Crafting an Effective Treatment Strategy for Borderline Personality Disorder

Borderline Personality Disorder (BPD) affects approximately 0.7% to 2.7% of the general population, with higher incidences seen in people receiving inpatient and outpatient treatment. BPD impacts how individuals perceive themselves and their relationships, often resulting in issues with self-worth, impulsivity, and managing relationships. Continue reading to discover how to construct an effective treatment strategy for individuals with borderline personality disorder.

Individuals experiencing BPD often harbor a profound fear of abandonment, which can greatly influence their actions. This may lead to frequent shifts in their values, passions, goals, and interests, typically in reaction to others. They may also form intense emotional attachments and affinity towards others at a quicker pace than usual. As a result, they often find themselves caught in a cycle of intense yet unhealthy relationships. BPD can trigger powerful emotional reactions, which may lead to self-harming and suicidal thoughts or actions.

A large number of individuals with borderline personality disorder also struggle with additional mental health conditions. These may include depression, anxiety, eating disorders, substance use disorders, bipolar disorder, PTSD, ADHD, and various other personality disorders. The presence of these co-occurring conditions can complicate a client’s mental health symptoms and may necessitate specialized treatment approaches.

Typical treatment strategies for BPD often involve psychotherapy, particularly Dialectical Behavior Therapy (DBT). DBT aids clients in managing their symptoms by teaching them emotional regulation, distress tolerance, interpersonal skills, and mindfulness techniques. Treatment frequently includes skills training, one-on-one therapy sessions, and phone support within outpatient settings.

DBT is particularly beneficial for clients who are dedicated to making positive changes in their lives and are ready to engage in treatment while focusing on the present rather than their past.

Establishing Goals and Objectives in Your BPD Treatment Plan

The initial step in formulating a treatment plan for borderline personality disorder is conducting a thorough mental health assessment. It’s crucial to evaluate risk indicators such as suicidal thoughts, intentions, and behaviors that may pose a danger, including unsafe sexual practices, reckless driving, or substance abuse.

Once this assessment is complete, you will gain a better understanding of which symptoms your client experiences most prominently. The data collected can help shape the direction of your treatment strategy. Even though two clients may share the same diagnosis, their symptoms, risk factors, and personal histories can vary significantly, necessitating tailored treatment plans.

As you work on your treatment plan, consider therapeutic methods that might benefit your client. Besides DBT, other widely utilized therapies include Cognitive Behavioral Therapy (CBT), Acceptance and Commitment Therapy (ACT), psychodynamic therapy, schema therapy, and Transference-Focused Psychotherapy (TFP).

Incorporating worksheets into your treatment plan for BPD can solidify the topics discussed during sessions. TherapyByPro is a top resource for therapists and clinicians, offering a variety of customizable worksheets and templates designed to meet your specific needs. Some examples of BPD worksheets that can be used include:

Elements to Include in a Treatment Plan for BPD + Sample

The rest of our article will follow the treatment plan template available via TherapyByPro. This template is customizable to better suit your clients’ needs. Keep reading for a hypothetical scenario that will be used to illustrate the various sections of a BPD treatment plan.

Case Study for Jane:

Jane is a 22-year-old woman who has been admitted to an inpatient facility following an unsuccessful suicide attempt. This wasn’t her first attempt, and she has a history of suicidal ideation and self-harming behaviors dating back to her childhood. Jane is currently single and recently ended a year-long relationship. She expressed a feeling of deep hopelessness and loneliness. Jane mentioned that she has always felt her emotions profoundly and struggles with feelings of sadness, anger, and frustration, which frequently leads her to impulsively use alcohol to escape these emotions.

During her assessment, she shared a history of abuse and neglect beginning in early childhood. She described how her parents struggled with alcoholism and went through multiple rehabilitation programs during her upbringing. While they did, she stayed with her grandparents, who were hesitant to care for her. Jane also recounted experiencing unhealthy romantic relationships since her teenage years. She acknowledges her difficulty in being alone and her ongoing challenge to cope with feelings of loneliness.

Currently, Jane has taken an unpaid leave from her job. She mentioned that she has frequently changed her career path over the years and never felt “settled” in any professional role. Her interests have changed frequently and are often shaped by her friends. Jane revealed that she had been hospitalized for a previous suicide attempt and did not comply with the treatment recommended afterward. She is now willing to engage in an inpatient program to acquire the skills necessary to manage her symptoms independently.

Agencies Involved and Care Coordination Plans

This portion of the treatment plan will document any healthcare providers you might consult while working with Jane. This may include a primary care physician or mental health professional. Jane indicated that she does not have a primary care doctor and is not currently in treatment with other professionals.

Example for Jane:

Care Coordination: None

Clinical Diagnoses

From the details provided, Jane displays characteristics of borderline personality disorder. Symptoms confirming this diagnosis include a pervasive fear of abandonment, a history of unstable relationships, impulsive behavior, an inconsistent self-image, recurring suicidal actions, emotional volatility, and intense anger. These symptoms correspond with the DSM-5 criteria for BPD.

Example for Jane:

Clinical Diagnosis: Borderline Personality Disorder, 301.83 (ICD-9-CM)

Current Medications and Their Effects

In this section, you would outline the medications your client is currently taking and their effects. This information is essential for documenting within…
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your treatment strategy, even if you’re not the one prescribing the medication.

Illustration for Jane:

Current Medications: Zoloft and Lamictal, showing positive responses to treatment

Presenting Issues and Associated Symptoms

In the presenting issues section of your treatment plan, include your analysis of the case. Provide detailed information regarding your client’s symptoms and history to support the goals and objectives outlined later.

Illustration for Jane:

Jane, a 22-year-old single woman, was hospitalized after a suicide attempt that was unsuccessful. This was her second recorded attempt. She has a history of self-harm and suicidal thoughts. Jane has reported a longstanding pattern of emotional instability, experiencing profound sadness, anger, and frustration. She battles with feelings of low self-esteem, isolation, and despair. To manage her emotions, Jane drinks about 2 to 3 alcoholic beverages twice a week.

Jane mentioned difficulty in maintaining healthy relationships since childhood, leading to a fear of being abandoned. Growing up, she faced abuse and neglect amid unstable caregiving and parental substance abuse.

Currently, Jane is on unpaid leave from her job. She feels challenged in achieving career stability due to her fluctuating interests and motivations. Nevertheless, Jane shows a willingness to engage in treatment and is eager to adhere to the proposed recommendations. Her identified goals include building healthier coping strategies, addressing her childhood trauma, and acquiring new skills for emotional regulation.

Goals and Objectives

The goals and objectives section should present specific, measurable targets tailored to your client’s unique needs. In this case, incorporate evidence-based therapies like DBT and CBT, which are effective for borderline personality disorder.

Illustration for Jane:

GOAL 1: Decrease suicidal ideation (SI) and self-harm

• Objective 1: Develop a safety plan that addresses her specific triggers and stressors
• Objective 2: Find three coping strategies to replace self-harming actions
• Objective 3: Apply the three coping strategies in times of distress

GOAL 2: Enhance Emotion Regulation

• Objective 1: Master five different emotion regulation techniques
• Objective 2: Utilize at least two emotion regulation techniques three times a week
• Objective 3: Maintain a journal to record emotions, rating their intensity on a scale from 0 to 10

GOAL 3: Foster Healthy Relationships

• Objective 1: Identify and establish two personal boundaries in her current relationships
• Objective 2: Recognize three relationship patterns that need improvement
• Objective 3: Apply the DEAR MAN technique in interactions at least once a week

Specific Interventions to Implement

In this section, outline interventions that can be effectively used in sessions to help achieve your client’s specific goals. Over time, feel free to update this section by adding new interventions as needed.

Illustration for Jane:

Intervention 1:

Cognitive restructuring to confront suicidal thought patterns

Responsible Person: Therapist

Intervention 2:

Utilizing a diary card to monitor mood

Responsible Person: Jane

Intervention 3:

Conducting the DBT module on emotion regulation

Responsible Person: Therapist

Intervention 4:

Leading the DBT module on Interpersonal Effectiveness, specifically focusing on the DEAR MAN skill

Responsible Person: Therapist

Intervention 5:

Engaging in role-playing for setting boundaries and effective communication

Responsible Person: Therapist and Jane

Involvement of Family

At times, including family or couples sessions can be beneficial. Before involving family members, confirm you have the necessary consents and explain what they can expect. In Jane’s case, her family members aren’t currently involved.

Illustration for Jane:

Family Involvement: None at this moment

Additional Services and Interventions

You can incorporate additional services to broaden your treatment approach and provide comprehensive support to your client. This might include trauma-focused therapy, psychiatric services, substance abuse education, and life skill training. Before making suggestions, evaluate which options would have the most positive impact currently. More recommendations can always be added as the treatment progresses.

Illustration for Jane:

Additional Services:

1. Psychiatric evaluations and medication management with Dr. Smith
2. Dual diagnosis support addressing substance abuse issues, possibly including peer-led groups

Timeframe for Completion

In an inpatient setting, various factors influence treatment duration, including the severity of symptoms, available programs, and insurance restrictions. Given the symptoms outlined, a six-week inpatient stay may offer sufficient time to stabilize her condition, reduce risks, establish a medication plan, and develop essential skills for emotional regulation and managing distress.

Illustration for Jane:

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Estimated time for completion: 6 weeks of inpatient treatment

Aftercare Strategies

Aftercare strategies need to be tailored to your clients’ specific symptoms and aspirations. It’s beneficial to draft aftercare plans as if your client were to leave today. There are many factors that can lead to early discharge, such as concerns about insurance and shifts in motivation. In such instances, it is recommended that Jane consult with her primary care doctor about her psychiatric medications and also follow up with a mental health professional who can provide psychiatric support.

Sample Plan for Jane:

Aftercare Strategy: Schedule a meeting with the Primary Care Physician and a community mental health provider specializing in psychiatric services.

Concluding Thoughts on Developing a Treatment Plan for Borderline Personality Disorder

When crafting a treatment plan for BPD, several elements will influence its effectiveness, including the type of care, available services, and resources at hand. Private care facilities might offer more services compared to public ones due to varied funding opportunities. Borderline personality disorder is a complicated mental health condition that impacts various facets of a person’s life. With the right assistance and direction, clients can learn to manage their symptoms effectively, improve their relationships, and achieve a stable self-identity.

To enhance your understanding of borderline personality disorder, evidence-based practices like DBT and CBT, consider pursuing continuing education and training that meets your professional standards.

References:

• Leichsenring F, Fonagy P, Heim N, Kernberg OF, Leweke F, Luyten P, Salzer S, Spitzer C, Steinert C. Comprehensive review of borderline personality disorder: diagnosis, clinical presentation, etiology, treatment, and current debates. World Psychiatry. 2024 Feb;23(1):4-25. doi: 10.1002/wps.21156. PMID: 38214629; PMCID: PMC10786009.
• Mayo Foundation for Medical Education and Research. (2024c, January 31). Overview of borderline personality disorder. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/borderline-personality-disorder/symptoms-causes/syc-20370237