Great question. I really like the principles of care as described on the BPD Awareness Week website. They provide a great framework for understanding how we might aim to work with someone with a diagnosis of BPD, specifically:

Collaborative Therapeutic Relationship

Research suggests that the therapeutic relationship is one of the key factors in the success of therapy. In my mind it is essential that this relationship is collaborative. It should feel like the client and clinician are working together to understand the client’s issues and to develop a clear treatment plan. Clinicians may have some expert knowledge around general treatment principles but each individual is the expert on themselves. Ideally therapy should be using the expertise of both people to help identify how best to support the client. In some cases what the clinician thinks is best and what the client wants can be different and it’s important to collaborate to be on the same page around this.

Trauma-Sensitive Care

When working with people with a diagnosis of BPD it is very important to be aware of an individual's experience of trauma and to work with them in a trauma sensitive way. This includes providing empathy and understanding around their experiences, taking the person seriously and providing a non-judgemental space. This doesn’t mean necessarily focusing on discussing trauma or expecting that clients do so but rather being aware of trauma and how this may impact on a person.

Working with Family/Friends/Supporters

Wherever possible we want to be able to involve family/friends/supporters in a client’s treatment. As treatment only occurs 1-2 times per week it is so important to build a network of supports outside of the treatment space. Some of the most valuable sessions I have been involved with have included a parent/friend/partner and being able to have these perspectives can be very powerful.

We also realise that this can be very challenging for some people. And in some cases people do not feel like they have supporters. We would only encourage this if people feel those around them can be supportive and helpful.

Recovery (Wellbeing) Focus

This is key because often the message that people get is that BPD is lifelong or not treatable. This is most certainly not the case and treatment for BPD will focus on moving towards recovery goals. It’s also important to remember that recovery will look different for each person and that identifying what recovery may look like is a collaborative process.

Balance Validation with Change

I really like this principle and think it’s so helpful for those seeking treatment as well as family/friends/supporters to understand this. Ideally your clinician should be attempting to balance empathy, understanding and listening while also helping to consider how things could be different. If there is only validation sometimes therapy can feel like it isn’t moving towards recovery. If there is too much push for change it can feel like the clinician is not understanding. Knowing this principle can help open up conversations with your clinician about how the work is going and if the balance is right.

Use a Structured Treatment Framework

This is another key principle common to all therapies. This helps to provide a clear organisation for therapy and an understanding of what is expected of the clinician and of the client. This can include items such as creating a collaborative treatment plan, a regular time for sessions and limits for what is offered in therapy.