- Counseling Application
b. Clinical Vignette
c. Counseling Approach: Dialectical Behavioral Therapy (DBT)
- List of resources
a. Local Specialists
c. Inpatient Treatment Centers
d. Resources for Clinicians
- Annotated Bibliography
b. Peer Reviewed Journals
c. Online Resources
- Handouts and Assessment Tools
Borderline personality disorder (BPD) is characterized by instability. This instability affects a number of areas of the person’s life including: emotions, affect, relationships, self-image and impulsivity. People with the disorder tend to become symptomatic in early adulthood. These symptoms include:
- An overwhelming aversion to abandonment. Including avoiding abandonment or separation in extreme ways (including self-harm).
- Relationship instability. Often people with BPD move between idealizing partners, friends, or parents, and then quickly feel these same people are not showing them enough love or care.
- An unstable self-image, leading to abrupt changes in views, goals, friends, sexual orientation, and plans.
- Marked impulsivity that is damaging to the person. This may include, gambling, shopping, unsafe sex, or reckless driving.
- Self-harming and suicide attempts are common in people with the disorder and 8% – 10% commit suicide.
- Affect instability. Manifest in a number of ways such as: extreme or inappropriate anger and difficulty controlling anger, feelings of emptiness, paranoid ideation, extreme mood changes, or dissociative symptoms that lead to affective changes.
Counseling Approach: Dialectical Behavioral Therapy
DBT was developed specifically to help treat people with borderline personality disorder. It is considered an evidence based treatment and research has been done on its efficacy. A study published by the British Journal of Psychiatry found that people who received DBT for one year had self-mutilation and self-harming behavior compared to a control group. DBT works by addressing a number of the areas of difficulty for people with the disorder. At the center of treating BPD is trying to help people regulate their emotions and change some of their core beliefs that exacerbate the disorder. In the simplest terms DBT could be explained as helping clients accept and tolerate difficult feelings and helping them change damaging beliefs.
Regulating emotions is addressed by:
- Distress tolerance
- Mindfulness skills
- Interpersonal effectiveness
Changing core beliefs is addressed by:
- Exploring early experience that led to belief formation
- Challenge the belief that “I am bad”
- Creating alternative meanings
List of Resources
Don Talley, PhD, NCC
Located in Santa Rosa
Specializes in CBT and DBT for people with borderline personality disorder
Average cost per session: $120 – $150
Lisa Wolper, LCSW, SAP
Located in Santa Rosa
She has over twenty years of clinical experience and specializes in DBT for people with BPD
Average cost per session: $130 or more
SOS Counseling Services
Located in Santa Rosa, Windsor, and Rohnert Park
Providing low cost psychotherapy and bilingual clinicians
Average cost per session: low cost – free
Adolescent DBT Skills Training Group
Group led by Lisa Rohe, PsyD
1008 Fifth Street
Santa Rosa, California 95404
Wednesdays 6:30pm – 7:45pm
Average cost per session: $65
DBT Center of Marin
Three groups per week led by various licensed clinicians
895 Sir Francis Drake Blvd,
San Anselmo, CA, 94960
Adult group: Tuesdays 12:30pm – 2:30pm
Wednesdays 6:30pm – 8:30pm
Fridays: 10:00am – 12:00pm
National Alliance on Mental Illness
Offers a discussion forum for people who are coping with BPD NAMI
Inpatient Treatment Centers for BPD
Clearview Women’s Center
Specializing in borderline personality disorder and emotional disorders. Offering residential, outpatients, and day treatment options. Women only.
Accepts most PPO insurance
Located in Los Angeles, CA
Offers inpatient treatment for BPD and other disorders. Minimum 30 day program.
Accepts most PPO insurance and Tricare
Located in Illinois
The Retreat at Shepard Pratt
Offers executive inpatient treatment for BPD and other disorders. Minimum 28 day program.
Private pay only
Located in Maryland
Resources for Clinicians
Specialized Training Services
You can purchase a DVD of Dr. Marsha Linehan, who is credited with developing DBT, as part of a home study program. The video covers screening and assessment tools as well as DBT training.
Offering four day workshops for specialized training in DBT. These are offered in various places around the US. CEU are offered.
National Education Alliance for BPD
Offering online classes and resources for clinicians. There is a six part continuing education series geared toward helping clinicians treat BPD.
Kreisman, J. J. & Straus, H. (2009). Sometimes I act crazy: Living with borderline personality
disorder. New Jersey: Wiley.
This book is an excellent source for both clients and family members of clients who are coping with borderline personality disorder. It starts each chapter with a case example of someone who has the disorder. It then goes into practical skills and tools that can be used to help treat and cope with the symptoms of BPD. It covers such topics as impulsivity, self-harm, and emotional dis-regulation. This is a follow up book from the author of the 1989 book I Hate You, Don’t Leave Me. Although that is considered one of the seminal books on BPD his new book is more recent and includes techniques stemming from updated research and clinical practices.
Linehan, M. (1993). Cognitive-behavioral treatment of borderline personality disorder. New
York City: The Guilford Press.
Marsha Linehan is considered one of the leading authorities in the treatment of BPD and the founder of dialectical behavioral therapy. This book serves as a guide for clinicians who want to understand BPD and treat it. This book can be used as a textbook for those in clinical practice who want guidance in working with BPD. It lays out and explains Linehan’s method of DBT. It begins with an explanation of the signs and symptoms of the disorder. It moves on to explain behavioral techniques that are helpful in treating the disorder. It continues by explaining cognitive strategies and interventions and the book ends with tips and tools for case management for BPD.
Linehan, M. (2014) DBT skills training handouts and worksheets, second edition. New York
City: The Guilford Press
Linehan, M. (2014) DBT skills training training manual, second edition. New York City: The
The DBT Skills Training Manual is a great supplement for clinicians to the textbook listed above. The DBT Skills Training Handouts and Worksheets book should be used in conjunction with the manual. It features 225 handouts and worksheets that can be done with clients or given to clients as homework assignments. The assignments in the skills training workbook are accompanied by instructions so that clients can do them on there own. However, clinicians interested in using these assignments with clients should read the manual which will give them a better understanding of how these worksheets should be used.
Peer-Reviewed Journal Articles
Bohus, M., Haaf, B., Simms, T., Limberger, M. F., Schmahl, C., Unckel, C., Lieb, K., & Linehan,
M. (2004). Effectivness of inpatient dialectical behavior therapy for borderline
personality disorder: a controlled trial. Behaviour Research and Therapy 42(5),
487-499. doi: 10.1016/S0005-7967(03)00174-8
This study discusses the effectiveness of inpatient DBT for treating BPD. It assessed two groups of people with borderline personality disorder. The first group was in a three month inpatient treatment program for the disorder and received DBT. The second group was on a waiting list for the program and received outpatient treatment including counseling but not DBT. The study found that participants in the inpatient DBT program had significantly better outcomes than the other group in a number of areas. These participants were less depressed, less anxious, had better interpersonal functions, were more socially adjusted, and had less self-mutilation.
Clarkin, J. F., Levy, K. N., Lenzenweger M. F., & Kernberg, O. F. (2007) Evaluating three
treatments for borderline personality disorder: A multiwave study. The American
Journal of Psychiatry 164(6), 922-928.
Researchers evaluated three different psychotherapy techniques for treating BPD in outpatient settings. The three approaches assessed were DBT, transference-focused psychotherapy, and dynamic supportive treatment. Results revealed that participants improved in all treatment conditions. DBT and transference-focused therapy were associated with improved suicidality. Transference-focused therapy and supportive therapy were both associated with improved impulsivity and anger. Many research studies show the benefit of DBT. This study is particularly helpful because it shows other treatments that have been shown to be effective in treating BPD.
Fallon, P. (2003). Travelling through the system: The lived experience of people with
borderline personality disorder in contact with psychiatric services. Journal of
Psychiatric and Mental Health Nursing. doi: 10.1046/j.1365-2850.2003.00617.x
This journal article details the experience of a number of people who have BPD. It discusses their experience with psychiatric care. The study found that most people valued their experience even though many of them had negative experiences with care providers or staff. Having positive relationships with care providers was shown to be an important part of healing for people with BPD. Some of the qualities that facilitated positive relationships were experienced staff and staff who understood the behavior of people with BPD. This resource can be helpful both for clinicians and clients who want to get a better understanding of people with BPD’s experience with mental health care.
Mercer, D., Douglass A. B., & Links, P. S. (2009). Meta-analysis of mood stabilizers,
antidepressants, and anti-psychotics in the treatment of borderline personality
disorder: effectiveness for depression and anger symptoms. Journal of Personality
Disorders 23(2), 156-174. doi: 10.1521/pedi.2009.23.2.156
This study analyzed a number of controlled double-blind clinical studies of mood stabilizers, anti-psychotic medication, and antidepressant medication for treating depression and anger in people with BPD. There is no medication that has been approved by the FDA to treat BPD. This study is important because it points to a few medications that might be helpful treating some of the symptoms of BPD. The study found that antidepressants and anti-psychotics had a moderate effect in reducing anger symptoms. Additionally, mood stabilizers had a small effect treating depression symptoms. This can be helpful information to have as a clinician if you are considering referring someone with BPD for a psychiatric evaluation.
The NIH website offers an overview of borderline personality disorder as well as some of the signs and symptoms. It also covers some screening techniques that may be used by clinicians. Additionally, it identifies some risk factors of who might be at higher risk of having BPD. It also provides an overview of therapies, medication, and other possible treatments. This source is a great place to start as a clinician because it can be a jumping off point for understanding the disorder. It can also be helpful to direct clients to this page if they are wanting to understand more about their own disorder or a loved one’s. It even offers tips of things that people can do for themselves or a loved one who might be coping with the disorder.
The Healthy Place website offers a mental health blog called More than Borderline. People with the disorder often contribute about their symptoms dealing with specific symptoms or issues associated with disorder. Most blogs are written by one person who has been coping with BPD for 29 years. Her experience may be helpful for clients who want to hear about someone’s direct experience with healing. It can also be helpful as a clinician to hear anecdotally what has helped and hurt someone with the disorder.
The National Alliance on Mental Illness offers a number of resources on their website that can help people understand BPD. It includes an overview of the disorder, possible treatments, and ways to support yourself or a friend. Additionally it includes a discussion forum with different topics related to BPD. Here people can get help from mental health professionals, others coping with the disorder, or family members. Some of the forums include people talking about help for children, questions about online healthcare, and financial assistance.
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