There are now several available psychotherapeutic treatment options, for patients with borderline personality disorder, for which scientific evidence exist that prove their effectiveness. Too name a few: Schema therapy; Dialectical Behaviour Therapy and also Mentalization-Based treatment. Although all these treatment have been only investigaged in western patients, for so far I know of. Just search the web. In my personal experience as a clinician, I also have found Schematherapy to be very helpfull (i have no personal experience with the other mentioned treatments).

Dear Maarten van Dijk

Certainly, when they are recieving some kind of trigger (stimulation) in Schema Modes. They can not able to control emotion. And there is the moment that, they return to calmly feelings, after the emotion drive (e.g., feelings of the anger) .

I think that there is a hint of the treatment at this timing.

There are many cases, Clinician and counselor is confused by their emotion and psychological manipulation. Their family also. However, it is necessary to provide the environment of healthy attachment to them. However, these are surely difficult issue.

The dialogue while we keep the appropriate sense of distance with them will be necessary.

Thanks.

Yasuko

Person-centred working is important with people with Borderline Personality Disorder. Therapists need to be genuine, consistent and accepting within clear boundaries. However, some of the behaviours exhibited by people with BPD can be problematic for patient and for others, and some other kinds of therapy, including problem management/CBT for self-harm, for example, will probably need to be integrated into a person-centred framework, to establish the safety, stabilization and security necessary to address the underlying trauma. Definitely not a project for the trainee counsellor!

Dear Jill Brennan

Yes, I agree. There is the case that their self-harm act escalates. And there is the risk that their trauma leads to a different obstacle.

I think that, the training of the counselors who are specialized in PD ( BPD ) is worth. In my country, some counselors performs a community-like treatment, but does not think that they success. They returned to the society, but return to treatment staying program, after all. ( they seems have metastasis feelings toward a counselor.) And these treatment-program services are out of an insurance, and counselor themselves are unripe. Training of the expert counsellor side is necessary.

Thanks.

Yasuko

I agree with Jill Brennan above. Quite often drug misuse issues are present as well. Long term psychodynamic psychotherapy is often used - but I am not aware of well-controlled studies demonstrating its efficacy. Counsellors/psychotherapists working with BPD clients must walk a narrow path between giving support without rescuing and encouraging independence without signalling abandonment. Abandonment is an issue for these clients. When working with BPD clients the counsellor must be consistent and structured in approach. Monitor the progress well and do not wait for a crisis to develop. These are very difficult clients to work with and the counsellor/psychotherapist has to be very careful in approach - include reality testing, provide structure, and avoid overstimulating "depth interpretations" (that might induce psychological disorganisation). Be aware of the fact that many BPD clients were physically, sexually, and/or emotionally abused by their caregivers at times. According to Kernberg (1975) BPD clients have a "constitutional" inability to regulate affects, which predisposes them to psychological disorganisation under specific adverse conditions during childhood. Ultimately the question is whether psychotherapy really helps? Some would argue that medication helps when combined with psychotherapy. I would like to hear the views on this.

In brief, a moderate sense of distance is important, to the treatment of the BPD patient. Between Clinician (counsellor) and them.

If we suppose that from quotation of Kernberg (1975), the symptom of the BPD patient is caused by a trauma at the time of the growth. Of course, to approach with the excessive stimulation for the trauma of their infant period is not appropriate method. However, surely the dismantling and the interpretation from their trauma are difficult technique.

However, who can treatment them? Other than a clinician and a counselor, an closer understanding person.

Are you aware of the literature on therapeutic communities? The UK National Health Service Trust I work for provides an innovative day-centre therapeutic community for people with PD type problems, alongside limited DBT (restricted to those actively self-harming) and mentalization-based groupwork.

Dear Jill Brennan

Excuse me, Above was the example case of my country.

In UK , How much about are success statistics in such group work ? Because I want to refer to it, please tell me if there is documents and the literature of community. In my country, the understanding for the PD patient is still unripe.

In my country, there are not the correct statistics about this problem, and there is hardly even the study.

The reason why I want to study about PD is because, I doubt relation between DD (DID) and PD which are my-own study.

Thanks.

Yasuko

I have two chapters (46 pages) on personality disorders in my book "Counseling Issues" together with detailed references. For further info and sample chapters of the book see my blogs at

http://authorgeorgeseber.wordpress.com/

Dear Mr.Seber

I want to reference your book by all means.

Thanks so much.

Yasuko

After working with someone for over 20 years with BPD, I have come to the conclusion that when the patient gives a window of opportunity where she is willing to be vulnerable about her BPD, that is the time to be gentle and honest. It is very6 difficult for someone to be honest about the BPD because at that moment they are opening themselves up to being abandoned. However be warned. When that window closes, it will feel as though you are no longer trusted. At that time, you must remain honest and don't be afraid to step up the assertiveness when you are being criticized.