Andrea Rosenhaft, LCSW-RPsy-Q: How can behavioral health providers best support patients with borderline personality disorder (BPD)?

Answer: It’s important to validate what people with BPD are experiencing and what they have been through, according to Andrea Rosenhaft, LCSW-R, who speaks from personal experience. Dr. Rosenhaft has BPD herself and has spent many years trying different treatment approaches before coming upon a combination that ultimately allowed her to get back to daily life. Today, she uses her insights as a social worker, helping others diagnosed with BPD. She also started a mental health advocacy and awareness organization called BWellBStrong.

“People who have been diagnosed with BPD are not manipulative or attention-seeking. They are chronically suicidal and/or they self-harm because they are suffering and have not been taught any other tools to cope with painful emotions,” Rosenhaft explains. “Some are raised in an abusive home (sexually, physically verbally and/or emotionally), their environment was invalidating, and they were taught that their feelings didn’t matter,” she adds.

For Rosenhaft, a combination of dialectical behavioral therapy (DBT) and transference-focused psychotherapy (TFP) was the answer – ultimately giving her the understanding and coping mechanisms she needed to function.

“DBT provides coping skills for clients to manage their painful emotions and decrease conflict in relationships,” Rosenhaft explains, pointing to DBT’s four modules: Mindfulness, Emotion Regulation, Interpersonal Effectiveness, and Distress Tolerance.

See also, using DBT in adolescent psychiatry and a patient primer on DBT.

“TFP is a psychodynamic treatment that focuses on the transference – or the relationship – that develops between the therapist and the patient. The premise is that the relationship that develops between the patient and the therapist holds up a mirror for all the other relationships in the patient’s life,” she shares. “As patterns of interaction come to light in the relationship with the therapist, patients are encouraged to apply these insights to other relationships.”

Rosenhaft admits that her own recovery with borderline personality disorder was long and difficult. One thing that slowed her down was an inability to trust her therapists at first and to open up to them. “This was a function of my fear of rejection and abandonment. I was in TFP for 11 years but if I had been open sooner, the therapy might not have been so prolonged,” she notes.

Her advice to other clinicians: be proactive in working with people with a borderline personality disorder. “Don’t be afraid of asking about suicidal ideation, past suicide attempts, self-harm,” she suggests. “Also, inquire about a sense of self and feeling chaotic inside, as most people with BPD have these symptoms,” she says.

Rosenhaft stresses the importance of being flexible when treating patients, noting that one approach does not apply to all. “Although DBT is typically the first-line treatment for BPD, it doesn’t work for everyone. There is also TFP, schema therapy, mentalization, and good psychiatric management,” she says. With the right support, the good news is that – as her own example demonstrates – “full and sustained recovery is possible.”

Last Updated: Jun 17, 2021