Psychotherapeutic Approaches to Borderline Personality Disorder

Two of the most innovative and promising new psychotherapeutic approaches to Borderline Personality Disorder are Dialectical Behavior Therapy (DBT) and Eye Movement Desensitization and Reprocessing (EMDR).

Dialectical Behavior Therapy was developed by Marsha Linehan, Ph.D., and is a type of psychotherapy that addresses the tendency of people who have Borderline Personality Disorder to see things only in black and white extremes. This type of therapy helps them find the middle ground between overvaluing themselves, on the one hand, and condemning themselves, on the other hand. It seeks to help them build self-esteem, encouraging them to make changes that will make their life more fulfilling.

Dialectical Behavior Therapy also focuses on developing problem-solving skills, interpersonal skills, an increased ability to regulate emotions, and the capacity to tolerate stress and pain.

Dialectical Behavior Therapy includes individual and group therapy, as well as therapists who are available by telephone to coach the patients through the solving of problems as they develop. This availability by telephone between sessions makes Dialectical Behavior Therapy an innovative approach, and is becoming more successful with Borderline Personality Disorder patients than traditional psychotherapeutic approaches have been.

Eye Movement Desensitization and Reprocessing (EMDR) was developed by Francine Shapiro, Ph.D., and was designed specifically to address the symptoms that result from emotionally traumatic experiences. This process combines the use of imagery with the physiological effects of rapid eye movements (REM), similar to the movements experienced during the dream stage of sleep. The rapid eye movements (REM) in EMDR are usually induced simply by having patients follow the therapist’s moving finger or a pencil.

EMDR is based on a theory that because intensely distressing events often seem frozen in time and are recalled in vivid and unchanging detail long after the actual events have occurred, these memories are “frozen” somewhere in our brains. These memories are like a videotape that plays over and over without any change, and the emotions accompanying the “memory-video” also remain vivid and identical from one replay to the next. These emotions are often accompanied by a state of arousal, or the “fight-or-flight” response that occurs in the face of a threatening situation, so to the person, it feels as if the original threat is still present.

When threatening events occur, they also tend to alter our view of ourselves, our relationships, and even the nature of the world around us. They may impact our self-esteem, our security, and our ability or willingness to risk trusting others. Such changes in beliefs may be as enduring as the original memories themselves. If the memories are sufficiently painful or traumatic, they may be kept from our awareness for long periods of time, which can be what happens with a person who has Borderline Personality Disorder.

While it is not known exactly how EMDR works, several effects are more than likely involved. The rapid eye movements (REM) themselves appear to affect arousal, eventually ending the “fight-or-flight” response, and producing relaxation. This is the "desensitization" part of the treatment, which robs the memory of its emotional intensity. The relaxation response varies considerably in strength and in pace from individual to individual. Moving the eyes also affects the pattern of activation in the brain, forcing the nervous system to turn on specific locations in sequence. This “patterned activation” may compete with the limited patterns associated with the “memory-video” and bring new resources to bear upon how we process the memory. This enables the characteristics of the memory, emotions, and accompanying beliefs to change which, because of this reprocessing, allows the original events to assume their proper place and time in our past, so that they no longer feel current.

EMDR can be a powerful and often quick treatment for trauma patients. However, the experience can be intense, and may temporarily stir up symptoms. This form of treatment should only be undertaken in the hands of a trained therapist experienced both in EMDR and in the treatment of people who have Borderline Personality Disorder.

About the Author

David Oliver is the founder of BorderlineCentral.com a one stop source of information on how to cope and deal with borderline personality disorder.

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