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Do Therapists Have a Hard Time Treating Someone with BPD?

Therapists, despite being trained to manage their emotions and maintain a professional demeanor, face unique challenges when working with clients diagnosed with Borderline Personality Disorder (BPD) due to the complex nature of the condition. While therapists are professionals equipped to handle a wide range of behaviors and conditions, it is also true that they are human and can experience a variety of emotions in response to their work.

Therapist writing on paper in front of client

In this article, we will explore how a therapist put their best efforts into treating someone with BPD and delve into the tailored treatment steps they use when faced with challenging cases of BPD.

How a therapist works to treat someone with BPD

Personalized Treatment Plan: The therapist develops a unique treatment plan tailored to the patient's specific needs. This plan may include a combination of therapies such as Dialectical Behavior Therapy (DBT), Cognitive Behavioral Therapy (CBT), and Schema-Focused Therapy.


Regular Reassessment: The therapist frequently reassesses the patient's progress and adjusts the treatment plan as necessary. This shows that the therapist is actively engaged in the patient's recovery and is willing to make changes to ensure the best possible outcome.

Emotional Regulation Training: The therapist may spend significant time teaching the patient skills for managing intense emotions, a common challenge in BPD. This could involve mindfulness techniques, distress tolerance strategies, or interpersonal effectiveness skills.

Treatment steps used by therapists treating someone with BPD

1. The therapist introduces the patient to the tailored therapy model concerning the severity of BPD. They explain the goals of therapy, the roles of the therapist and patient, and the expectations for therapy.

2. The therapist teaches the patient skills in four key areas: - Mindfulness - Distress tolerance - Emotion regulation - Interpersonal effectiveness

These skills are designed to help the patient manage their emotions, tolerate distress, and interact effectively with others.

3. Then, the therapist works one-on-one with the patient to apply the skills they've learned to specific challenges and events in their life. The therapist helps the patient to develop and use effective coping strategies.

4. Some therapists are also available for brief phone/online consultations between sessions to help the patient apply their skills to real-life situations as they arise.

5. The therapist meets regularly with a team of other professionals. This team provides support, helps the therapist to stay grounded, and assists in problem-solving when difficulties arise in therapy.

6. The therapist regularly reviews the patient's progress towards their goals and adjusts the treatment plan as necessary. This may involve introducing new skills or strategies or focusing more on certain areas of treatment.

What are some challenges faced by therapists when treating someone with BPD?

Here are some of the most difficult problems therapists may face when treating someone with BPD:

  • Individuals with BPD often experience intense and rapidly changing emotions, making it challenging for therapists to keep up with their emotional states. Managing extreme highs and lows requires a delicate balance and skilled therapeutic interventions.

  • A pervasive fear of abandonment is a core feature of BPD. This fear can lead to difficulties in forming and maintaining therapeutic relationships. Therapists must navigate this fear carefully, providing consistent support while setting appropriate boundaries.

  • Individuals with BPD may engage in impulsive behaviors such as self-harm and substance abuse. Therapists need to address and manage these behaviors while working towards healthier coping mechanisms.

  • People with BPD often struggle with an unstable sense of self, which can impact their goals, values, and identity. Therapists may face challenges in helping clients develop a more cohesive and stable self-concept.

  • Due to past experiences of real or perceived betrayal, individuals with BPD may find it difficult to trust others, including their therapists. Building and maintaining trust is crucial for effective therapy, but it can be slow and challenging.

  • A sense of emptiness is a common experience for individuals with BPD. Therapists may struggle to address this pervasive feeling and help clients find ways to fill the void in healthier ways.

  • BPD often coexists with other mental health disorders, such as depression or anxiety. Addressing multiple issues simultaneously requires a comprehensive and integrated treatment approach.

Frequently Asked Questions (FAQs)

Do therapists get annoyed by BPD patients? While therapists are trained to manage their emotions and maintain a professional demeanor, they are still human and may occasionally feel frustrated or challenged. However, they use these feelings to inform their approach and improve the therapy process.

How do therapists handle difficult patients? Therapists use a variety of strategies to handle difficult situations, including setting boundaries, seeking supervision or consultation, and using self-care techniques to manage their own emotions.

Can a therapist refuse to treat a BPD patient? In some cases, if a therapist feels they are not the best fit for a patient or lack the necessary skills to provide effective treatment, they may refer the patient to another professional who is better equipped to help.

What should a BPD patient do if they feel their therapist is annoyed with them? Open communication is key in therapy. If a patient feels their therapist is annoyed, it's important for them to express this concern. The therapist can then clarify their feelings and adjust their approach if necessary.


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