Treatments
There are six key elements of care that directly bear on the effectiveness of the treatment you receive for borderline disorder. These include your level of commitment to treatment, locating a skilled primary clinician, determining the most appropriate level of care for you, evaluating your need for medication, and selecting the type of psychotherapy and support group that will be most effective.
1. Taking Responsibility
If you have borderline disorder, it is essential that you understand clearly and believe deeply that you, more than anyone or anything else, have the ability and responsibility for gaining increasing control over your life.
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2. Primary Clinician
You will need help. The number and complexity of decisions involved in the proper treatment of a patient with borderline disorder requires that a highly skilled clinician assumes a central role in helping you. This person is referred to as your primary clinician, and ideally will be a psychiatrist experienced in treating borderline disorder.
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3. Level of Care
Most patients with borderline disorder are most appropriately treated as outpatients. However, there are times when acute inpatient or residential care is necessary. Under most circumstances, this decision is best made by you, your primary clinician, and your family or spouse.
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4. Medications
Medications play three very important roles in the treatment of most patients with borderline disorder. 1) They are effective in reducing at least three of the four major symptoms of the disorder. 2) They thereby enhance the rate and quality of improvement derived from psychotherapy. 3) Finally, medications are effective in treating other emotional disorders that frequently are associated with borderline disorder, for example, depression, anxiety/panic attacks, and ADHD, and physical disorders such as migraine headaches.
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5. Psychotherapy
Psychotherapy is a very important component of your treatment program. A number of different psychotherapeutic approaches appear to be effective in the treatment of borderline disorder. I have treated some patients with medications because they refuse to enter therapy, even with strong urging. Some of them, especially older patients with reasonably stable lives and relationships, appear to benefit with a reduction of emotional dysregulation. However, most do not benefit as much as they might with therapy.
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6. Education and Support
During the past decade, an increasing number of educational and support groups have been formed for patients with borderline disorder, and for their families. Many of these have been the result of the efforts of lay advocacy groups dedicated to increasing knowledge about, and reducing the stigma associated with borderline disorder.
Family Education / Support Groups
Family Educational Programs
A growing number of educational programs are being conducted for people with borderline disorder and their families. These are often co-sponsored by community organizations working with the assistance of consumer and family organizations such as the National Education Alliance for Borderline Personality Disorder (NEA-BPD), the Treatment and Research Advancements National Association for Personality Disorder (TARA), and the National Alliance on Mental Illness (NAMI).
A recent addition to the therapeutic opportunities for family members of people with borderline disorder has been the introduction of family educational and training programs.
Family Connections
The family education program, Family Connections (FC), is available in multiple locations throughout the US, and at several locations in Canada, Europe and the UK. It operates under the auspices of NEA-BPD with research funding from the National Institute of Mental Health. Experienced family members co-lead the 12-week manualized series of sessions for other families. These sessions provide participants with the most current information and research about borderline disorder, teach DBT and family coping skills, and provide an opportunity to develop a support network.
Research documents a reduction in family member depression, burden, and grief, and an increase in coping skills. No registration fee is required, but in some locations a donation to cover costs of the course materials is suggested.
Family-to-Family
The National Alliance on Mental Illness (NAMI) has recently designated borderline disorder as a “priority population.” In doing so, NAMI has now extended its popular 12 week Family Education Program to include this disorder. The course is taught by trained NAMI volunteers in every state in the country. It provides a broad range of information essential to those caring for loved ones with borderline and other serious mental disorders.
Family Training Workshop
TARA sponsors an eight session DBT family training workshop in New York City and other cities across the country. The main goals of the program are similar to that provided by NEA-BPD. Each training cycle is limited to sixteen members, and a registration fee is required.
Support Groups
In some communities, groups of people with borderline disorder and family members meet on a regular basis, without a therapist or trained and skilled group leader, to help one another. Such support groups typically do not charge members a fee and can be very beneficial for the reasons cited above for therapist-assisted group therapy.
There are three types of support groups:
◾groups for the person with borderline disorder
◾groups for their family members
◾groups for psychotherapists
Although it may be helpful, participation in such groups should be approached with caution by the person with borderline disorder or family members. Considerable harm can be done if one or more individuals in the group act in an angry, manipulative, malicious, or otherwise inappropriate and destructive way toward another group member or the group as a whole. Without a skilled leader or facilitator present to step in to handle the situation promptly and properly, a member of the group, and even the group itself, may be exposed to significant trauma.
Prior to joining a support group, it is wise to seek recommendations about groups in your community from your nearest NAMI Chapter, or from mental health professionals working with patients with borderline disorder. In addition, it may be helpful to request information from members of such groups before joining.
Finally, Appelbaum (see Supportive Psychoanalytic Psychotherapy) has wisely suggested that a support group for therapists, now utilized at a few research centers, be employed more broadly to enhance the treatment of borderline disorder. Because the field of therapy for borderline disorder is in its early stages of development, and because the work is delicate and demanding, such groups would stimulate much-needed training and progress, and increase availability of experienced therapists.
Conclusion
In summary, there are a number of different levels of care, medications, and individual and group therapy approaches that can be utilized to help you gain increasing control over your life. The treatment plan that works best for another patient may not be appropriate or work well for you. Therefore, it is very important that you work closely with your psychiatrist and other mental health professionals to formulate that treatment plan which will produce the best results under your specific circumstances.
