Resource Guide for Borderline Personality Disorder

Contents

1. Counseling Application
   1. Overview
   2. Clinical Vignette
   3. Counseling Approach: DBT
2. List of Resources
   1. Local Specialists
   2. Groups
   3. Inpatient Treatment Centers
   4. Resources for Clinicians
3. Annotated Bibliography
   1. Books
   2. Peer Reviewed Journals
   3. Online Resources
4. Handouts and Assessment Tools

Counseling Application

Overview

Borderline personality disorder (BPD) is characterized by instability. This instability affects a number of areas of the person's life including: emotions, affect, relationships, self-image and impulsivity. People with the disorder tend to become symptomatic in early adulthood. These symptoms include:

• An overwhelming aversion to abandonment. Including avoiding abandonment or separation in extreme ways (including self-harm).

• Relationship instability. Often people with BPD move between idealizing partners, friends, or parents, and then quickly feel these same people are not showing them enough love or care.

• An unstable self-image, leading to abrupt changes in views, goals, friends, sexual orientation, and plans.

• Marked impulsivity that is damaging to the person. This may include, gambling, shopping, unsafe sex, or reckless driving.

• Self-harming and suicide attempts are common in people with the disorder and 8% - 10% commit suicide.

• Affect instability. Manifest in a number of ways such as: extreme or inappropriate anger and difficulty controlling anger, feelings of emptiness, paranoid ideation, extreme mood changes, or dissociative symptoms that lead to affective changes.

Counseling Approach: Dialectical Behavioral Therapy

DBT was developed specifically to help treat people with borderline personality disorder. It is considered an evidence based treatment and research has been done on its efficacy. A study published by the British Journal of Psychiatry found that people who received DBT for one year had  self-mutilation and self-harming behavior compared to a control group. DBT works by addressing a number of the areas of difficulty for people with the disorder. At the center of treating BPD is trying to help people regulate their emotions and change some of their core beliefs that exacerbate the disorder. In the simplest terms DBT could be explained as helping clients accept and tolerate difficult feelings and helping them change damaging beliefs.Regulating emotions is addressed by:

• Distress tolerance

• Mindfulness skills

• Interpersonal effectiveness

Changing core beliefs is addressed by:

• Exploring early experience that led to belief formation

• Challenge the belief that “I am bad”

• Creating alternative meanings

List of Resources

Local Specialists

Don Talley, PhD, NCC - Located in Santa Rosa. Specializes in CBT and DBT for people with borderline personality disorderAverage cost per session: $120 - $150(707) 412-8919

Lisa Wolper, LCSW, SAP - Located in Santa RosaShe has over twenty years of clinical experience and specializes in DBT for people with BPDAverage cost per session: $130 or more(707) 524-8864

SOS Counseling Services- Located in Santa Rosa, Windsor, and Rohnert Park. Providing low cost psychotherapy and bilingual cliniciansAverage cost per session: low cost - free(707) 284-3444

Groups

Adolescent DBT Skills Training Group -Group led by Lisa Rohe, PsyD. 1008 Fifth Street, Santa Rosa, California 95404. Wednesdays 6:30pm – 7:45pm. Average cost per session: $65

DBT Center of Marin - Three groups per week led by various licensed clinicians. 895 Sir Francis Drake Blvd,San Anselmo, CA, 94960. Adult group: Tuesdays 12:30pm – 2:30pm, Wednesdays 6:30pm – 8:30pm, Fridays: 10:00am – 12:00pm.

National Alliance on Mental Illness -Offers a discussion forum for people who are coping with BPD NAMI

Inpatient Treatment Centers for BPD

Clearview Women's Center - Specializing in borderline personality disorder and emotional disorders. Offering residential, outpatients, and day treatment options. Women only. Accepts most PPO insurance. Located in Los Angeles, CA. (866) 367-3216

Timberline Knolls - Offers inpatient treatment for BPD and other disorders. Minimum 30 day program.Accepts most PPO insurance and Tricare. Located in Illinois. (844) 604-2252

The Retreat at Shepard Pratt - Offers executive inpatient treatment for BPD and other disorders. Minimum 28 day program. Private pay only. Located in Maryland. 410-401-5602

Resources for Clinicians

Specialized Training Services - You can purchase a DVD of Dr. Marsha Linehan, who is credited with developing DBT, as part of a home study program. The video covers screening and assessment tools as well as DBT training. Cost: $99. http://www.specializedtraining.com/p-102-borderline-personality-disorder.aspx

Linehan Institute - Offering four day workshops for specialized training in DBT. These are offered in various places around the US. CEU are offered. Cost: $1,310.00. http://behavioraltech.org/training/schedule.cfm

National Education Alliance for BPD - Offering online classes and resources for clinicians. There is a six part continuing education series geared toward helping clinicians treat BPD. Cost: Free.

https://bpdalliance.org/documents/the-experience-of-the-process-and-outcome-of-dbt/

Annotated Bibliography

Books

Kreisman, J. J. & Straus, H. (2009). Sometimes I act crazy: Living with borderline personalitydisorder. New Jersey: Wiley.This book is an excellent source for both clients and family members of clients who are coping with borderline personality disorder. It starts each chapter with a case example of someone who has the disorder. It then goes into practical skills and tools that can be used to help treat and cope with the symptoms of BPD. It covers such topics as impulsivity, self-harm, and emotional dis-regulation. This is a follow up book from the author of the 1989 book I Hate You, Don't Leave Me. Although that is considered one of the seminal books on BPD his new book is more recent and includes techniques stemming from updated research and clinical practices.

Linehan, M. (1993). Cognitive-behavioral treatment of borderline personality disorder. NewYork City: The Guilford Press.Marsha Linehan is considered one of the leading authorities in the treatment of BPD and the founder of dialectical behavioral therapy. This book serves as a guide for clinicians who want to understand BPD and treat it. This book can be used as a textbook for those in clinical practice who want guidance in working with BPD. It lays out and explains Linehan's method of DBT. It begins with an explanation of the signs and symptoms of the disorder. It moves on to explain behavioral techniques that are helpful in treating the disorder. It continues by explaining cognitive strategies and interventions and the book ends with tips and tools for case management for BPD.

Linehan, M. (2014) DBT skills training handouts and worksheets, second edition. New YorkCity: The Guilford Press

Linehan, M. (2014) DBT skills training training manual, second edition. New York City: TheGuilford press.The DBT Skills Training Manual is a great supplement for clinicians to the textbook listed above. The DBT Skills Training Handouts and Worksheets book should be used in conjunction with the manual. It features 225 handouts and worksheets that can be done with clients or given to clients as homework assignments. The assignments in the skills training workbook are accompanied by instructions so that clients can do them on there own. However, clinicians interested in using these assignments with clients should read the manual which will give them a better understanding of how these worksheets should be used.

Peer-Reviewed Journal Articles

Bohus, M., Haaf, B., Simms, T., Limberger, M. F., Schmahl, C., Unckel, C., Lieb, K., & Linehan,M. (2004). Effectivness of inpatient dialectical behavior therapy for borderlinepersonality disorder: a controlled trial. Behaviour Research and Therapy 42(5),487-499. doi: 10.1016/S0005-7967(03)00174-8This study discusses the effectiveness of inpatient DBT for treating BPD. It assessed two groups of people with borderline personality disorder. The first group was in a three month inpatient treatment program for the disorder and received DBT. The second group was on a waiting list for the program and received outpatient treatment including counseling but not DBT. The study found that participants in the inpatient DBT program had significantly better outcomes than the other group in a number of areas. These participants were less depressed, less anxious, had better interpersonal functions, were more socially adjusted, and had less self-mutilation.

Clarkin, J. F., Levy, K. N., Lenzenweger M. F., & Kernberg, O. F. (2007) Evaluating threetreatments for borderline personality disorder: A multiwave study. The AmericanJournal of Psychiatry 164(6), 922-928.Researchers evaluated three different psychotherapy techniques for treating BPD in outpatient settings. The three approaches assessed were DBT, transference-focused psychotherapy, and dynamic supportive treatment. Results revealed that participants improved in all treatment conditions. DBT and transference-focused therapy were associated with improved suicidality. Transference-focused therapy and supportive therapy were both associated with improved impulsivity and anger. Many research studies show the benefit of DBT. This study is particularly helpful because it shows other treatments that have been shown to be effective in treating BPD.

Fallon, P. (2003). Travelling through the system: The lived experience of people withborderline personality disorder in contact with psychiatric services. Journal ofPsychiatric and Mental Health Nursing. doi: 10.1046/j.1365-2850.2003.00617.xThis journal article details the experience of a number of people who have BPD. It discusses their experience with psychiatric care. The study found that most people valued their experience even though many of them had negative experiences with care providers or staff. Having positive relationships with care providers was shown to be an important part of healing for people with BPD. Some of the qualities that facilitated positive relationships were experienced staff and staff who understood the behavior of people with BPD. This resource can be helpful both for clinicians and clients who want to get a better understanding of people with BPD's experience with mental health care.

Mercer, D., Douglass A. B., & Links, P. S. (2009). Meta-analysis of mood stabilizers,antidepressants, and anti-psychotics in the treatment of borderline personalitydisorder: effectiveness for depression and anger symptoms. Journal of PersonalityDisorders 23(2), 156-174. doi: 10.1521/pedi.2009.23.2.156This study analyzed a number of controlled double-blind clinical studies of mood stabilizers, anti-psychotic medication, and antidepressant medication for treating depression and anger in people with BPD. There is no medication that has been approved by the FDA to treat BPD. This study is important because it points to a few medications that might be helpful treating some of the symptoms of BPD. The study found that antidepressants and anti-psychotics had a moderate effect in reducing anger symptoms. Additionally, mood stabilizers had a small effect treating depression symptoms. This can be helpful information to have as a clinician if you are considering referring someone with BPD for a psychiatric evaluation online.

Sources

https://www.nimh.nih.gov/health/topics/borderline-personality-disorder/index.shtml

The NIH website offers an overview of borderline personality disorder as well as some of the signs and symptoms. It also covers some screening techniques that may be used by clinicians. Additionally, it identifies some risk factors of who might be at higher risk of having BPD. It also provides an overview of therapies, medication, and other possible treatments. This source is a great place to start as a clinician because it can be a jumping off point for understanding the disorder. It can also be helpful to direct clients to this page if they are wanting to understand more about their own disorder or a loved one's. It even offers tips of things that people can do for themselves or a loved one who might be coping with the disorder.

http://www.healthyplace.com/blogs/category/borderline/

The Healthy Place website offers a mental health blog called More than Borderline. People with the disorder often contribute about their symptoms dealing with specific symptoms or issues associated with disorder. Most blogs are written by one person who has been coping with BPD for 29 years. Her experience may be helpful for clients who want to hear about someone's direct experience with healing. It can also be helpful as a clinician to hear anecdotally what has helped and hurt someone with the disorder.

http://www.nami.org/Learn-More/Mental-Health-Conditions/Borderline-Personality-Disorder/Treatment

The National Alliance on Mental Illness offers a number of resources on their website that can help people understand BPD. It includes an overview of the disorder, possible treatments, and ways to support yourself or a friend. Additionally it includes a discussion forum with different topics related to BPD. Here people can get help from mental health professionals, others coping with the disorder, or family members. Some of the forums include people talking about help for children, questions about online healthcare, and financial assistance.