Therapy for Borderline Personality Disorder – building a life instead of digging up the past?

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Simone Hoermann, Ph.D., is a Psychologist in private practice in New York City. She specializes in providing psychotherapy for Personality Disorders, Anxiety, and Depression ...Read More

Many people with Borderline Personality Disorder (BPD) have experienced difficult and traumatic childhoods. This is not to say that everyone who had a difficult childhood will develop BPD, nor does every person with BPD have a history of trauma.  Nevertheless, traditional talking therapy that focuses on exploring childhood experiences would seem in order, one may think.

Not so, states Joel Paris, a researcher at the Sir Mortimer B. Davis Jewish General Hospital in Montreal. Paris is a Professor at McGill University and has studied personality disorders for decades. In his recent book “Treatment of Borderline Personality Disorder –A Guide to Evidence-Based Practice”, Paris looks at different forms of psychotherapy that have been developed through research and tested in controlled clinical trials. The therapies that are effective in treating BPD come from very different theoretical points of view, says Paris, but they have one important thing in common: They focus on the present, and on the current issues a person is dealing with.  According to Joel Paris, people with BPD don’t get better by uncovering memories and rehashing the past, but by using the past as a context for understanding the present. This includes validating and acknowledging a person’s life history, and then putting it behind them.  What sets successful therapies for BPD apart is that, in one way or another, they teach people how to tolerate painful feelings and to how experience difficult emotions without acting upon them in self-destructive ways. 


Central to a successful treatment for BPD is a person’s commitment to building a life for oneself, according to Joel Paris.  This commitment to life can be a challenge for BPD patients who tend to feel suicidal often and sometimes chronically. The idea is to work on building a life worth living, while putting the past into perspective and learning skills to tolerate intense emotions. Building a life for oneself is by no means an easy task. It includes developing goals for the future, finding work, and building relationships.

Joel Paris stresses that having a job can do wonders for a person’s sense of self-worth, highlighting the satisfaction that can come from fulfilling a social role and from contributing to the community. He also discusses the trials and tribulations that are associated with building and maintaining relationships. Intimacy, family and children may be important and helpful for some people, but may not be for everyone. For some people, being part of a larger community, such as a church or social group, might provide emotionally satisfying connections. What’s important though is to not just focus on one single area of one’s life, or on just one relationship. The trick is to diversify one’s interests, and to try to retrieve satisfaction and pleasure from a range of different activities, relationships, and emotional investments. It also means accepting the fact that sometimes things don’t work out.  We can have bad luck, we can make mistakes; Work can be unstable, relationships can be conflictual. That said, as the author wisely states, “an imperfect life is better than no life at all”.  

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