Borderline personality disorder can have a deep and broad impact on a young person’s life. Young people with BPD experience a wide range of symptoms that affect their relationships, work, education, well-being, and safety. Without adequate support, BPD symptoms and traits often continue for years, even if a young person no longer meets the criteria for a complete diagnosis.
Young people with BPD usually experience one or several co-occurring disorders, including anxiety, depression, and PTSD. The disorder is linked to higher unemployment and social challenges, and many people with BPD face daily stigma from peers, employers, and healthcare workers alike.
However, while stigma surrounding the disorder leads many people to believe that BPD is “untreatable”, in reality, there are several treatment approaches available that can support people to recover from the disorder. Even those experiencing the most serious BPD symptoms can see profound improvements in their symptoms.
Treatment for borderline personality disorder usually involves a team of professionals, including psychologists, social workers, occupational therapists, and crisis support teams. Together, these professionals can support young people in different aspects of their everyday lives, forming resilience and stability. Within this network, psychotherapists play a vital role.
What Kinds of Psychotherapy are Effective for Borderline Personality Disorder?
There are multiple evidence-based psychotherapies for borderline personality disorder. These include:
- Dialectical behavioural therapy
- Schema therapy
- Mentalisation-based therapy
- Transference-focused psychotherapy
- Acceptance and commitment therapy
- Supportive therapy
Dialectical Behavioural Therapy
Dialectical-behavioural therapy is the most established psychotherapy for borderline personality disorder. It combines individual therapy with group skills training sessions and phone coaching. It focuses on developing skills in four main areas:
- Mindfulness
- Distress tolerance
- Interpersonal effectiveness
- Emotional regulation
DBT is a type of cognitive-behavioural therapy that emphasises the interactions between our thought patterns and behaviours. It supports individuals in identifying unhelpful patterns and replacing them with more positive ones. At the same time, it embraces radical acceptance of emotions and experiences, encouraging young people to accept these experiences without judgment and recognise that some things are out of their control.
Dialectical-behavioural therapy has been adapted for adolescents (DBT-a) and for residential treatment.
Schema Therapy
Schema therapy is a type of psychotherapy that addresses an individual’s schemas: patterns of thinking and beliefs that may cause them to engage in harmful behaviours or struggle in interpersonal relationships. Schemas can develop in childhood in response to ongoing threatening or distressing situations when caregivers are unable to meet children’s emotional and physical needs. Young people may form ideas about other people’s intentions and trustworthiness, and what is necessary to survive, that don’t fit with the situations they experience later in life.
Schema therapy combines aspects of psychoanalysis and cognitive behavioural therapy to help individuals identify unhelpful schemas and the way these impact their daily life. It then supports them in altering their schemas, changing their thought and behavioural patterns to help them cope with and navigate their everyday experiences.
Mentalisation-Based Therapy
Mentalisation-based therapy is a type of cognitive-behavioural therapy that focuses on understanding the mental states behind one’s own and others’ actions. Many people with borderline personality disorder may not have developed or use mentalisation skills, responding impulsively to other people’s behaviours rather than considering the thoughts and feelings that cause someone to act in a certain way. This can cause difficulties in interpersonal relationships and make it harder to cope with emotional distress.
By teaching mentalisation skills, mentalisation-based therapy helps individuals better understand their own and others’ mental states. It supports them in developing a more coherent sense of self and more stable relationships with friends, family members, and romantic partners. It also helps young people avoid impulsive reactions that may put themselves in danger.
Transference-Focused Psychotherapy
Transference-focused psychotherapy is a type of psychotherapy that’s grounded in psychoanalytic theory. It’s based on the idea that traits and behaviours of BPD are influenced by thoughts, emotions, and experiences that may be subconscious, suppressed, or not immediately obvious to an individual or others around them.
Transference-focused therapy aims to help individuals understand shifts in their own experiences and experiences of others, which play out in their work and relationships. These shifts in identity also manifest in the relationship between the individual and the therapists, where they can be identified and addressed.
Acceptance and Commitment Therapy
Acceptance and commitment therapy is rooted in behavioural therapy approaches. It emphasises the acceptance of negative thoughts, feelings, and experiences as part of the human experience that do not need to prevent someone from living a fulfilling life. Like dialectical behavioural therapy, it aims to find a balance between acceptance of what is, alongside commitment to changing coping mechanisms and behaviours to make life more manageable.
How Effective is Psychotherapy for Borderline Personality Disorder?
Research has established that different types of psychotherapy can effectively treat borderline personality disorder. Last year, a systematic review of 25 studies found that all nine types of psychotherapy that it assessed, including the above therapies, led to improvements in BPD symptoms and day-to-day functioning.
Until now, a lack of comparison studies means that there isn’t enough evidence to clearly say if some types of therapy are more effective than others. And, since every individual is different, the right treatment for each person will depend on their personal characteristics, experiences, and environment. But it’s clear that psychotherapy is an important and valuable treatment for BPD.
Residential and Outpatient Treatment for BPD
Psychotherapy approaches can be delivered in both residential and outpatient settings. In outpatient settings, young people with borderline personality disorder attend regular therapy sessions while continuing to live in their home environment. They may participate in a combination of different approaches, or one psychotherapy approach alongside other kinds of psychosocial support.
In outpatient treatment settings, it’s important for young people to have a crisis plan and people to call if they feel like a situation is escalating. This might include a social worker, mental health professional, or a crisis support team.
Residential settings are sometimes required to keep a young person safe if they are at a high risk of harm to themselves. They can also support young people who may be living in a stressful home environment or overwhelmed by certain patterns or routines in their daily lives. Residential treatment can give young people time and space to focus on recovery, away from triggers and conflicts.
In residential treatment, young people typically engage in a combination of psychotherapies alongside other forms of support. Psychotherapies may be adapted to integrate the additional resources that residential settings provide into a therapy plan. For example, support staff, who help young people navigate day-to-day living, can play a valuable role in the practical application and reinforcement of skills.
The Wave Clinic: Transformative Mental Health Support for Young People and Families
The Wave Clinic offers residential and outpatient support for young people with borderline personality disorder, eating disorders, complex trauma, and other mental health challenges. Our treatment spaces provide a diverse selection of evidence-based modules, delivered with exceptional expertise from around the world. Our residential space offers education, adventure, and enriching experiences alongside clinical care, supporting young people to learn, grow, and develop, nurturing resilience and self-belief.
Our treatment programs for borderline personality disorder combine psychotherapies, art therapies, experiential therapies, education, and family therapies, supporting adolescents and young adults to develop coping mechanisms, build a stable identity, find a sense of belonging, and discover new life paths.
If you’re interested in finding out more about our programs, get in touch today.
