Understanding Therapists' Perceptions Towards Borderline Clients
It's a bewildering paradox that those battling borderline personality disorder (BPD) often face significant hurdles in securing and receiving appropriate mental health care. Compared to most other mental health issues, BPD is often viewed as one of the most challenging to treat. Individuals with BPD endure an extraordinary level of stigma, making their quest for suitable treatment even more daunting, within an already stigmatized mental health population.
BPD is characterized by a pattern of persistent instability in relationships, self-perception, and emotions. Those impacted by this disorder may also demonstrate impulsive behaviors. Borderline personality disorder is relatively uncommon in the population at large.
What sets individuals with BPD apart is their unpredictable and intense emotions. Their connections with others are rapid, intense, and frequently transient. Whether it's a friendship or a therapeutic relationship, maintaining attachment can prove challenging. Their thoughts are often framed in stark, polarized terms, such as "all or nothing," revealing no middle ground.
This intrinsic perspective of the world makes engaging with individuals with BPD complex. These individuals may intentionally test the therapist working with them, through impulsive, potentially hazardous actions (requiring rescue by the therapist, such as self-harm) or by pushing the boundaries of the therapeutic relationship into taboo territories, like proposing romantic or sexual encounters.
For many mental health professionals, the endeavor of treating those with BPD is discouraging. The time and energy exerted tend to exceed typical patient care requirements, and traditional therapeutic practices often fail to yield positive results with BPD patients.
Throughout the years, countless BPD patients have vocalized their frustration at locating therapists willing and able to collaborate with them. Their stories frequently revolve around cycling through local practitioners like one might cycle through tissues at a funeral – a distressing recurrence.
Despite this, BPD should not be marginalized. It is a legitimate, recognized mental disorder, characterized by persistent negative behavior patterns that cause significant distress to those suffering. Individuals with BPD are in need of assistance just as those with depression, bipolar disorder, or anxiety, but they are often overlooked due to the reluctance of therapists to engage with BPD patients.
While therapists may decline to treat specific conditions if they lack the skills, experience, and education to provide appropriate care, BPD requires a unique form of cognitive-behavioral therapy known as Dialectical Behavior Therapy (DBT). This particular approach needs specialized training and education to utilize effectively and ethically. Unfortunately, few mental health professionals invest in learning this technique because of the perceived challenges associated with BPD patients. Additionally, they may believe that insurance companies do not cover the treatment of personality disorders.
Although the argument for insurance reimbursement may be a red herring, skilled mental health professionals can via ethical means seek coverage for BPD treatment, often by listing additional, reimbursable diagnoses on the patient's chart.
The stigmatization of individuals with BPD among mental health professionals is unacceptable and reflects negatively on professionals who perpetuate inaccurate and unfair generalizations about them. Professionals should work to identify local, experienced, and competent mental health professionals within their community, and if necessary, consider pursuing BPD specialization.
At a minimum, therapists must cease categorizing individuals with BPD as second-class mental health citizens and instead, treat them with the respect and dignity all individuals deserve.
Enrichment Data:
Dialectical Behavior Therapy (DBT) has proven highly efficacious in treating borderline personality disorder (BPD). Some of the impressive benefits of DBT include:
- Symptom Improvement: Research shows considerable symptom reduction in patients with BPD who opt for DBT treatment. For instance, the Berlin Borderline Study pointed to substantial symptom improvement in patients who underwent DBT in an outpatient setting[1].
- Reduced Parasuicidal Behavior: Studies reveal that individuals who receive DBT experience fewer instances of parasuicide and less severe incidents compared to non-DBT patients[1].
- Enhanced Emotional Control and Distress Tolerance: DBT focuses on instilling coping mechanisms in patients, such as emotional labeling and problem-solving, which enable them to manage emotional reactions and tolerate distress more effectively[1].
- Improved Interpersonal Effectiveness: DBT addresses interpersonal challenges, common in BPD, by teaching communication and relationship maintenance skills, ultimately improving social adjustment and overall functioning[1].
- Positive Long-term Outcomes: Long-term DBT treatment has shown significant positive changes in depression, anxiety, global functioning, and social adjustment in individuals with BPD[1].
The underutilization of DBT among mental health professionals can be due to a variety of reasons, including the complexity of BPD, the structured nature of DBT, the need for specialized training, persistent stigma, and challenges related to telehealth delivery.
Although Borderline Personality Disorder (BPD) is a legitimate mental health condition that requires specialized treatment such as Dialectical Behavior Therapy (DBT), many mental health professionals underutilize DBT due to perceived challenges. This lack of specialized training and education in DBT can contribute to the stigma surrounding BPD and hinder individuals with BPD from receiving adequate mental health care. Moreover, the intense emotional demands and unpredictability of BPD can take a toll on mental health professionals, potentially leading to burnout and reluctance to work with these individuals.
