Treatment for Borderline Personality Disorder
It is not easy for doctors and therapists to deal with patients with this disorder. Depending on the situation, the patient may sometimes feel that the clinician is very helpful to him, but when problems arise, he may begin to think that the therapist is "bad" and uncaring. Clinicians should always be aware of this and be careful not to validate it. Also, the constant suicidal gestures, thoughts, and behaviors, and the possibility of self-damaging behavior, may affect the therapist.
However, psychotherapy is nearly always the treatment of choice for this disorder; although medications may be used to help stabilize mood swings, but they cannot help the patient learn new coping skills, emotion regulation, or any of the other important changes in a person's life. Also, using other ways of treatment might lead to overmedicating patients with this disorder.
Like all personality disorders, psychotherapy is chosen to treat borderline personality disorder.
An initially important aspect of psychotherapy is usually contracting with the person to ensure that they do not commit suicide. Suicidality should be carefully assessed and monitored throughout the entire course of treatment. If suicidal feelings are severe, medication and hospitalization should be seriously considered.
The most successful and effective psychotherapeutic approach to date has been Marsha Linehan's Dialectical Behavior Therapy. It aims to teach the client how to learn to better take control of their lives, their emotions, and themselves through self-knowledge, emotion regulation, and cognitive restructuring. Because the skill set learned is new and complex, it is not an appropriate therapy for those who may have difficulty learning new concepts.
Another way to treat this disorder includes those which focus on social learning theory and conflict resolution. These types of solution-focused therapies, though, often neglect the core problem of people who suffer from this disorder -- difficulty in expressing appropriate emotions and emotional attachments to significant people in their lives due to faulty cognition.
Clinicians need to be aware of their own feelings towards their client's "inappropriate" behavior. They need to understand that persons diagnosed with this disorder indeed need more care than many other patients, their behavior is caused by their disorder.