There are several evidence-based treatments for BPD, such as Dialectical behaviour Therapy (DBT), Mentalization-Based Treatment (MBT), Schema-Focused Therapy (SFT) and Transference-Focused Psychotherapy (TFP). However, these may require many years of mastery and often have limited availability. Recently, structured generalist approaches have been developed drawn from the core principles of ‘what works’ from these specialist therapies. They have been proven to work for people experiencing BPD.
The core principles of care can be easily incorporated in the practice of health professionals, expanding access to treatment, and working to ensure that every interaction can be therapeutic.
Whilst these principles have been developed for health professionals that can also guide how family/friends/kin and supporters can do to be in a more sustainable relationship for everyone. It is important to note that we are not suggesting that you become their therapist – they still need you to be their mum, dad, partner, child, friend, supporter etc and to do everyday things and activities with them.
The core principles are:
Focus on building a collaborative and trusting relationship
A strong therapeutic alliance is crucial
Aim to build mutual respect, active collaboration, and shared decision-making.
Be active and responsive
Treat the person as an individual, collaborating with them, i.e. “doing with” rather than “doing to”
Foster trust to allow strong emotions to be freely expressed
Be human and be prepared to acknowledge both the serious and funny side of life where appropriate
Seek to be educated and informed by those living with BPD/Lived Experience- what works for them
Remember aspects of challenging behaviours have survival value given past experiences
Be compassionate
Demonstrate empathy
Stay calm
Remain respectful
Remain caring
Engage in open communication
Listen to the person’s current experience
Take the person’s experience seriously, noting verbal and non-verbal communications
Maintain a curious and non-judgemental stance
Family/friends/supporters can become active allies in the person’s care and support team (unless inappropriate)
Acknowledge, respect and validate their contribution, and their emotional distress
Help support families, partners and carers of people with BPD by:
Arranging contact with any support services
Use language that conveys hope and optimism
Giving them clear, reliable information about BPD
Refer to ongoing supports
People living with BPD can lead meaningful lives
Build and help the person maintain motivation
Encourage a sense of agency balanced with support as needed
Focus on life situations – relationships and vocation
Integration of skills into daily life
Validate the person’s current emotional state
Convey encouragement and hope about the person’s capacity for change whilst validating their current emotional experience
Maintain hope even when the person may be feeling none
Structured (manual directed) approach
Be clear, consistent, and reliable
Work with the person to explain the diagnosis. Does it resonate for them?
Help the person make connections of feelings to events and actions
Collaboratively define goals of treatment
Schedule regular sessions
Use a systematic approach to addressing specific therapeutic tasks or topics.
Provide psychoeducation
Clear limits of what the therapist can and can’t provide
Collaboratively develop a treatment (wellness plan) involving family and/or carers
Teach emotional awareness, distress tolerance, coping techniques, skills and strategies to recognize, understand, and regulate their emotions in less/non-harmful ways
Focus on the emotions underlying the person’s action/s
The therapist accessing their own supervision and support
For more information about these core principles please refer to:
