Treatment for borderline personality disorder is extensive therapy. Borderline personality usually develops when people are very young, and it takes a long time to adapt or learn responses that are less painful. This condition is often considered one of the most difficult to treat. The strong dependence on the therapist, which can easily shift to defiance and acting out, can be exhausting, and some therapists will avoid this type of patient. Such avoidance is unnecessary given the right therapeutic tools, and it’s quite possible to establish a strong and improving alliance with a borderline patient, though rate at which gains are made is variable.
Any early treatment must look at some possible risks with this condition. A number of people with borderline personality disorder can be suicidal or self-injurious. Early treatment could work on ways to reduce these tendencies. Sometimes for egregiously ill patients, third wave behavioral therapies like dialectical behavioral therapy (DBT) are used first.
DBT has been shown effective in reducing acting out of emotions toward self or others. Therapists may also need to contract with patients so they will not injure themselves. Without these contracts, hospitalization might initially be necessary.
If treatment for borderline personality disorder involves hospitalization, it might also entail use of psychiatric medications. Drugs aren’t deemed necessary in functional patients because borderline is not considered a chemically based disorder. This personality type may be present with other chemical disorders or with simply extreme acting out, which might require a variety of medicines to reduce depression, psychotic behavior, or anxiety. Some people benefit from continued medication after leaving a hospital, but not all need it.
Objects Relations schools tend to provide a lot of theoretical groundwork about effective treatment for borderline personality disorder. Specific theory of these varied schools is highly technical. From a patient perspective, the process is easier to understand and involves talking about past or present events, with a supportive therapist occasionally drawing attention or asking questions about some things that are mentioned.
From the therapist’s perspective, treatment is about slowly drawing attention to the destructive behavioral patterns of the client, expanding tolerance for feeling but not acting out emotions, and helping the patient to avoid splitting into black and white views of the world. Emphasis in much of the treatment for borderline personality disorder is working on eliminating behaviors that are destructive. This is incredibly nuanced because a push too far can send a patient spiraling into anger or splitting, and too little may simply create total dependency of the client on therapist, with the client’s belief the therapist is there to fix the problems.
Borderline clients often switch therapists, particularly if they’re not diagnosed early and feel they are being attacked and confronted. Preliminary approach works on building a strong alliance with minimal forays into calling the client to account for inconsistencies. As an alliance is built, treatment for borderline personality disorder can shift, and it may slowly intensify as the client learns more adept handling of destructive and defensive responses.