Choosing the right therapist is crucial. While many wonderful therapists are knowledgeable about BPD, many aren't.

A therapist on the Net warns, "Therapists who work with BPD patients must be absolutely committed to the process of working with the patient and the family. This is not short term therapy, and anyone looking for short term solution focused therapy quick fixes is not going to accomplish it with this type of client. (Speaking of the therapist here.) The therapist must be absolutely committed to long term therapy with both the client and the family if any help or change is to be obtained."

We recently chatted with a psychologist in California who specializes in treating BPD and related disorders. He also has provided many professional workshops on the subject, and he supervises therapists and consults on these cases. He said,

"One of my principal concerns is the absence of adequate training in the recognition and treatment of BPD, which results in bad outcomes for many. Most of my current clients ended up with me after multiple prior treatment failures, often because the therapist, while well meaning, did more harm than good...Much of the damage occurs because the therapists have lousy boundaries, either because of their own issues or because they are inadequately trained.

"The 'harm' results when the therapist recognizes the boundary violations and suddenly changes the rules, even blaming the BPD patient. Since issues of trust, rejection and safety are so important to the BPD client, this therapist behavior can be very destructive.

"The second type of harm often occurs when patients requiring long term treatment are invited into a short term process, only to be dropped when money runs out. BPD patients need to understand what they are undertaking, up front. Most of the other problems occur via simple therapist incompetence."

Therapists tend to work in one of three ways (or they may use a combination):

1. Psychotherapy: The therapist explores the patient's early childhood and develops a healthy relationship with the patient in an attempt to resolve interpersonal issues. This type of therapy may be appropriate for people with mild BPD.

2. Supportive Counseling: This is less intensive than psychoanalytic. The therapist helps the patient with problems that are more current rather than trying to resolve early childhood issues. This type of therapy may be more appropriate for people with more severe BPD.

3. Cognitive Therapy: The goal of this type of therapy is to reduce immediate behaviors that are either life threatening (suicide threats, self-mutilation) or interfere with quality of life (rages directed toward others).

When trying to find a therapist, ask many questions. Determine the person's attitude toward BPD and their knowledge of the subject::

• What percentage of their patient load is people with BPD?

• What treatment approach do they use?

• What is their philosophy about calls between visits?

• Read up on BPD and visit the therapist.

• Ask insurance questions as well.

Here are some closing thoughts from the California therapist:

"Regarding my approach, I spend a good deal of time early in treatment just outlining and reinforcing the rules and structure of treatment. It is important to have a clear model in one's head that can be articulated simply to the BPD patient, so much of what I am doing is behavioral (i.e., it's okay to feel suicidal and it is okay to think about suicide, but it is against the rules to do it). I also make certain that I follow through on everything I say that I will do. Third, it is useful, I think, to predict struggles for the BPD patient, but this is a bit complicated to describe at this point."

Please note: We have not screened any of these clinicians. We simply compiled their names from several sources. We cannot guarantee that they are experts in BPD; they simply indicated that they would like to be listed on this page. We strongly advise you to interview them carefully before becoming a patient, just as you would a clinician whose name you found in the yellow pages.