A Relational Approach to Psychotherapy and Counselling for Borderline Personality Disorder

This is the second in a series of posts about relational therapeutic approaches to mental health issues. You may find it helpful to get background to this by reading the last post, on a relational approach to depression.

Borderline personality disorder, like depression, has in the past often been medicalised, objectified, or managed. I’ll attempt to give a brief no-jargon sense of a different, more relational way of working with people whose symptoms fit this diagnosis.

People with this diagnosis are known for having intense, chaotic, and often destructive relationships. Relational therapy with people with this diagnosis is an attempt by both client and therapist to build what may be the client’s first experience of a stable, healthy, and boundaried relationship. This involves both therapist and client acknowledging and working through the inevitable challenges of staying in relationship with each other. These challenges include the disappointments, the injuries, the wounds, and the traumas both large and small that are often the reflections of the hurts and inadequacies of earlier relationships. This is big work - connecting with someone consistently over the long term in a real and honest way. Once we've developed the capacity to do this with a therapist, then we're much more likely to be able to do this in our other relationships, and we probably will no longer fit the diagnostic criteria for borderline personality disorder.

Realistically, enough attending to relationships has to happen in any successful therapy with people with this diagnosis. My experience is that the more openly and consciously relationship issues (including the therapist and clients, as real fallible humans) are addressed, the better. This doesn’t exclude other approaches, such as practising DBT distress tolerance skills to get through crisis.

Please let me know in e-mail or comments what you think about this. Check in again soon for the next post in this series: a relational approach to anxiety.