by Paul J. Hannig, Ph.D., MFCC

Choosing the right therapist is crucial. While many wonderful therapists are knowledgeable about BPD, many aren't experienced in treating the disorder.

When choosing a therapist, ask many questions. Determine the person's attitude toward BPD and their knowledge of the subject.

• What percentage of their patient load are people with BPD?
• What treatment approach do they use?
• What is their philosophy about calls between visits?
• Read up on BPD and visit the therapist.
• Ask insurance questions as well.

Different therapeutic approaches may be used to treat Borderline Personality Disorder: (they can be used separately or in combination)

• Cognitive Therapy: The goal of this type of therapy is to reduce immediate behaviors that are either life threatening (suicide threats, self-mutilation) or interfere with quality of life (rages directed toward others). Cognitive therapy deals with interpersonal behaviors, belief systems, and perceptual problems that manifest the BP’s life and the lives of his/her significant others.
• Supportive Counseling: This is less intensive than psychoanalytic. The therapist helps the patient with problems that are more current rather than trying to resolve early childhood issues. This type of therapy may be more appropriate for people with more severe BPD.
• Deep Feeling Psychotherapy: The therapist explores the patient's early childhood and develops a healthy relationship with the patient in an attempt to resolve interpersonal issues. Repressed feelings of childhood events and adulthood are encouraged to be expressed and released, thereby reducing the emotional overload of the BPD and negative projection onto others. This approach is integrative and is for those who wish to deal with buried, repressed feelings. Cognitive therapy is used in conjunction with deep feeling therapy. This type of therapy may be appropriate for people with mild BPD.
• Spiritual Psychotherapy: This approach is directed towards those individuals who feel that they have been invaded by negative spiritual forces and wish to be healed. It encourages a closer relationship with God and attempts to rebuild the lost soul of the BPD.

Relationship and Family Involvement:

Borderline Personality Disorder does not exist in a vacuum in a relationship or family. In families, personality and mood disorders are, in general, inherited through the generational transmission process. It is extremely difficult for children not to be affected by borderline parents and care must be taken to reflect this concern.

In relationships, the involvment is so chaotic and unstable, that a significant other may feel like he or she exists in a living "hell". The attraction is intense and separation from it is difficult. Therapy is absolutely important for the partner of a BPD, in order to break up the destructive patterns of the relationship and re-establish separate identities of both individuals.

Some closing thoughts from Dr. Paul:

"Regarding my approach, I spend a good deal of time early in treatment just outlining and reinforcing the rules and structure of treatment, and building a therapeutic alliance. Trust and commitment are difficult issues for the Borderline, and needs to be established during the beginning phases of therapy. I also make certain that I follow through on everything I say that I will do. Secondly, it is important to have a clear model in one's head that can be articulated simply to the BPD patient. This enhances understanding and concretizes the rules and ultimate goal of therapy. Third, it is useful, I think, to predict and outline potential struggles for the BPD patient, but this is a bit complicated to describe at this point as each struggle is unique to the individual."

Dr. Paul can be reached for consultation at phannigphd@socal.rr.com. Go to http://www.nvo.com/psych_help/telephonetherapy/ for more information about Telephone Therapy with Dr. Paul.

Paul J. Hannig, Ph.D. • 10170-4 Larwin Ave. • Chatsworth, CA 91311 • (818) 882-7404 • phannigphd@socal.rr.com • http://www.nvo.com/psych_help