Therapy for Borderline Personality Disorder

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Written by:Minkyung Chung, MS, LMHC

Published On: June 29, 2022

Medically reviewed by: Ashley Ertel, LCSW, BCD

Reviewed On: June 29, 2022

Updated On: July 28, 2023


Borderline personality disorder (BPD) is a mental health condition marked by an intense fear of rejection that results in a poor self-image and extreme difficulty maintaining interpersonal relationships.

BPD usually manifests in late adolescence or early adulthood. It’s estimated that about 1.6% of the American population are living with it. The good news, though, is that with a consistent treatment plan in place, borderline personality disorder can be successfully managed for most people.

Borderline personality disorder treatment — including therapy, some types of medication, and family and peer support — often results in long periods of remission or significant improvement of BPD symptoms.

Here, we’re discussing the different types of therapy that have been found effective in treating BPD. We’re also discussing how to find a therapist who can help.

Therapies for BPD include:

  • Dialectical behavior therapy (DBT)
  • Schema therapy (ST)
  • Transference-focused therapy (TFP)
  • Mentalization-based therapy (MBT)
  • Systems training for emotional predictability and problem solving (STEPPS)

Note that, as of today, no medications are FDA-approved to treat borderline personality disorder. However, combining therapy with some types of medication might be effective in minimizing certain symptoms and related conditions, such as depression and anxiety.

“Most types of treatment for borderline personality disorder involve learning to become aware of one’s behavior and reactions to others, learning to manage relationships, and understanding the situations that may trigger an episode of decompensation (to name a few). Treatment also involves learning the coping skills that will help an individual work through a particularly hard episode.”

Licensed Mental Health Counselor (LMHC), MS Minkyung Chung

Dialectical behavior therapy (DBT)

Dialectical behavior therapy (DBT) is a form of cognitive behavioral therapy (CBT) that was developed specifically for the treatment of BPD. It uses individual and group talk therapy to teach people the skills they can use to manage difficult emotions. DBT for BPD has proven extremely successful. In fact, one study showed that 77% of people no longer met diagnostic criteria after just a single year of treatment.

This type of therapy focuses on mindfulness, emotion regulation, and building strong, healthy relationships. Several studies, including one done by researchers in 2014, found that DBT also helps people with BPD avoid self-harm and hospitalization.

Schema therapy (ST)

Schema therapy (ST) is a borderline personality disorder therapy that seeks to reshape someone’s schemas (ingrained patterns of thinking).

Schemas are generally formed in childhood and become set patterns. The goal of schema therapy is to replace negative schemas with positive and healthy thought patterns.

A 2016 pilot study by the Department of Psychiatry, University of Lübeck in Germany, found that ST can result in a striking reduction of symptom severity, reduced time of hospitalization, and several other positive impacts. (However, it’s important to note that the sample size of this study was small, just 10 patients, and more research is needed).

Transference-focused therapy (TFP)

Another promising BPD therapy is transference-focused therapy (TFP). TFP seeks to break the pattern of transferring emotions onto someone else, which causes reactions that have little basis in reality.

In TFP, a therapist helps people recognize that their reactions are based on their own experiences, not reality, and helps them begin to develop better coping strategies.

Mentalization-based therapy (MBT)

Mentalization-based therapy (MBT) is a type of therapy for borderline personality disorder that helps people with BPD better understand their own mental state and the mental states of the people around them. It’s been found effective in treating depression and anxiety while also improving social functioning.

This therapy is based on the theory that people with BPD have difficulty in relationships because they have trouble understanding the emotions, thoughts, and feelings of others. Thus, MBT seeks to teach people better ways to interpret the words and actions of others.

Systems training for emotional predictability and problem solving (STEPPS)

STEPPS is another frequently-used borderline personality disorder therapy. It’s a skills-based, group method that’s typically used in conjunction with another form of BPD therapy.

STEPPS teaches people skills that help them with emotion regulation. It also touches on self-care strategies like healthy eating, getting enough sleep, and avoiding self-harm.

Effectiveness of Therapy for BPD

The effectiveness of therapy depends on each individual person. Everyone’s symptoms are unique, so people can react to therapy somewhat differently. To achieve the best results possible, there needs to be a full commitment to BPD therapy. People who hope to get better must be dedicated to keeping their appointments and “doing the work.”

What therapy type is best for BPD?

What works well for one person may not be effective for another. A good therapist can help you find the treatment plan that works for you and your symptoms.

“There is no ‘best type’ of treatment for borderline personality disorder, or any disorder, as it’s based on what’s best for the individual. It’s important for people to be aware of their own feelings on the effectiveness of a particular treatment. Advocating for oneself is important in finding the right treatment.”

Licensed Mental Health Counselor (LMHC), MS Minkyung Chung

BPD therapy in conjunction with BPD medication

BPD medication is sometimes used in conjunction with therapy to help people with BPD. While it’s true that the FDA hasn’t approved any medication specifically to treat BPD, some antipsychotic, antidepressant, and mood-stabilizing medications can help symptoms and comorbid conditions like depression, hostility, and anxiety.

Coupling medication with therapy can help people learn to cope with day-to-day life without anxiety and depression so they can concentrate on developing new ways to process their own feelings and interpret the feelings of others.

Finding a Therapist for Borderline Personality Disorder

When you’re learning how to deal with borderline personality disorder, finding a good therapist to treat BPD is essential. It’s the only way to ensure you work towards having the best quality of life possible. It’s also important to find someone you trust and who you’re comfortable sharing your thoughts and feelings with. To find a therapist, ask your primary care physician for a recommendation.

You can also ask trusted friends and colleagues for a referral. Searching online via BPD support groups and online resources like the National Alliance on Mental Illness is yet another option. However you go about finding a therapist, starting therapy with someone experienced in treating BPD is the first step. With the right support and therapy, you can live a full, productive life with minimal, if any, symptoms related to borderline personality disorder.

Talkspace’s online therapy platform is a game-changer when it comes to treating mental health conditions like BPD. Online therapy means you can get the help you need, without the headache and hassle of getting to and from appointments. No traffic, no parking, no time needed for a commute, just log on and get critical care and guidance from a trusted and skilled therapist. You can manage BPD. Talkspace can show you how.

See References

Minkyung Chung, MS, LMHC

Minkyung Chung has over 10 years of experience and specializes in multicultural issues, specifically issues unique to the Asian American population. She enjoys working within the Asian American community to help reduce the stigma associated with seeking mental health services and normalize the process of it. Her passion for this topic has led her to focus her research efforts in examining how to help the Asian American community.

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