woman in psychotherapy session for borderline personality disorder
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Summary: Yes, psychotherapy is considered good treatment for borderline personality disorder (BPD).

Key Points:

Good Treatment for Borderline Personality Disorder: The Seven APA Recommendations

In 2024, the APA released the publication “The American Psychiatric Association Practice Guideline for the Treatment of Patients With Borderline Personality Disorder,” a comprehensive set of treatment guidelines published for BPD. The authors of the guideline define the goals of the guidelines as follows:

“This practice guideline aims to help clinicians improve the care and well-being of their patients by reviewing current evidence and providing evidence-based statements that are intended to enhance knowledge and optimize the assessment and treatment of BP [and] provide clinicians with the necessary knowledge…for treating patients with BPD, thereby reducing the mortality, morbidity, and significant psychosocial and health consequences of this important psychiatric condition.”

While medication has a place in treating people with BPD, medications such as antidepressants, antipsychotics, anxiolytics, and mood stabilizers are generally effective for specific symptoms in certain contexts. Medication alone is not effective in addressing the full suite of disruptive symptoms associated with BPD. The guideline authors observe:

“Psychotherapy is at the core of treatment for BPD for adolescents and adults. A structured [evidence-based] approach is recommended. The specific psychotherapy should target the core features of the disorder.”

Essential components of effective psychotherapy for BD include:

  • A positive, trusting therapeutic alliance between patient and therapist.
  • A validating, compassionate, non-judgmental attitude from the therapist
  • Desire to change from the patient
  • Willingness to develop self-efficacy from the patient
  • The creation of a treatment framework, i.e. setting clear goals and defining how to achieve them, developed through collaboration between therapist and patient

To learn more about the signs and symptoms of BPD and how BPD affects relationships and daily functioning, please read What Is Borderline Personality Disorder? You can also visit our BPD Treatment Page. A broader and deeper understanding of BPD can help explain why a positive therapeutic alliance in BPD treatment is necessary for successful recovery.

Read those pages, or read the brief overview of BPD, BPD symptoms, and the prevalence of BPD we offer below. We’ll cover that information to ensure we’re on the same page. Then we’ll get straight to our discussion of the modes of psychotherapy considered good treatment for borderline personality disorder.

BPD Facts: Definition, Symptoms, Prevalence

Mental health experts define BPD as follows:

“A mental health condition that characterized by a pervasive pattern of instability in relationships, self-image, moods, and behavior and hypersensitivity to possible rejection and abandonment.”

The symptoms of BPD include, but are not limited to:

  • Extreme, excessive, and intense fear of abandonment
  • Unstable and/or volatile interpersonal relationships with family and peers
  • Identity instability/frequently changing concept of self
  • Impulsive, risky behavior
  • Suicidality and self-harm
  • Extreme, sudden mood swings
  • Unpredictable rage/anger that’s difficult to control
  • Paranoia/dissociation

Those symptoms help us understand why a positive and trusting relationship with a therapist – the positive therapeutic alliance – is essential for helping someone with BPD. In relationships, an individual with BPD may shift between extremes in the way they perceive others: one moment they may see a friend as their favorite person on earth, and the next they may see them as their nemesis. The same is true for family: one moment they may believe a beloved family member has their best interests at heart, and the next they may be suspicious of them and believe they intend to cause harm.

That’s the volatility associated with BPD that makes life extremely challenging, and why expert, appropriate treatment is necessary for most people with BPD.

But how many people experience this disorder?

The National Alliance on Mental Illness (NAMI) provides the most recent data on the prevalence of BPD among adults in the U.S.:

BPD: Prevalence Among Adults, 18 +

Those are the basic facts on BPD, which offer an initial understanding of the disorder, and why it’s challenging for individuals, families, and treatment providers. Now let’s take a look at the latest information on psychotherapy for BPD.

Psychotherapy For BPD: What Works?

We’ll spend the rest of this article reviewing the types of psychotherapy experts identify as good treatment for borderline personality disorder, as identified in the APA guidelines we introduce above. In total, the guideline discusses seven (7) types of psychotherapy:

  1. Dialectical Behavior Therapy (DBT)
  2. Mentalization based treatment (MBT)
  3. Transference Focused Psychotherapy (TFP)
  4. Dynamic Deconstruction Psychotherapy (DDP)
  5. Solution Focused Therapy (SFT)
  6. Systems Training for Emotional Predictability and Problem Solving (STEPPS)
  7. Good Psychiatric Management (GPM)

We’ll discuss (4) of those below: DBT, MBT, SFT, and GPM. For a detailed understanding of the remaining three (3), please refer to the links provided.

Dialectical Behavior Therapy (DBT)

There are three primary modes of treatment in DBT: individual talk therapy, skills training, and one-on-one coaching. During individual talk therapy, patient and provider collaborate on establishing the need for treatment, create goals for treatment, and design a roadmap or plan to reach those goals. Skills training involves learning effective techniques in mindfulness, distress tolerance, emotion regulation an interpersonal effectiveness. Many providers off one-on-one coaching on call, to help patients use DBT skills to overcome emotional and behavioral challenges in the moment.

DBT is effective in BPD symptom reduction, improving emotion regulation, improving relationships, and developing stress tolerance skills.

Mentalization based treatment (MBT)

Experts define mentalization as “…the process by which we make sense of each other and ourselves, implicitly and explicitly, in terms of subjective states and mental processes.” In the context of BPD, treatment with MBT assumes that “…vulnerability to frequent loss of mentalizing is the underlying pathology that gives rise to these characteristic symptoms.” During MBT treatment, the therapist takes a nonjudgemental stance, ensures the patient feels safe, and prioritizes trust. Once a trusting alliance is established, the therapist guides the patient through a process of assessing difficult interpersonal situations, focusing on emotions associated with attachment, and then helps them apply concepts of mentalization to recalibrate their behavioral and emotional responses to these challenging/difficult situations.

MBT is effective in reducing overall BPD symptoms, reducing impulsivity, and improving interpersonal functioning.

Solution Focused Therapy (SFT)

This approach is based on the idea that people understand themselves and others by developing cognitive schema or maps/outlines of personal understanding based on significant developmental experiences. In BPD, personal schemas appear as “…persistent patterns of thinking, feeling, and behaving…” These remain consistent through the intense emotions, thoughts, and behavioral patterns associated with BPD. In BPD, these personal schemas are maladaptive, dysfunctional, and are identified as the primary source of difficulty for patients. During treatment with SFT, the therapist first establishes a positive attachment with the patient. Then they apply cognitive, behavioral, emotion regulation, and education techniques to help patients reassess and revise maladaptive schemas.

SFT is effective in reducing overall symptom severity in patients with BPD, improving interpersonal functioning, and helping patients feel safe, seen, and accepted.

Good Psychiatric Management (GPM)

This is considered a generalist approach based on principles of psychodynamic therapy that views BPD as rooted in extreme interpersonal hypersensitivity. This approach prioritizes a positive therapeutic alliance and focuses on helping people with BPD improve vocational and social functioning.

GPM is effective in overall symptom reduction and shows promise in improving interpersonal relationships for people with BPD.

Connecting the Dots: What Defines Good Treatment for Borderline Personality Disorder?

Good treatment for BPD means:

  1. Person with BPD feels safe, seen, and understood.
  2. Overall reduction in symptom frequency and severity.
  3. Collaboratively defined treatment goals are met.
  4. Relationship function improves.
  5. Improved daily function, decreased daily difficulty.

Challenges around emotional attachment and abandonment cause most of the disruptive symptoms associated with BPD. This means many people with BPD live in a state of fear and/or heightened vigilance of any change in their relationships. Therefore, effective therapy revolves around first establishing a sense of safety and a connection wherein the patient both feels and believes the therapist is trustworthy and has their best interests in mind.

Before experts understood BPD from a clinical perspective, many treatment professionals avoided supporting people with BPD. Now we understand that BPD is treatable and patients can and do learn to manage their symptoms and live productive lives. We’ll close with the words of Dr. John Gunderson, whose work on BPD led to the GPM approach we describe above, from the article “Research Spotlight: Meeting the Treatment Needs of Individuals With Borderline Personality Disorder,” which quotes his GPM treatment handbook:

“You don’t need to be a specialist or selflessly devoted to be good enough; you need to be warm, reliable, interested, and unintimidated, and you need basic knowledge about case management to provide GPM to patients with BPD.”

That’s the new approach to BPD. It’s also a template for how psychotherapy can be good treatment for borderline personality disorder. When a patient and a caring therapist can form an honest connection, a patient with BDP can make real treatment progress.