Borderline Syndrome: Therapy

Is borderline curable?

For a long time, the treatment of borderline patients was considered particularly problematic. As in the relationship to all other people, Borderliners tend to idealize the therapist at first, to devaluate him extremely at the least disappointed expectation. Frequent therapist changes and treatment discontinuations are the result.

The prospect of a full borderline cure is low. However, the chances for patients to get the most serious effects of the disorder under control have increased significantly. For patients who are prone to self-harming behavior (auto-dilation) or are even suicidal, a stationary therapy unit is important first. Especially younger people with borderline benefit from the structured life in the facility.

The advantage of an outpatient borderline therapy is that the patients learn to work through the conflicts with their usual environment. However, the range of outpatient borderline therapies is very limited.

Whether borderline is curable also depends on the severity of the symptoms and the social situation. Maternity and marriage should support recovery. From the age of 30, the impulsive symptoms disappear and the handling of the mental disorder becomes easier.

Borderline Therapy: Dialectical Behavioral Therapy (DBT)

The breakthrough in borderline treatment was achieved by US therapist Marsha Linehan. She developed the Dialectic Behavioral Therapy (DBT), which was specially tailored to Borderliner. This is a special form of cognitive behavioral therapy.

In the first phase of therapy, the borderline patients are initially stabilized. The focus is on strategies that prevent the patient from continuing to harm themselves or terminating therapy prematurely. As part of a group therapy then various new behavior and thinking are trained. Goals are:

• The perception of oneself and others is improved.
• Measures for self-control and dealing with crises are practiced.
• Extreme black and white thinking is reduced.
• The handling of stress and the control of one’s own feelings are learned.

It is only in a second phase of therapy that the burdensome life events, which have contributed to the disorder, come into focus. Unlike a psychoanalytically sound therapy, it is not about re-experiencing and working through the traumatic experience, but accepting life with experience as part of the personal but completed past.

The third stage of the therapy is geared towards applying what has been learned in everyday life, increasing self-esteem and developing and implementing personal life goals.

Borderline Therapy: Psychodynamic-Conflict-Oriented Psychotherapy

In addition to behavior therapy, psychodynamic therapies are a possibility for borderline patients. Studies confirm their effectiveness, at least for adult patients. Like all therapies that have their roots in psychoanalysis, the focus here is on understanding relationships between biographical experiences and current problematic relationships and behaviors. They should lead to a mental work-up of the traumatic experiences.

Psychodynamic-conflict-oriented psychotherapy focuses on:

• Traumas overcome
• The self-image of the patient strengthened or even built
• The relationship skills improved
• The typical black and white thinking dismantled
• The ability to control one’s own feelings and impulses, strengthened (affect regulation)

Borderline Therapy: Family Therapy

Especially with the borderline therapy of adolescents, it is crucial to involve the family. On the one hand, because this makes it easier for relatives to deal with the affected family member. Above all, however, because cooperation with the family is an essential prerequisite for the young person to successfully change their thinking and behavior patterns.

Especially important is the involvement of the family, if the disorder has its roots at least partially in the family. If there are pathological relationship patterns in the family, a family therapy can make sense.

Borderline therapy: Further forms of therapy

Other therapies used in borderline disorders include:

• Mentalization-based Therapy (MBT): Mentalization-based therapy helps the patient better cope with himself and other people. People with borderline have difficulty assessing their own behavior and those of others. In this form of therapy, the person concerned learns to be able to better interpret and understand the background of behavioral patterns.
• Scheme Therapy / Scheme-Focused Therapy: Scheme therapy relies on each person developing patterns from childhood to deal with experiences. If the basic needs of children are not met, these form unhealthy strategies and thought patterns. For example, patients with borderline often expect to be abandoned and are suspicious of others. The aim of the schema therapy is to recognize and process negative patterns of thoughts and feelings.
• Transference-focused psychotherapy (TFP): Borderline patients often have a pronounced black-and-white or good or bad thinking. The therapist is either idealized or perceived as threatening. Old relationship experiences, for example, with the parents, the patient transfers to the therapist. For example, the therapist could be experienced as a strict father. The transmission-focused therapy works with the patient to recognize and change these transmissions.

Borderline therapy: medication

Some patients also receive a drug therapy. Borderline, however, can not be treated by medication alone – there are no special borderline medications. However, mood stabilizers like lithium can help to control extreme emotional states.

Patients with borderline anxiety sufferers often prescribe benzodiazepines, such as lorazepam, to the doctor or psychiatrist. However, benzodiazepines are very addictive and should only be used for a short time. If depression also occurs, selective serotonin reuptake inhibitors (SSRIs) are used.