In order to effectively treat BPD, we have to get to the core of the issue
Borderline Personality Disorder or BPD (I will refer to it as BPD throughout this article) has proven to be exceptionally difficult to treat. While there are cases where individuals with the disorder have recovered or re-integrated from it, those cases are exceptionally rare. So what makes the disorder to difficult to treat?
For starters, it's completely misunderstood. Therapists can't treat it because they don't understand it. Yes, they are formally educated about it, in most cases, but they're generally not getting education that is helping them to understand it well enough to effectively treat it.
Perhaps one of the most difficult things about BPD is the tendency to focus on their behavior when the behavior is so inconsistent that it creates a lot of confusion. It's difficult to understand the disorder because of how chaotic the disorder is. The lack of consistency makes it extra difficult to grasp. In order to understand it better, I have found it far more important to look beyond their behavior and understand what's happening in the psyche.

I have been told by many that my understanding of BPD is virtually unparalleled and I can say, with all honesty, that I put in a lot of effort to understand it because I knew, years ago, that I didn't. I came to understand it better by crossing paths with an individual who had successfully recovered and re-integrated from BPD. I reached out to her because I wanted to ask her some questions and what followed was hours and hours of discussion. When it clicked for me, it really clicked but that didn't necessarily mean that I could effectively treat it. That's a whole other puzzle that has needed to be solved.
Even after coming to understand how the BPD psyche works, it still required a lot of digging and a lot of work. If there's one thing I've learned about BPD is that it's extremely complicated. There are layers and layers of complexity.
"Can BPD be cured?"
This is a question that I've encountered across the internet a countless number of times. It's a topic of debate and anxiety and a question that draws a lot of pseudo experts who frankly don't know what they're talking about. Let's tackle it. Can be BPD be cured? Well, first of all, cure is a problematic word and I just use here as a blanket term to address the question of whether or not people can actually get over the disorder and live at least a semi-normal life? (Whatever that means.)
The short answer is yes, absolutely. Personally, I believe there is a solution for everything. I believe that there's hope for everything and that the right answer exists for everything. We may not know what those right answers are, necessarily, but I believe they exist and in some cases, we have to work rigorously to find the others. Just because we haven't found the right answer doesn't mean that it doesn't exist and it doesn't mean that we can't find it and I believe that we have found it, we just don't realize it.
First, we have to stop talking about mental illness in the same way as a pathogen or a medical illness. They're different things which is why the word 'cure' is a problem. It sets an incorrect precedence. Mental illness isn't a pathogen like the flu. The word cure also implies that you just have to get rid of it and it's gone and BPD doesn't work this way.
As I've already mentioned, BPD is complicated and one of the major reasons why treatment has been pervasively unsuccessful is because there is no agreed upon consensus of what the real issue is and what exactly is driving the disorder and so different clinicians are addressing the wrong issue. The least effective thing they do is to address the behavior when the problem runs much deeper than that. Behavior is usually just a symptom of the real underlying problem.
Because it has proven to be so difficult to treat, it has seemed hopeless for them to get better to the point that many people believe that it cannot ever be solved and that they cannot recover or reintegrate but I completely disagree. It be effectively treated if we know what to work with.
I have encountered many individuals online and in real life who have found their way through the labyrinth of BPD and found a way to recover and reintegrate. There are many people who have found their disorder to be in remission. I consider myself to be one of the few clinicians that has a true grasp on this disorder and so if you listen to anyone, listen to me. There is a solution for BPD, we can effectively treat it.
Standard treatments for BPD
There are so many different approach to therapy, most of which provide some help and benefit for different issues and different populations but BPD is notoriously treatment resistant. Standard therapies just aren't helpful.
Most people with the disorder end up seeking Dialectical Behavioral Therapy (DBT) and/or EMDR, I'm going to break both of these down. The short of it is, neither of them are effective for treating BPD.
DBT was specifically developed for BPD by Dr. Marsha Linehan who experienced a short lifetime of mental health issues herself. She developed DBT because she believed that those with BPD needed some cognitive restructuring as well as different ways to soothe their intense emotions. She first rolled it out in 1993, just over 30 years ago.
After all this time, how has DBT held up? Does it make good on it's promise to solve BPD?
In my experience, no. Frankly, DBT is complicated. The skills outlined with this therapy model are structured and concrete and I've found them to be helpful to teenagers who connect more to things that are more concrete and less abstract. Unfortunately, DBT has produced disappointing results with BPD. Those who have the disorder struggle with making a connection to it. They don't relate to the principles or the skills. It just feels alien or foreign to them. DBT speaks an entirely different mental and emotional language and it's difficult for them to connect to.

While DBT makes promises to help them find their way out of the emotional labyrinth, the results and the outcomes have been extremely disappointing. DBT just hasn't delivered on those promises. I think solving this disorder has a lot more to it than just a set of skills and tools but DBT has proven to be almost as ineffective for BPD treatment as everything else we've thrown at it. It's easy for mental health professionals to throw the blame onto those with the disorder and how difficult it has been to treat. Perhaps we just haven't found the right answers yet?
"EMDR has a much better reputation than it deserves."
People with BPD also often find themselves seeking out EMDR therapy. EMDR, for those who don't know, stands for Eye Movement Desensitization and Reprocessing and is a modality designed specifically for treating trauma. Those who develop BPD often also have significant trauma and so they naturally seek EMDR as a means to resolve the trauma, hoping that their issues are simply trauma related. The hope is that if the trauma is resolved, they will improve but that hasn't proven to be effective either.
It also doesn't help BPD clients when we avoid looking at the proper diagnosis. While PTSD has a place and is fitting diagnosis, it shouldn't be the primary diagnosis. Many clinicians are hesitant to diagnose BPD and many continue to practice in denial about how common and prominent it has become these days and so applying a PTSD diagnosis seems less harsh and scary, it ultimately does people a disservice. People need to know what they're dealing with and it makes things worse to avoid it.
EMDR has one of the same issues that DBT has. It's just far to complicated and as I've learned, when a therapy model is complicated, there's almost an endless number of ways that it can break down in real time. People who are familiar with my content and my practice may already know that I have many issues and concerns about EMDR and not just for those with BPD. There are many issues with EMDR, I wish that the biggest one was that it's far to complicated. The worst part about EMDR is that if it's not done properly, it can cause a major relapse of symptoms. EMDR can and does often create a retraumatizing effect in people which is especially bad for something like BPD.
It's not uncommon for BPD patients to seek EMDR therapy and see themselves deteriorate. Their anxiety gets worse and they can become far more chaotic and destructive, especially to themselves. I actively steer people away from EMDR but I especially want to let anyone out there with BPD to actively avoid EMDR except in cases, perhaps, where the practitioner is well experienced and is highly sensitive to the possibility or retraumatizing people. Instead of healing the trauma in BPD, EMDR tends to trigger the defense mechanisms and causes them to be overactive which is why EMDR has a tendency to make BPD patients worse.
While I support the individual choices of each person and respect their right to seek whatever treatment they believe is best for them, I think people should be informed. EMDR is not what it claims to be and it has a much better reputation than it deserves. Frankly, it has acquired somewhat of a cult following with die practitioners who are die hard devotees. They refuse to acknowledge the issues with it.
The core issue
I've spent years peeling back the layers to fully understand BPD and by this point, my biggest gripe with DBT and EMDR is that it's not getting to the core of the problem. The conclusion that I've drawn is people with BPD are shattered into pieces. I've talked to many of them and they have almost universally confirmed this idea. They feel horribly broken and shattered into pieces. For years, I've been saying that they are broken into fragments or that they are "fragmented."
To be clear, all people experience this, to a degree, but I believe it's far more pronounced for those experiencing a personality disorder. The more fragmented a person is, the more they're going to experience chaos and distress. The diagnostic criteria for BPD in the DSM calls this an "identity disturbance."
I believe that DBT and EMDR are completely ineffective for BPD because they fail, entirely, to address this issue. In order to help them recover or reintegrate, as I call it, we have to work with the identity disturbance or the fragmented self and essentially bring those pieces back together. Neither DBT nor EMDR does this when Internal Family Systems or IFS, does.
Internal Family Systems Therapy
I've created other content specifically about Internal Family Systems Therapy or IFS including a separate article and YouTube video. I made one YouTube video specifically about why I believed that IFS might provide us with the means to solve BPD. If you'd like to watch the video, you can see it here.
My videos don't typically get a lot of views but this one has done better than most and there are multiple comments by individuals who are validating exactly what I've been saying. IFS gets to the core of the problem and seeks to repair it. This is one of the comments from that video:
"I have BPD/PTSD and struggled for a long time even with DBT therapy but ever since I started IFS therapy, I've finally been entering remission for BPD!
I agree for sure that IFS can help both address BPD and PTSD. For me personally, IFS therapy helped address the fundamental problem of BPD where the sense of self is shattered and we create maladaptive parts to help ourselves survive even if they don't serve us well. As well as BPD can come from chronic invalidation. IFS helps bring the sense of self back and helps create self-validation by listening to all the parts and giving them a sincere appreciation for trying their best to help us! And now I'm finally teaching all of my parts DBT/CBT skills now that I finally addressed the core issue with IFS."
This comment stood out to me because of how detailed it was but there are several others who have expressed positive outcomes with IFS.

There are so many things that I love about IFS. It's not just that it gets straight to the core of the problem but also because of how it promotes such a highly compassionate approach and seeks to help the individual actively practice some compassion directed toward themselves which is something that I believe is badly needed these days. An approach full of compassion and empathy directed toward oneself has a healing impact, it really does.
For those who aren't familiar with IFS, the basic theory is that each of our psyche's is made up of different parts. These different parts sort of broke off and started doing their own thing. It's usually because of some type of trauma and is a trauma defense mechanism. The goal of IFS is to identify individual parts and work directly with them. The goal is help those parts stop serving these contradictory functions and reintegrate with the individual.
This is significant for BPD because of how shattered and fragmented BPD clients are. The techniques and methods of IFS are simple, highly compassionate and get to the core of the problem. I've worked for years to develop a deep understanding of this disorder and IFS is the only formal organized therapy model that directly addresses the identity disturbance issue and the problem of the fragmented self and actively works to heal and repair it.
Therapy and mental health has moved away from the process of healing and it has done so to the point that too many people, unfortunately, no longer understand and realize that healing isn't just possible but is really the most important thing you can do in this life and I mean that truly. When you find healing, your life changes. There is no greater freedom than living authentically but it can't be done if you're not finding some kind of wholeness.
In case it's not already clear and obvious, I believe that IFS provides the solution for BPD because it addresses the core problem and seeks to repair it. BPD is what happens when people are fragmented or broken into pieces. I'm confident that we can use IFS techniques to gather up the shards inside of a broken person and individually work to heal them and reintegrate them to the core self. I hope one day that IFS will overtake DBT and take that top spot as the industry standard for treating BPD. Mostly, I hope that it helps to generate results.
IFS is one of the few approaches to therapy that helps people build and improve their relationship with themselves and become more whole.
Thanks for reading this article, I hope you found it helpful. Feel free to reach out to me if you'd like to get more information about IFS and work with this therapy approach.
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