borderline personality disorder, online therapy, relationships, therapy tools, treatment protocols

What Is The Best Therapy For BPD?

If you or a loved one has been diagnosed with Borderline Personality Disorder, you may be wondering what the best therapy for BPD is. You want help and you want to get a good result. You certainly don’t want to waste money on therapy that isn’t the best fit for you. Or maybe you’ve tried a method that doesn’t work for you and you want to know some alternatives.

What Does It Mean to Be the Best?

The idea of a “best therapy” for BPD is highly subjective. Many people with BPD have been helped by Dialectical Behavior Therapy (DBT), but it seems like almost as many people have tried it and didn’t like it. Fortunately, DBT is just one of many options.

The best therapy for BPD is really the best therapy for you. As you read through this list, consider what would best help you in your recovery. Also consider what format might be best for you. Many methods of therapy for BPD are available as intensive outpatient programs or even partial hospital programs. This can be good if you think you would benefit from more intensive work.

DBT: The First Best Therapy for BPD

I refer to Dialectical Behavior Therapy as the first best therapy for BPD because it was one of the first methods that was created especially for people with a BPD diagnosis. If you’ve been around BPD circles for a while, you’ve heard of DBT. You probably also have an opinion on DBT and its effectiveness.

If you’re newly diagnosed or just haven’t heard about DBT, it’s an offshoot of Cognitive Behavior Therapy (CBT). But it’s been modified to help people with BPD because it emphasizes mindfulness. DBT integrates some very meditative and philosophical ideas. Its main goal is to help you become less emotionally reactive. Mindfulness helps you slow your mind down so you don’t say or do things you might regret later.

DBT is based on skills, and it’s commonly used in a group format to help you learn and practice skills with other people. The groups can support you as you try to use the skills in real life situations. Group therapy also reminds you that you’re not alone with your BPD.

Full DBT can be hard to find. The official method is pretty intense, and most therapists don’t offer every part of “full” or “real” DBT. It’s hard to say that DBT is the best therapy for BPD when most therapists and programs don’t offer the full DBT experience.

Still, DBT skills can give you a helpful foundation to get started. You can often find DBT skills workbooks at libraries and bookstores so you can work through the skills without a therapist or program. Despite some of the issues, DBT is still considered the gold standard for best therapy for BPD… at least in America.

MBT: The Other Best Therapy for BPD

Mentalization Based Treatment was created in the late 1980s, around the same time as DBT. Like DBT, MBT was created by people with BPD and meant to help people with BPD. (Lots of acronyms!) Despite its background of evidence, proven effectiveness, and ease of use, it’s not quite as popular as DBT.

The ease of use is a huge factor in why I personally believe MBT should be more standard in the US. As I mentioned in the previous section, DBT is highly complex and requires significant training to be fully used. Most therapists aren’t fully trained and don’t offer the full complement of DBT supports. In contrast, MBT is easy for therapists to learn so they can offer a more complete therapy experience for you as the client.

MBT assumes that a primary cause of BPD is poor attachment as a child. If you don’t have a parent figure who you can safely attach to, you can’t develop your full emotional capacity or sense of yourself. MBT’s focus in treatment is to help you overcome the deficits in your childhood so you can develop secure attachments as an adult.

If your main issues are centered on your relationships, MBT may be the best therapy for BPD for you. It will help you heal your attachment wounds from your early childhood so you have less volatility in your current relationships. You’ll become less sensitive to small changes in your interactions. You’ll also learn how to soothe yourself when you become overwhelmed.

TFP: Best Therapy for BPD…For Some

Transference Focused Psychotherapy (TFP) is a modern psychoanalytic method. If the term “psychoanalytic” made you think of Freud, you’re right! That’s why I think TFP is best defined as a possible best therapy for BPD for some people. Not everyone is the best fit for psychoanalysis.

Modern psychoanalysis is different from how it was in the past. You typically won’t have 5 sessions a week or lay on a couch. But it is still focused mostly on internal work. You won’t necessarily learn new skills or insights right away. Instead, you’ll need to pay a lot of attention to your thoughts and to the relationship between you and your therapist.

One of the core ideas of psychoanalysis is that the relationship between you and the therapist is a reflection of your outside relationships. So any work you do in the sessions will help you out in the “real” world. You’ll be challenged to stick with the therapeutic relationship through all the ups and downs. Your therapist will help and prompt you to communicate everything. This includes your fears of abandonment and your feelings of idealizing, anger, emptiness, and suicide.

Could this be the best therapy for BPD for you? One caution is the lack of empirical evidence. Because TFP is highly individualized, it’s hard to create an effective scientific study. Another caution is that TFP can feel intense. It’s personal, not skills-based, so each session will be directly about you and the ways you relate to others. But if you’ve tried DBT and didn’t like it, TFP might be a good alternative to try.

There Is Help For BPD

Whatever therapy method you choose, and there are many more not listed here, the key focus is finding the one that helps you. There’s no point in finding the highest rated method if it’s not a good fit for your needs. The best therapy for BPD is the one you can stick to. Therapy works best when you can meet regularly and when you can feel comfortable with your therapist.

BPD Therapy With Me

My method of BPD therapy pulls from many kinds of therapy. I love the DBT focus on mindfulness and developing internal awareness. Some of the DBT skills are useful to provide structure when you feel like you’re falling apart. I also incorporate the attachment focus of MBT. Many of the people I work with had a very invalidating childhood and don’t feel secure in relationships. Finally, I think it is important to take the TFP perspective that the therapy relationship is meant to help heal your outside relationships. In therapy, you have a safe space to practice boundaries, stating your opinions and preferences, and expressing your emotions.

Since BPD is highly associated with a history of trauma, I use many of the same methods I use for trauma clients without a personality disorder.

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