After diagnosis, your mental health professional (or GP) will discuss with you a treatment plan, which may include a combination of medication and therapies. There are many types of therapy, and sometimes it can take a while to find the right one for you. The one rule with all therapy is that you get out what you put in – this therapy is there for you to get well, and stay well, and will only work if you are invested in it. Here are some of the common therapies you might be offered.
Cognitive Analytic Therapy (CAT)
Cognitive Analytic Therapy (CAT) offers a unique blend of cognitive and relational techniques to address the complex interplay of thoughts, feelings, and behaviours characteristic of BPD. CAT, developed by Anthony Ryle, integrates principles from cognitive psychology, psychoanalytic theory, and interpersonal therapy. Rooted in the understanding of reciprocal roles – patterns of interaction learned in early relationships – CAT emphasizes the exploration of these patterns and their impact on current functioning and relationships.
Cognitive behavioural therapy (CBT)
Cognitive behavioural therapy (CBT) is a talking therapy that can help you manage your problems by changing the way you think and behave. It’s most commonly used to treat anxiety and depression, but can be useful for other mental and physical health problems. CBT is based on the concept that your thoughts, feelings, physical sensations and actions are interconnected, and that negative thoughts and feelings can trap you in a negative cycle. CBT aims to help you deal with overwhelming problems in a more positive way by breaking them down into smaller parts. You’re shown how to change these negative patterns to improve the way you feel. Unlike some other talking treatments, CBT deals with your current problems, rather than focusing on issues from your past. It looks for practical ways to improve your state of mind on a daily basis.
DBT – Dialectical Behavioural Therapy
Dialectical Behavioural Therapy (DBT) is the main therapy that has been proven to help people living with BPD – it was created by Marsha Linehan, who herself lives with BPD. DBT can help you in a number of ways. There are four key skills taught in DBT:
- Mindfulness: the practice of being fully aware and present in this one moment
- Distress Tolerance: how to tolerate pain in difficult situations, not change it
- Interpersonal Effectiveness: how to ask for what you want and say no while maintaining self-respect and relationships with others
- Emotion Regulation: how to change emotions that you want to change
Dialectical literally means opposites. So DBT teaches you how to reframe a negative or unhelpful emotion, and gives you the skills to effectively cope with these difficult situations day-to-day. One of the key things DBT does is validate you – helping you accept yourself as you are, without feeling misunderstood or that your feelings aren’t valid. As people with BPD often have extreme emotional sensitivity, working together on validation helps keep a careful balance between acceptance and change. You can find out more about DBT here.
Eye Movement Desensitization and Reprocessing (EMDR)
Eye Movement Desensitization and Reprocessing (EMDR) therapy was developed by psychologist Francine Shapiro in the late 1980s as a treatment for post-traumatic stress disorder (PTSD). It involves a structured eight-phase approach that integrates elements of exposure therapy, cognitive restructuring, and bilateral stimulation to process distressing memories and alleviate associated symptoms. The core principle of EMDR is facilitating the brain’s natural capacity to heal by reprocessing traumatic experiences and integrating them into adaptive memory networks. Borderline Personality Disorder often stems from early childhood trauma or adverse experiences that shape maladaptive beliefs and coping mechanisms. EMDR therapy targets these underlying traumas and dysfunctional patterns by accessing and reprocessing associated memories, beliefs, and emotions. By engaging in bilateral stimulation, typically through eye movements, tactile tapping, or auditory tones, EMDR facilitates the desensitization of distressing memories and promotes the integration of adaptive responses.
Mentalisation-Based Therapy (MBT)
MBT aims to challenge your thoughts about what other people are feeling or thinking. BPD can cause us to feel abandoned if a loved one wants to go and do something alone, we might think they don’t care about us anymore, that they hate us or even that they will never come back. MBT can help you to better understand other people’s behaviours and your reaction to it, helping you take a more balanced view of what might actually be going on in the minds of others.
Being able to focus solely on the present can be difficult for those living with BPD, as we often are unable to ‘switch off’ the thoughts that go round and round. Mindfulness teaches you to control those thoughts and emotions and focus on the present moment, helping you to manage your emotions.
Schema Therapy integrates elements of cognitive-behavioural, psychodynamic, and experiential approaches to psychotherapy. At its core, Schema Therapy posits that early maladaptive schemas – deeply ingrained emotional and cognitive patterns developed in childhood – underlie many psychological disorders, including BPD. These schemas shape individuals’ perceptions, beliefs, and behaviours, often leading to dysfunctional coping mechanisms and recurrent interpersonal difficulties.
STEPPS Therapy offers a structured and skills-based approach to help individuals with BPD manage their symptoms and improve their quality of life. STEPPS therapy is a group-based intervention and aims to provide individuals with practical skills and strategies to manage their emotions, behaviours, and interpersonal relationships effectively.
Therapeutic communities are places that you can go to have treatment with groups of people experiencing mental health problems. Community members are able to support each other with understanding of living with a mental health condition. Communities might meet up regularly, or may even be live-in communities. As well as group therapy, communities might also offer activities.
Transference-Focused Psychotherapy (TFP)
Transference-Focused Psychotherapy (TFP) is a dynamic and in-depth treatment modality specifically designed to address the complex interplay of emotions and relational patterns characteristic of BPD. TFP employs a range of techniques to facilitate exploration and resolution of interpersonal difficulties and emotional dysregulation. Central to TFP is the concept of transference – the unconscious redirection of feelings and attitudes from past relationships onto the therapist – as a vehicle for understanding and resolving interpersonal difficulties and emotional dysregulation.
Many people with BPD, especially those who have suffered trauma, find talk therapy incredibly helpful. Most NHS trusts in the UK have the option to self-refer for a course of talking therapy. There are often long waiting lists, and you will be offered a limited amount of sessions, but having an outlet to discuss your main problems can be very helpful in your recovery.