses topics such as:

  • Education on BPD
  • Research on BPD
  • Family Perspectives and Experiences
  • Relationship Mindfulness Skills
  • Emotion Regulation Skills
  • Effective Communication Skills
  • Validation Skills
  • Problem Management Skills

In addition to information on the Family Connections program, clients and families can also download for free a 16-page booklet, Family Guidelines, by John Gunderson and Cynthia Berkowitz that offers dozens of specific tips for helping to manage the home environment.

Although it's not part of the NEABPD site, families and therapists may also be interested in the STEPP program (Systems Training for Emotional Predictability and Problem Solving), a promising program to help families with someone who has BPD. The program offers a DVD for about $50 (including shipping) which walks family members through the STEPP program. (For a research article on STEPPS, see Blum, N, St. John, D, Pfohl, B, Stuart, S, McCormick, J, Allen, J, Arndt, S, and Black, DW (2008), Systems Training for Emotional Predictability and Problem Solving (STEPPS) for Outpatients With Borderline Personality Disorder: A Randomized Controlled Trial and 1-Year Follow-Up, American Journal of Psychiatry, 165: 468 - 478).

Also not part of the NEABPD website, but an online support group for family members of people with BPD

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Resources for Therapists

Borderline Personality Disorder Demystified. A good site for overviews of the signs and treatments for BPD, geared primarily toward clients and families but also for therapists.

Dialectical Behavior Therapy. Perhaps the therapy with the strongest empirical support for BPD. Therapists can order materials and receive information on DBT and on training.

Middle Path. A New England-based advocacy and resource center for BPD that presents causes, symptoms and treatments in a straightforward manner, well-suited for clients. It looks at BPD from both an object-relations and biopsychosocial perspective and believes that treatments that utilize both perspectives, such as mentalization and DBT, are the most effective.

Online support groups. A list of several online and in-person support groups for people with personality disorders

BPD World. This U.K. support center for people with BPD is founded by Joshua Cole, who himself has BPD. BPD World offers online support groups, blogs and chat rooms. In addition, the section for professionals has a list of advice for professionals that bears repeating and speaks to the informed and humane quality of the website:

"Working with people who have a diagnosis of personality disorder can be both rewarding and challenging. We have put together a list of do's and don'ts for you. As well as this you may wish to download some information from our online shop."

  • Do be non-judgmental and validating.
  • Do show respect.
  • Do recognize that the distress felt is very real.
  • Do seek your own support, from supervision and peers.
  • Do remain consistent.
  • Do recognize that they are a difficult client group, and it is easy to feel demoralized.
  • Do ask for training- it's VITAL.
  • Do recognize there may be other, Axis I disorders, which may be more treatable.
  • Do recognize that BPD patients are among the most creative people.
  • Do look after yourself. If you find it hard to look after yourself when working with this client group, you aren't going to find it any easier to work with them!
  • Don't think their behavior is a personal attack.
  • Be careful with managing professional boundaries, such as accepting gifts, self-disclosure, out-of-office experiences, meals, texting, home visits, etc.
  • Don't let yourself become burnt-out by not seeking support.
  • Don't feel guilty for strong emotional responses to clients.
  • Don't act on the emotional responses-that's what supervision is for.
  • Don't underestimate risk-it is easy to become complacent with someone who has a long history of self-harm.
  • Don't be afraid to challenge the patient, let them know how their behavior is affecting you!
  • Don't be tempted to collude with the patient, even if you secretly agree with them!
  • Don't treat the patient like a child-they may behave like one at times, but this will not help!
  • Don't put yourself at risk-if you feel out of your depth, seek support from the appropriate place.

Miano, A, Fertuck, EA, Roepke, S, Dziobek, I (2017). Romantic relationship dysfunction in borderline personality disorder—a naturalistic approach to trustworthiness perception. Personality Disorders: Theory,  Research, and Treatment, Vol 8(3), Jul 2017, 281-288

Metcalf, RK, Fitzpatrick, S, Kuo, JR (2017). A laboratory examination of emotion regulation skill strengthening in borderline personality disorder. Personality Disorders: Theory, Research, and Treatment, Vol 8 (3). Metcalfe, Rebecca K.; Fitzpatrick, Skye; & Kuo, Janice R.

Choi-Kain, LW, Finch, EF, Jenkins, JA, Masland, SR, Unruh, BT (2017). What Works in the Treatment of Borderline Personality Disorder, Current Behavioral Neuroscience ReportsMarch 2017, Volume 4, Issue;1, pp 21–30

Schultz, HE, Hong, V (2017). Psychosis in borderline personality disorder: How assessment and treatment differs from a psychotic disorder, Current Psychiatry. 2017 April;16(4):24-29

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Risk Management with Borderline Personality Disorder

 

Critique of BPD Diagnosis

Should We Abolish the Diagnosis of Borderline Personality?

 

Additional References

Cerutti, Rita; Presaghi, Fabio; Manca, Maura; & Gratz, Kim L. (2012). Deliberate self‐harm behavior among Italian young adults: Correlations with clinical and nonclinical dimensions of personality. American Journal of Orthopsychiatry Vol 82(3), Jul 2012, 298-308

Chun, Seokjoon; Harris, Alexa; Carrion, Margely; Rojas, Elizabeth; Stark, Stephen; Lejuez, Carl; Lechner, William V.; & Bornovalova, Marina A. (2017). A psychometric investigation of gender differences and common processes across borderline and antisocial personality disorders. Journal of Abnormal Psychology, Vol 126(1), Jan 2017, 76-88 http://dx.doi.org/10.1037/abn0000220

Ebner-Priemer, Ulrich W.; Houben, Marlies; Santangelo, Philip; Kleindienst, Nikolaus; Tuerlinckx, Francis; Oravecz, Zita; Verleysen, Gregory; Van Deun, Katrijn; Bohus, Martin; & Kuppens, Peter (2015). Unraveling affective dysregulation in borderline personality disorder: A theoretical model and empirical evidence. Journal of Abnormal Psychology Vol 124(1), Feb 2015, 186-198

Few, Lauren R.; Miller, Joshua D.; Grant, Julia D.; Maples, Jessica; Trull, Timothy J.; Nelson, Elliot C.; Oltmanns, Thomas F.; Martin, Nicholas G.; Lynskey, Michael T.; & Agrawal, Arpana. (2016). Trait-based assessment of borderline personality disorder using the NEO Five-Factor Inventory: Phenotypic and genetic support. Psychological Assessment, Vol 28(1), Jan 2016, 39-50

Gee, J & Reed, S (2013). The HoST programme: A pilot evaluation of modified dialectical behaviour therapy with female offenders diagnosed with borderline personality disorder, European Journal of Psychotherapy & Counselling Vol. 15 (3)

Gutz, Lea; Renneberg, Babette; Roepke, Stefan; & Niedeggen, Michael. (2015). Neural processing of social participation in borderline personality disorder and social anxiety disorder. Journal of Abnormal Psychology , Vol 124(2), May 2015, 421-431

Hallquist, Michael N.; Hipwell, Alison E.; & Stepp, Stephanie D. (2015). Poor self-control and harsh punishment in childhood prospectively predict borderline personality symptoms in adolescent girls. Journal of Abnormal Psychology Vol 124(3), Aug 2015, 549-564

Houben, Marlies; Claes, Laurence; Vansteelandt, Kristof; Berens, Ann; Sleuwaegen, Ellen; & Kuppens, Peter. (2017). The emotion regulation function of nonsuicidal self-injury: A momentary assessment study in inpatients with borderline personality disorder features. Journal of Abnormal Psychology, Vol 126(1), Jan 2017, 89-95

Krabbendam, AA, Colins, OF, Doreleijers, TAHH, van der Molen, E, Beekman, ATF, & Vermeiren, Robert, R (2015). Personality disorders in previously detained adolescent females: A prospective study. American Journal of Orthopsychiatry Vol 85(1), Jan 2015, 63-71

Kramer, Ueli; Keller, Sabine; Caspar, Franz; de Roten, Yves; Despland, Jean-Nicolas; & Kolly, Stéphane. (2017). Early change in coping strategies in responsive treatments for borderline personality disorder: A mediation analysis. Journal of Consulting and Clinical Psychology Vol 85(5), May 2017, 530-535

Lavner, Justin A.; Lamkin, Joanna; & Miller, Joshua D. (2015). Borderline personality disorder symptoms and newlyweds' observed communication, partner characteristics, and longitudinal marital outcomes. Journal of Abnormal Psychology, Vol 124(4), Nov 2015, 975-981

Liebman, RE.; Burnette,.(2013). It's not you, it's me: An examination of clinician- and client-level influences on countertransference toward borderline personality disorder. American Journal of Orthopsychiatry Vol 83(1), Jan 2013, 115-125

Metcalf, RK, Fitzpatrick, S, Kuo, JR (2017). A laboratory examination of emotion regulation skill strengthening in borderline personality disorder. Personality Disorders: Theory, Research, and Treatment, Vol 8 (3)

Miano, A, Fertuck, EA, Roepke, S, Dziobek, I (2017). Romantic relationship dysfunction in borderline personality disorder—a naturalistic approach to trustworthiness perception. Personality Disorders: Theory, Research, and Treatment, Vol 8(3), Jul 2017, 281-288

Pearson, Carolyn M.; Lavender, Jason M.; Cao, Li; Wonderlich, Stephen A.; Crosby, Ross D.; Engel, Scott G.; Mitchell, James E.; Peterson, Carol B.; & Crow, Scott J. (2017). Associations of borderline personality disorder traits with stressful events and emotional reactivity in women with bulimia nervosa. Journal of Abnormal Psychology, Vol 126(5), Jul 2017, 531-539

Reas, Deborah L.; Pedersen, Geir; Karterud, Sigmund; & Rø, Øyvind. (2015). Self-harm and suicidal behavior in borderline personality disorder with and without bulimia nervosa. Journal of Consulting and Clinical Psychology Vol 83(3), Jun 2015, 643-648

Reid, W. H. (2009) Borderline personality disorder and related traits in forensic psychiatry. J PsychiatrIc Practice.15(3):216-20.

Ruocco, Anthony C. (2016). Compliance on neuropsychological performance validity testing in patients with borderline personality disorder. Psychological Assessment, Vol 28(3), Mar 2016, 345-350

Ruocco, Anthony C.; Laporte, Lise; Russell, Jennifer; Guttman, Herta; & Paris, Joel. (2012). Response inhibition deficits in unaffected first-degree relatives of patients with borderline personality disorder. Neuropsychology, Vol 26(4), Jul 2012, 473-482

Schultz, HE, Hong, V (2017). Psychosis in borderline personality disorder: How assessment and treatment differs from a psychotic disorder. Current Psychiatry. 2017 April;16(4):24-29

Scott, Lori N.; Wright, Aidan G. C.; Beeney, Joseph E.; Lazarus, Sophie A.; Pilkonis, Paul A.; & Stepp, Stephanie D. (2017). Borderline personality disorder symptoms and aggression: A within-person process model. Journal of Abnormal Psychology, Vol 126(4), May 2017, 429-440 http://dx.doi.org/10.1037/abn0000272

Sharp, Carla; Wright, Aidan G. C.; Fowler, J. Christopher; Frueh, B. Christopher; Allen, Jon G.; Oldham, John; & Clark, Lee Anna. (2015). The structure of personality pathology: Both general ('g') and specific ('s') factors? Journal of Abnormal Psychology Vol 124(2), May 2015, 387-398

Tomko, Rachel L.; Lane, Sean P.; Pronove, Lisa M.; Treloar, Hayley R.; Brown, Whitney C.; Solhan, Marika B.; Wood, Phillip K.; & Trull, Timothy J. (2015). Undifferentiated negative affect and impulsivity in borderline personality and depressive disorders: A momentary perspective. Journal of Abnormal Psychology Vol 124(3), Aug 2015, 740-753

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