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Simone Hoermann, Ph.D.Simone Hoermann, Ph.D.
A blog about the personality disorders (borderline, narcissistic, etc.) with a focus on research and therapy

Therapy for Borderline Personality Disorder – building a life instead of digging up the past?

Simone Hoermann, Ph.D. Updated: Mar 25th 2009

small plant in a handMany people with Borderline Personality Disorder (BPD) have experienced difficult and traumatic childhoods. This is not to say that everyone who had a difficult childhood will develop BPD, nor does every person with BPD have a history of trauma.  Nevertheless, traditional talking therapy that focuses on exploring childhood experiences would seem in order, one may think.

Not so, states Joel Paris, a researcher at the Sir Mortimer B. Davis Jewish General Hospital in Montreal. Paris is a Professor at McGill University and has studied personality disorders for decades. In his recent book “Treatment of Borderline Personality Disorder –A Guide to Evidence-Based Practice”, Paris looks at different forms of psychotherapy that have been developed through research and tested in controlled clinical trials. The therapies that are effective in treating BPD come from very different theoretical points of view, says Paris, but they have one important thing in common: They focus on the present, and on the current issues a person is dealing with.  According to Joel Paris, people with BPD don’t get better by uncovering memories and rehashing the past, but by using the past as a context for understanding the present. This includes validating and acknowledging a person’s life history, and then putting it behind them.  What sets successful therapies for BPD apart is that, in one way or another, they teach people how to tolerate painful feelings and to how experience difficult emotions without acting upon them in self-destructive ways. 

Central to a successful treatment for BPD is a person’s commitment to building a life for oneself, according to Joel Paris.  This commitment to life can be a challenge for BPD patients who tend to feel suicidal often and sometimes chronically. The idea is to work on building a life worth living, while putting the past into perspective and learning skills to tolerate intense emotions. Building a life for oneself is by no means an easy task. It includes developing goals for the future, finding work, and building relationships.

Joel Paris stresses that having a job can do wonders for a person’s sense of self-worth, highlighting the satisfaction that can come from fulfilling a social role and from contributing to the community. He also discusses the trials and tribulations that are associated with building and maintaining relationships. Intimacy, family and children may be important and helpful for some people, but may not be for everyone. For some people, being part of a larger community, such as a church or social group, might provide emotionally satisfying connections. What’s important though is to not just focus on one single area of one’s life, or on just one relationship. The trick is to diversify one’s interests, and to try to retrieve satisfaction and pleasure from a range of different activities, relationships, and emotional investments. It also means accepting the fact that sometimes things don’t work out.  We can have bad luck, we can make mistakes; Work can be unstable, relationships can be conflictual. That said, as the author wisely states, “an imperfect life is better than no life at all”.  

Simone Hoermann, Ph.D.Simone Hoermann, Ph.D., is a Psychologist in private practice in New York City. She specializes in providing psychotherapy for Personality Disorders, Anxiety, and Depression. She is a faculty member of Columbia University, and facilitates psychotherapy and skills training groups at the Columbia East 60th Street Day Treatment Program.

Reader Comments
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Where to begin - quickAngel - May 5th 2009

I wonder sometimes if BDP get's worse with time. Or if it can become to late for someone. I want to start helping myself because i feel as if it is a never ending escalation of emotions that bottle up and have strated to make me cross the line further and further. Depending on the outcome i either feel satisfied if i get the last word, but if i feel cheated. I get unreal outbursts of narcissitic rage that leave me breathless at times. But it never really goes away. When i feel i have lost or dissapointed i feel extreme depression and get dark thougts. I feel like i try to hard and that i expect to much of myself and am never happy always afraid of someone out to get me. I have been a burden to many and i have a guilty conscience. I feel more and more scared to interact with others because of past experiences have left me alone in this world and live ine one constructed from my workoholic behaviour that encapsulates me from this world. I wish i find one day my path back home but i wonder if there is still hope for me.

Agreed - Willow - Apr 23rd 2009

This was an interesting read because as I've begun to study DBT on my own, I've wondered if this treatment ignores where the pain came from to begin with. I read and reread that those with BPD are often abused, neglected, and what have you, though I hardly read anything about touching on these subjects with the client. As it is, I'm not in therapy so I can't give a perspective on how it might be if I were. I can say when I was in therapy, and before anyone diagnosed me with BPD, I was quite interested in examining my past, as well as the present. I can appreciate the present-minded focus, but I do think there is a balance in this and there needs to be respect for the fact that many clients with this diagnosis will have past pain that needs consideration and time, too. You don't tell someone who is otherwise healthy but who has experienced rape to just move on, so in the same vein, it is counter-productive in my opinion to completely put aside past pains of a BPD client because the big DMV word takes presedence.I also agree with what Hema is saying about a loss of sense of less, or lack of stable identity. I mean, it is part of the diagnosis, but this might be overlooked at times, too, as the focus is usually on the extreme emotions and actions because of them. At least for myself, it is hard for me to differentiate between my own values, and ones I wish to have for someone else, or for the benefit of my relationship with someone else. I could probably write pages upon pages on what I think my values are if I were so inclined, but in the end, I'd really have a hard time knowing for certain that they were purely mine and not inspired by some outer source, if that makes sense. In other words, I think it's important to consider just how dependent someone with BPD can be on the opinions of others, as I recognize in myself the fact that I've put my needs and wants aside to please others and/or 'keep the peace' for a very long time, and simply doing what I want/need to please myself is very foreign and scary, because a lot of why I began doing it in the first place was to protect myself from abandonment/rejection. With that in mind, more often than not, the extreme emotional outbursts I experience have more to do with the fear that what I give of and up of myself won't be reciprocated, which is hinged on my perception of what compromise is, so this sense of self/identity, seperate from outer influences, is a very important and difficult aspect. 

Parenting BPD children - - Apr 8th 2009

I am the guardian for 4 girls who came from long-term traumatic family background.  My oldest has been diagnosed with BPD and we have received counseling from a wonderful therapist but my daughter chooses not to recieve therapy on a regular basis.  Their natural mother is seeking termination of our guardianship and I am seeing signs in my oldest that usually lead to a huge upset in our family (suicide attempt, running away, physical fights with siblings...)  I have been trying to keep in touch with her via phone during the day, stopping into her room at night, outings with just the two of us and assurance that things will work out and that I understand and can see how she's feeling.  What therapeutically ? as a parent can I do in times of non-stress to help her handle stressful times? 

Helping BPD clients from a cultural perspective - Hema - Apr 7th 2009

I would like to add that it is important to consider the past cultural aspects of the client's life history to understand where they got their life views and understanding of their notion of self from. I tend to think that BPD cleints have lost some sense of "who they are". This is a question is not taught as a subject in any of our modern day courses in schools and businesses. There is a sense of dependence on people to figure out this on their own through their faith or family. But many cleints have been denied both and they ought to be given something else to help them determine the answer to this question. It is a matter of confused identity, I think, that is so difficult for BPD clients.

Hema (MSc Mental Health Student)

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