Friday, October 30, 2020

My top 7 tips for helping those with borderline personality disorders

One of my favourite group of patients to look after are those on the Borderline Personality “spectrum”. I acknowledge that many may not share my enthusiasm for looking after this group.  Having said that, I also do acknowledge that this group is extremely difficult to look after. 

Generally, I find the term “borderline personality” unhelpful, and prefer to use the term “emotional personality” instead. 


It may help us to reframe how we see these folks, and how we can help them better. 

These folks tend to follow their feelings rather than their thinking, and hence, can be quite impulsive. 

They tend to be very “fused” rather than defused/detached, from their thoughts, stories and narratives. 

Their need for connection is very high, so their fear of disconnection is also very high. This may manifest as a fear of rejection or abandonment, but fundamentally, I see it as a fear of disconnection. 

They tend to respond to disconnection through fight or flight responses, which then leads to more disconnection. 

With the above perspective in mind, when doing counseling for these folks, I would apply the following principles. 

1. Have unconditional positive regard or compassion for these folks. This provides a stable connection as a “foundation” to work from. 

2. Help these folks to be present, grounded, and defuse/detach from their thoughts and stories. 

3. Validate their feelings first before any challenge with alternative thinking. 

4. Help them to follow their heart but take their head with them. We aim to be their “thinking mind” for a while. 

5.  Help them to embrace and accept their superpower around “feelings”, and over time, balance it with their “thinking mind”. 

6. We help them with skills to reconnect when disconnected, rather than to fight or flight. 

7. It is often the relationship that heals for these folks. 

There are many more strategies, but these are my top seven tips for assisting this group.  

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