Borderline Personality Disorder Therapies: The Why Behind Four Approaches

Kyle Lincoln
Mar 1
11 min read

Tattoo artist with text — Cover for *7 Days Inside: Borderline* "Treatment Options for BPD"

Episode summary

For years, BPD was considered untreatable, but research has proven otherwise. In this episode, Kyle Lincoln explores four evidence-based therapies designed to help individuals with BPD build stability, regulate emotions, and navigate relationships. From understanding deep-seated patterns in Transference-Focused Psychotherapy to learning practical coping skills in Dialectical Behavior Therapy, this episode breaks down how each approach works and what makes it effective. Whether you're considering therapy or looking to understand treatment options better, this episode provides a roadmap for making meaningful progress.

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Episode transcript

Transcript, Introduction (Part 1)

[Kyle]: Hello and welcome back to 7 Days Inside: Borderline. I’m Kyle Lincoln, a counselor in private practice based in Salem, Massachusetts, and your host for this series. This podcast is all about exploring Borderline Personality Disorder therapies, or BPD, to bring understanding, tools, and hope to those navigating it.

[Kellyn]: Hi, everyone! I’m Kellyn, and I work behind the scenes at the practice. I’m here to keep things focused and ask the kinds of questions that make these conversations practical and relatable.

[Kyle]: Thanks, Kellyn. For a long time, BPD was misunderstood—even thought to be untreatable. But today, research has given us effective therapies designed specifically for BPD.

[Kellyn]: And that’s what we’re exploring today, the treatments.

[Kyle]: Exactly. Today, we’ll take a closer look at four evidence-based approaches: Transference-Focused Psychotherapy, or TFP; Mentalization-Based Therapy, or MBT; Schema Therapy; and Dialectical Behavior Therapy, or DBT. Each of these therapies offers unique tools for managing emotions, understanding relationships, and creating a life that feels more stable and fulfilling.

[Kellyn]: That’s a lot, especially for the average listener. So where do we start?

[Kyle]: You’re right, it is a lot to cover. Before we jump into specifics, let’s set the stage by talking about the framework that makes therapy effective. Understanding this foundation helps you see how these therapies work and how they might fit into your journey.

Transcript, The Framework for Treatment (Part 2)

[Kyle]: Before we get into the specifics of the therapies, let’s talk about something more foundational: the commitment to treatment itself. Picture moving cross-country in a U-Haul: the boxes, furniture, and everything you’ve collected over the years. There’s a big journey ahead.

[Kellyn]: Ah, yeah. Maybe explain that a bit more to me.

[Kyle]: Okay, so it's a metaphor. On one coast, before treatment, you might feel stuck, repeating the same problems, avoiding change, or waiting for things to magically get better. But on the other coast, which represents what you’re working towards in treatment, there’s a life where you understand yourself better, where old wounds have started to heal, and where your relationships and sense of self feel more stable and fulfilling.

[Kellyn]: I like that image, and I think lots of people can relate to it; wanting to find the other coast. But it sounds like the journey between those coasts isn’t exactly easy.

[Kyle]: It’s not. Just like an actual cross-country move, the process takes effort, planning, and commitment. Along the way, there are plenty of opportunities for detours. In working with clients, there are time I’ve seen people half-doing therapy, skipping sessions, testing boundaries, or trying to renegotiate the terms of treatment they helped create when things get uncomfortable. These behaviors might feel like relief in the moment, but they can stall your progress and keep you from reaching the destination you’re working toward.

[Kellyn]: So, the key is staying on course, even when it feels challenging?

[Kyle]: Staying motivated is an art and not a science. But, therapy is about more than showing up once a week to talk. It’s about committing to the journey itself and working collaboratively with your counselor to build a plan that works for you. You’re not a passenger on this trip—you’re the driver!

[Kellyn]: Sure, that make sense!

[Kyle]: You’re the one investing in your future, and the agreements you make at the start of therapy—like showing up consistently and working toward your goals—are decisions on the map that help you stay on track.

[Kellyn]: What happens if someone takes one of those detours?

[Kyle]: It’s not uncommon. Sometimes the work feels too hard, or the changes feel too slow. But when that happens, it’s important to talk about it with your therapist. Those moments create opportunities to refocus and learn more about what’s getting in the way. What matters is not giving up on the journey. The structure you and your therapist or team create together is there to support you and keep you moving forward.

[Kellyn]: And I imagine the agreement can change, say from two sessions a week to one…

[Kyle]: …just not over text fifteen minutes into a missed session.

[Kyle]: Right. Ok, so we’re talking about four treatments, but here’s the truth: most people can benefit from any of the therapies we’ll talk about today, as long as they stay committed to the process. The work is what gets you to the other coast—not just the specific road you take. Therapy is about reflecting on your past, understanding your present, and taking responsibility for your future. That commitment is what transforms the journey from just getting by to truly growing.

[Kellyn]: So, therapy is really about choosing to move forward, even when it’s difficult?

[Kyle]: That’s exactly it. And when you commit to the process, you’re choosing to make the journey worth it. Now that we’ve set the stage, let’s dive into the first approach: Transference-Focused Psychotherapy, or TFP.

Transcript, Treatment 1: Transference-Focused Psychotherapy (Part 3)

[Kyle]: TFP is grounded in object relations theory, which explores how early relationships shape our emotional experiences and patterns of interacting with others throughout our lives.

[Kellyn]: So, it’s about understanding the roots of our emotions and behaviors?

[Kyle]: Exactly. For people with BPD, intense, undefined emotions—what we call “primitive affects”—often drive behavior. These might include rage, helplessness, or even a deep fear of annihilation. To cope, people develop defense mechanisms like splitting, where they see others as all good or all bad. While these patterns might have been protective in the past, such as during childhood, they can now create instability.

[Kellyn]: So, TFP brings those patterns to light?

[Kyle]: That’s the goal. In therapy, the relationship with your therapist serves as a kind of mirror for these patterns. If you feel your therapist doesn’t care about you after a canceled session, they might ask, “Could this feeling be connected to a fear of rejection?” By exploring these feelings in the “here and now,” you can start to understand and shift these patterns.

[Kellyn]: How does that process work in a session?

[Kyle]: The therapist uses real-time interactions as a window into your emotional world. For example, if you feel upset with your therapist, they might gently ask, “What’s making you feel this way? Connect the dots for me. What just happened?”

[Kellyn]: So, the therapist helps you connect the dots between your feelings, behaviors, and patterns?

[Kyle]: Exactly. In real time. TFP uses techniques like clarification—asking questions to help you better understand your emotions—and confrontation, which gently challenges distortions in thinking. Over time, these insights help you develop healthier ways of relating to others and managing your emotions.

[Kellyn]: That sounds like it could be really intense.

[Kyle]: It is intense, but it’s also rewarding. The goal is to help you understand yourself better and learn to navigate relationships in a more balanced way starting with a healthy relationship with your counselor. TFP focuses on building awareness, which creates the foundation for lasting change.

[Kellyn]: Cool. Where do we go next?

[Kyle]: Next, let’s move to Mentalization-Based Therapy, or MBT. While TFP focuses on the emotional patterns that shape relationships, MBT takes a different angle by helping you better understand and interpret your own thoughts, feelings, and those of others. This cognitive approach can be a game-changer for creating clarity and connection in your inner and outer worlds.

Transcript, Treatment 2: Mentalization-Based Therapy (Part 4)

[Kyle]: Now let’s talk about Mentalization-Based Therapy, or MBT. This approach has its roots in attachment theory and focuses on something called "mentalizing." Simply put, mentalizing is the ability to understand your own thoughts, feelings, and motivations, as well as those of others.

[Kellyn]: Well, doesn’t everyone do that? I feel like that’s something I was taught to do growing up. Why does mentalizaing pose a challenge for someone with BPD?

[Kyle]: The theory behind MBT is that difficulties with mentalizing often stem from early attachment experiences. If a caregiver was inconsistent, neglectful, or emotionally unavailable, it could lead to a fearful or insecure attachment style. Over time, this can disrupt the ability to make sense of one’s own mental states or those of others, leaving the world feeling unpredictable or even hostile.

[Kellyn]: That kind of scary. If you can’t understand what’s going on in your own mind—or in someone else’s—I imagine I’d feel pretty overwhelmed or unsafe.

[Kyle]: Exactly. Without a strong internal organizing function, emotions can feel chaotic, and relationships can become sources of confusion or conflict. For example, someone might misinterpret a friend’s delayed response to a message as rejection, which could trigger intense feelings of hurt or anger. MBT aims to rebuild that internal function, helping people better understand their own thoughts and emotions, as well as the intentions and behaviors of others.

[Kellyn]: It sounds like MBT encourages curiosity instead of jumping to conclusions.

[Kyle]: Exactly. By slowing down and examining assumptions, you can start to see alternative explanations. For instance, maybe your friend wasn’t avoiding you but was dealing with their own stress. This process helps reduce emotional intensity and promotes healthier, more balanced relationships.

[Kellyn]: Ok, so what’s next?

[Kyle]: Schema Therapy shifts the focus from understanding mental states, like in MBT, to uncovering the deeply rooted beliefs—or schemas—that shape how we interpret and respond to the world. These schemas, often shaped by early experiences, can create recurring patterns of pain and difficulty. Let’s explore how Schema Therapy works.

Transcript, Treatment 3: Schema Therapy (Part 5)

[Kyle]: Schema Therapy helps uncover and transform deeply rooted schemas—mental frameworks that guide how we view ourselves, others, and the world. For someone with BPD, these schemas are often distorted by inconsistent or painful early experiences.

[Kellyn]: So, schemas are like mental maps that guide how we navigate life?

[Kyle]: Exactly. For someone with BPD, those maps may be skewed by early experiences, leading to beliefs like “I’m inherently bad” or “People will always leave me.” These beliefs influence how situations are interpreted, often fueling emotional pain and reinforcing the schema in a cycle that feels hard to break.

[Kellyn]: So for someone with BPD, the mental framework in their head brings them to the extreme, which is usually not connected to reality?

[Kyle]: It is. Take the schema of abandonment, for example. If a friend cancels plans, it might feel like proof that people will always leave you. This could trigger intense emotions—panic, anger, sadness—and lead to actions like lashing out or withdrawing completely.

[Kellyn]: How does Schema Therapy work to change that?

[Kyle]: It focuses on identifying these schemas and addressing the emotional states—or schema modes—they activate. For someone with BPD, modes like the Vulnerable Child, Angry Child, or Punitive Parent may take over, driving extreme emotional responses. The goal is to strengthen the Healthy Adult mode, which is more balanced, compassionate, and capable of navigating situations constructively.

[Kellyn]: How do sessions help someone shift into that Healthy Adult mode?

[Kyle]: In therapy, the therapist works with you to examine triggering situations—like the canceled plans. They help you uncover the schema at play, such as “This proves I’m unlovable,” and trace it back to early experiences. Together, you challenge that belief and explore healthier, more realistic perspectives. Your therapist might engage int role-playing exercises to do this, and ultimately you might physically write out these schemas.

[Kellyn]: It’s almost like your mental framework is under construction, and with your counselor working beside you, you learn to build healthier and safer paths and replace those outdated beliefs?

[Kyle]: Exactly. Over time, you replace distorted schemas with healthier, more accurate beliefs. For example, instead of “People will always leave me,” the new belief might be, “Some relationships may end, but I’m capable of forming meaningful connections.” Key here is that Schema Therapy doesn’t just change behaviors—it reshapes the core patterns that drive them.

[Kellyn]: What’s next?

Transcript, Treatment 4: Dialectical Behavior Therapy (Part 6)

[Kyle]: Finally, let’s explore Dialectical Behavior Therapy, or DBT. It’s one of the most widely recognized treatments for BPD and focuses on managing intense emotions and the behaviors that can arise from them. While Schema Therapy focuses on long-term transformation of beliefs, DBT provides practical, day-to-day tools for managing intense emotions and building healthier behaviors. It’s especially effective for addressing immediate challenges and creating stability

[Kellyn]: DBT feels like it comes up a lot in conversations about BPD. What makes it so essential? and what is it that makes them related to each other?

[Kyle]: DBT addresses a key challenge for many with BPD: extreme mood states that feel overwhelming. Often, people haven’t had the chance to learn coping strategies for these emotions because their environments growing up invalidated their feelings. This can lead to behaviors like self-harm or impulsivity—ways to get quick relief that often make things worse long term.

[Kellyn]: So, DBT helps break that cycle?

[Kyle]: Exactly. It does this by balancing validation with change. Therapists acknowledge and validate your feelings—they’re real and they matter—but they also push for growth, helping you build healthier responses. That balance between acceptance and change is the core of DBT.

[Kellyn]: How does that balance come through in practice?

[Kyle]: DBT focuses on practical skills, divided into four areas: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. Instead of diving into all four, let’s look at a couple. For example, mindfulness teaches you how to pause, observe your feelings without judgment, and choose how to respond. Distress tolerance provides techniques like grounding exercises to help you get through tough moments without making things worse. Neither of these guarantee the circumstances triggering the emotions will change, that’s where acceptance is key, but the change is in the new behavioral responses.

[Kellyn]: Those skills sounds familiar, kind of like steps to creating the “solid, flexible self” that we discussed in Episode 2.

[Kyle]: Absolutely. A mentor of mine once said “You make your choices and your choices make you.” In this sense, our behaviors do matter and can make imperfect situations better. Practically, in sessions I want to look out for instances of life-interfering behaviors and therapy-interfering behaviors, so that we can notice if a person is on their way to developing a “solid, flexible self” or engaging in self-sabotaging behaviors. For example, you might use a diary card to track behaviors like moments of self-harm or conflict and work with your therapist to analyze patterns and develop healthier responses.

[Kellyn]: So, DBT gives you tools for both understanding and changing your behavior?

[Kyle]: Exactly. It’s a structured, supportive approach that helps you move from surviving to thriving, one small step at a time.

Transcript, Wrap-up (Part 7)

[Kellyn]: Wow, that was a lot. Can we slow down for a second to make sure we’ve got it all?

[Kyle]: Absolutely. We’ve covered four therapies today—Transference-Focused Psychotherapy, Mentalization-Based Therapy, Schema Therapy, and Dialectical Behavior Therapy. Each one offers a unique approach, but they’re all working toward the same goal: helping you move from feeling stuck and overwhelmed to building a life that feels stable, meaningful, and fulfilling.

[Kellyn]: So, if we think back to the cross-country move metaphor, these therapies are like the different routes you could take. The roads might vary, but the destination stays the same, right?

[Kyle]: Exactly. And it’s not about finding the “perfect” therapy—it’s about committing to the journey. Detours and challenges are part of the process, but as long as you keep going, you’ll make progress. The important thing is showing up, sticking with the plan, and staying engaged with your work.

[Kellyn]: And that work isn’t just about managing symptoms—it’s about real growth. It’s about changing how you see yourself, relate to others, and navigate the world.

[Kyle]: That’s right. When you stay committed to treatment, you’re investing in your future. You’re creating the conditions for healing—both in how you feel day-to-day and in the deeper ways that allow you to move past old patterns and step into a more balanced and fulfilling life. So, whether someone is just starting therapy or thinking about making a change, the first step is like packing that first box for the move—it’s small, but it gets the whole process started. And once you’ve started, the key is staying with it, even when the road gets tough. Remember, progress isn’t about being perfect—it’s about making meaningful steps forward. And that’s something anyone can do with the right commitment and support.

[Kellyn]: Just talking about treatment and everhting today has made me feel a lot of hope. Thanks for breaking all of this down, and thank you to everyone listening. Just by being here, you’re taking those first steps on your journey.

[Kyle]: In our next episode, we’ll explore how loved ones can support someone navigating BPD—a crucial part of fostering understanding and connection. Until then, keep moving forward, stay committed to the journey, and take care of yourselves.