Exciting developments have occurred in relation to the psychological treatment for BPD over the last 25 years. During that time several models of therapy have been developed specifically for treatment of BPD and shown to be effective in research studies.
• Dialectical Behaviour Therapy (DBT) is a therapy developed by Marsha Linehan. It includes a combination individual sessions and skills training sessions which support development of mindfulness, emotional regulation, self-soothing and interpersonal effectiveness
Behavioural Tech Founded by Marsha Linehan who original developed DBT.
DBT in a Nutshell by Dr. Marsha Linehan
DBT Peer Connections a peer support community for peers who are dedicated to improving their emotional health through daily dialectical behavior therapy (DBT) skills practice. Also a peer support group on Facebook
DBT Skills for Carers an open facebook group for carers
An animation about DBT for adolescents
• Mentalisation Based Therapy (MBT) is a therapy that aims to increase a person's capacity to reflect on their personal internal experiences (feelings, thoughts, urges, memories, beliefs andwishes) as well as learning how to better understand other people's internal experiences. This increases self-understanding and improves relationships with others and reduces many of the challenging behaviours associated with a diagnosis of BPD.
Mentalization developed by Andrew Bateman and Peter Fonagey. Article on Mentalization
• Cognitive Analytic Therapy (CAT) is a time limited therapy. The CAT practitioner works to identify chains of events, thoughts, emotions and motivations which help explain how behaviours such as self harm, angry outbursts etc develop and are maintained. It also aims to identify patterns that may cause problems in relationships between the person with BPD and others. Often these patterns are developed early in childhood and are repeated later in life.
• Schema Focused Cognitive Behaviour Therapy (SFT). Schemas are ridged core beliefs about oneself. The basis of BPD maybe seen as a pattern of maladaptive schemas that develop in early life. SFT addresses these maladaptive schemas and the associated emotional, cognitive and behavioural difficulties.
Developed by Jeffrey Young from the Schema Therapy Institute.
• General Psychiatric Management∗ (GPM) is an evidence-based treatment developed by John G. Gunderson, MD. It was designed to be an outpatient intervention that could be easily delivered by community mental health professionals. GPM includes education for patients and their families, a persistent focus on the patient’s life outside of therapy, and a focus on big goals (e.g., stable partnerships and vocations). The treatment is often delivered as once weekly individual therapy and combined with other treatments such as medication management, family interventions, and group therapy. YouTube clip from McLean Hospital (USA)
A research study comparing DBT, Schema Therapy and Mentalisation Based Therapy from researchers at the University of WA: InPsych 2018 | Vol 40 April | Issue 2
Studies show that therapy given by a person trained in treating BPD and guided by the National Practice Guidelines can be just as effective as one of the therapies mentioned providing it includes the factors listed in Factors for Effective treatment
Self-harm may continue during therapy as a way on managing intense emotions.
The patient’s readiness for long term therapy needs to be carefully considered by both the patient and the therapist prior to both making a commitment to a full course of psychological treatment.
For a person to achieve the best results from psychological therapy he or she will need to be willing and able to attend appointments regularly (often weekly) and to be able to openly explore their expectations of the therapy and their therapist.
Assessment and some pre-therapy sessions can help patients who are apprehensive or anxious about committing to therapy to familiarise themselves with what is involved.
There is no evidence at this time that any of the treatments mentioned is better than any of the others.
∗ “General Psychiatric Management” and “Good Clinical Care” should not be confused with TAU (Treatment as Usual).