BPD is not a life sentence. Many longitudinal studies show that with treatment, symptoms decrease significantly over time. Most people no longer meet full diagnostic criteria for BPD after 10 years, even if they were initially hospitalized.

Evidence: The McLean Study of Adult Development (Zanarini et al., 2010), a landmark longitudinal study, found that:

• 85% of clients with BPD remitted (no longer met diagnostic criteria) after 10 years, and
• 50% remained in recovery (defined as remission plus good psychosocial functioning).

In addition to formal therapy, social and family support play a crucial role in recovery.

• Psychoeducation for families (e.g., our Family Connections™ Programs) helps relatives understand BPD and respond more effectively.
• Peer support and group therapy provide validation, reduce isolation, and encourage skill use in real-life situations.

Evidence: Hoffman et al. (2005) found that families participating in psychoeducation experienced reduced burden and improved coping, which correlated with better outcomes for the individual with BPD.

Improvement does not mean all symptoms disappear, but rather that:

• The person learns to manage emotional instability.
• Self-harming or impulsive behaviors are reduced or eliminated.
• Interpersonal relationships and daily functioning improve.
• Life satisfaction and identity stability increase.

The idea that BPD is untreatable is outdated. With evidence-based therapies, consistent support, and a compassionate therapeutic environment, many people with BPD not only improve, but can go on to live fulfilling, meaningful lives. Recovery is not only possible—it is probable with the right approach.

• DBT, MBT, and Schema-Focused Therapy have the strongest evidence for helping people with BPD.
• Other treatments may help, and new research continues to emerge.
• If evidence-based care is not available, finding an experienced and compassionate clinician is still worthwhile.
• Medication can be useful for related issues, not a standalone treatment for BPD.
• Family support and education can make a significant difference.

In mental health treatment, research provides an important guide. Evidence-based treatments are therapies that have been carefully studied and proven to help many people with BPD. By focusing on these treatments, we help reduce frustration and misinformation.

It’s important to know:

• BPD Alliance does not create or test these treatments ourselves.
• We rely on expert reviews, such as those conducted by the American Psychological Association’s Division 12 and our Scientific Advisory Board, which evaluates therapies based on established scientific standards.
• If new, high-quality research shows a treatment is effective, we are glad to recognize it.
• A treatment is said to have “strong” research support if multiple well-designed studies, carried out by independent researchers, consistently show that it works.
• A treatment is said to have “modest” research support if there is at least one strong study, or two or more reasonably solid studies, showing that it works. Both “strong” and “modest” levels of support can also be shown through a series of carefully run single-case studies.
• A treatment is said to have “no research support” if there are no reliable studies showing that it works. This means its effectiveness has not yet been proven by scientific evidence.
• Finally, research support is labeled “controversial” if studies give conflicting results, or if the treatment clearly helps but the explanation for why it works doesn’t match the research evidence.

According to APA’s Society for Clinical Psychology (Division 12), based on current research (according to), the following psychotherapies are most supported for BPD:

• Dialectical Behavior Therapy (DBT) 
• Mentalization Based Therapy (MBT)
• Schema Based Therapy

DBT is a type of cognitive behavioral therapy that was originally developed by psychologist Marsha Linehan in the late 1980s to treat individuals with borderline personality disorder (BPD). It focuses on helping people regulate their emotions, tolerate distress, and improve interpersonal relationships. The word “dialectical” refers to the balance between acceptance and change—two key principles at the core of DBT. Therapists using DBT work with clients to validate their feelings and experiences while also encouraging strategies that promote positive behavioral changes. This combination helps individuals better cope with intense emotions and reduce harmful behaviors like self-injury or substance abuse.

DBT is structured around four main skill areas: mindfulness, which promotes present-moment awareness; distress tolerance, which helps individuals manage crises without making things worse; emotion regulation, which provides strategies to better understand and control emotional responses; and interpersonal effectiveness, which builds healthy communication and relationship skills. While DBT is most well-known for treating BPD, it has also been adapted to help with depression, eating disorders, substance use, and post-traumatic stress disorder (PTSD). Its structured, skills-based approach and emphasis on both acceptance and change make it a powerful tool for building resilience and improving mental health.

Features of DBT

• • It is the most widely available evidence-based treatment for BPD in the US.
  • Comprehensive DBT involves five key parts:
    • Weekly individual therapy (typically 45-60 minutes):
      • • Sessions are structured with the use of a Diary Card to ensure that the client’s targets are being addressed.
        • Ensure that the individual therapist has received intensive DBT training or is a DBT-LBC, Certified Clinician™ or supervised by someone who has been intensively trained or is a DBT-LBC, Certified Clinician™.
    • Weekly DBT skills training group (2 hours):
      • • The group is educational in nature,  not a processing group. New material is taught, and weekly homework is reviewed.
        • For Adult DBT, research indicates that outcomes for adult clients are best if they complete 2 full cycles of the program’s skills training curriculum.
        • For Adolescent DBT, the group is typically a Multi-Family Group where the client and caregivers attend together.
    • Between-session phone coaching helps the client use skills in daily life and avoid higher levels of care.
    • DBT therapists participate in a weekly Clinician Consultation Team meeting with other DBT-trained therapists to improve efficacy.
    • Family and/or school Involvement
  • Best outcomes are linked to a comprehensive DBT program including all five components.
  • Skills-only DBT is separate from comprehensive DBT, and may help with less severe problems.

To find a certified DBT Therapist

MBT is a psychotherapy developed by Peter Fonagy and Anthony Bateman specifically to help individuals with BPD. Its foundation lies in the concept of mentalizing—the process by which we make sense of ourselves and others, both implicitly and explicitly, in terms of thoughts, feelings, intentions, and other subjective states. Clients with BPD often have reduced capacities to mentalize, particularly during times of stress or in close relationships. This can lead to difficulty regulating emotions, managing impulsivity, and navigating interpersonal interactions, all of which are core challenges in BPD.

MBT is a structured, time-limited treatment that combines individual and group therapy sessions to strengthen clients’ ability to mentalize. Rather than focusing solely on symptom reduction, the therapy emphasizes slowing down, reflecting on mental states, and considering multiple perspectives before reacting. By developing these reflective capacities, patients become better equipped to regulate intense emotions, reduce impulsive and self-destructive behaviors, and form more stable, trusting relationships. Research has shown that MBT can reduce hospitalizations, improve emotional stability, and foster long-term recovery, making it a highly effective, compassionate treatment for BPD.

Features of MBT

• • Focuses on improving the ability to understand one’s own thoughts and feelings and those of others.
  • Solid evidence of effectiveness exists for adults; there is growing evidence for youth.
  • Availability in the U.S. is limited; it is more common in Europe and other countries.

Training Opportunities

Information on training and workshops can be found through the Anna Freud Centre.

SFT is an integrative approach, originally grounded in cognitive behavioral therapy and expanded to include concepts and techniques from other therapies. The central focus is on early maladaptive schemas—the deeply rooted beliefs and emotional patterns we develop in childhood. For many people with BPD, these schemas revolve around themes like abandonment, defectiveness, emotional deprivation, and mistrust. These internal “rules” may have once helped the child survive difficult circumstances, but in adulthood they create ongoing cycles of emotional pain and self-defeating behaviors.

SFT’s difference is its goal of not just managing symptoms in the moment but healing the deeper wounds that fuel them. The therapy works to weaken harmful schemas, develop healthier ones, and replace old survival patterns with more adaptive ways of living. Therapists use a wide range of tools: cognitive techniques to challenge distorted thinking, experiential exercises such as imagery and “chair work” to process emotions, and behavioral pattern-breaking to encourage new responses. The therapeutic relationship itself is also central—offering a safe, consistent space where healthy attachment and boundaries can be experienced directly.

SFT places strong emphasis on the client’s daily life and relationships while also addressing the traumatic childhood experiences that are common in BPD. Treatment is typically a long-term commitment, often lasting several years rather than months. This extended timeframe allows for the deep psychological restructuring needed to create real and lasting change.

Features of SFT

• Combines elements of cognitive, behavioral, and psychodynamic approaches.
• Strong research support in Europe; limited availability in the U.S.
• Particularly effective when delivered in structured, long-term programs.

According to the APA Practice Guideline for the Treatment of Patients with BPD, some therapies are sometimes mentioned for BPD, though current research does not provide strong support.

Transference-Focused Psychotherapy (TFP)

Evidence on the effectiveness of TFP is mixed, and it is rarely available outside a few U.S. cities.

TFP focuses on revealing the underlying causes of a client’s BPD and working to build new, healthier ways for the client to think and behave. From the perspective of TFP, the client’s perceptions of self and of others are split into unrealistic extremes of bad and good. These conflicting dyads are thought to be expressed through the specific self-destructive symptoms of BPD. The term “transference” refers to the client’s experience of his or her moment-to-moment relationship with the therapist. The treatment focuses on transference because it is believed that clients will display their unhealthy dyadic perceptions not only in day-to-day life, but also in the interactions they have with their therapist. TFP focuses on using client-therapist communications to help the client integrate these different representations of self and, in the process, develop better methods of self-control.

General Psychiatric Management aka Good Psychiatric Management (GPM)

General Psychiatric Management, also called Good Psychiatric Management (GPM) is a generalist and practical model that can be learned by a wide range of clinicians, including psychiatrists, primary care providers, nurse practitioners, and other mental health professionals. It can be used across outpatient, inpatient, and emergency settings, expanding access to informed and effective care.

At the core of GPM is a focus on interpersonal sensitivity—how emotional distress and behavioral reactions are often triggered by stress in relationships. Clinicians help patients connect emotions and behaviors to relational stressors while incorporating education, practical problem-solving, realistic goal setting, and support for improving daily functioning and stability.

At the heart of GPM are several evidence-based principles that guide treatment. GPM is grounded in the understanding that recovery does not require the same level of intensity for everyone; many people benefit most from consistent, well-informed, and “good enough” care delivered over time. Central to this approach is a focus on relationships, as emotional distress and impulsive behaviors are often triggered by interpersonal stress, perceived rejection, or fears of abandonment. By helping patients understand and respond more effectively to these relational triggers, GPM supports meaningful and lasting change.

GPM keeps attention on the patient’s life outside of therapy. Treatment emphasizes practical support through case management, including assistance with housing, work, insurance, and daily structure. GPM prioritizes engagement in meaningful activities such as employment, education, volunteering, and consistent routines, following the principle of “work before love.” Patients are encouraged to take an active role in their treatment and assume responsibility for their safety and quality of life, while still receiving consistent clinician support. The approach is flexible, allowing clinicians to integrate helpful elements from other evidence-based treatments, such as CBT strategies, DBT skills, or peer support, based on the individual patient’s needs.

Ketamine, IFS, and EMDR for BPD

Current research is not robust enough to support ketamine, Internal Family Systems (IFS), or Eye Movement Desensitization and Reprocessing (EMDR) as primary or stand-alone treatments for Borderline Personality Disorder. While emerging studies and clinical reports suggest these approaches may offer benefits for other mental health conditions—such as treatment-resistant depression, post-traumatic stress disorder, or complex trauma—there is insufficient evidence to conclude that they reliably address the core features of BPD itself.

That said, many individuals with BPD experience co-occurring conditions for which these treatments may be appropriate and helpful when used within a comprehensive treatment plan. In such cases, they are best viewed as adjunctive or supportive interventions rather than replacements for evidence-based BPD treatments.

Because of the current limits of the scientific literature and a commitment to minimizing frustration and cost for those seeking care, we have chosen not to include these approaches on our core list of recommended treatments for BPD at this time. As the evidence evolves, these treatment methods may warrant reconsideration, but for now, our recommendations prioritize treatments with the strongest and most consistent empirical support.

What About “Treatment as Usual”?

In many communities, evidence-based treatments may not be available. In these cases, people may receive more general therapy—sometimes called treatment as usual. Treatment as Usual (TAU) represents the conventional mental health care available to individuals with BPD, typically lacking the structure and targeted approach of evidence-based therapies. While TAU can provide essential support and stabilization, research shows that when clinicians have deep experience working with BPD, outcomes are often much better than with therapists who are unfamiliar with these challenges. 

If DBT, MBT, or Schema Therapy is not available, it is reasonable to seek out an experienced clinician and ask:

1. How many people with BPD have you worked with?

2. What outcomes do your clients with BPD typically experience after a year of treatment?

These simple questions can help identify therapists who may be a good fit, even if they are not trained in one of the major evidence-based models.

There is currently no medication approved specifically for BPD. Medications are sometimes prescribed to address related problems such as depression, anxiety, ADHD, or sleep difficulties.

• When medication is used, it is usually targeted at specific symptoms rather than BPD as a whole.

• If a medicine doesn’t help, best practice is to discontinue it before trying something else.

• Medications should be viewed as supports, not cures.

There is not much useful support out there for parents who are dealing with a child in crisis. It is exhausting, isolating, and often causes parents to experience their own mental health issues. … I felt overwhelmed and fearful that our child and family would be stuck in a cycle of dysregulation and pain. Learning that there are evidence-based approaches that we can utilize … has been so helpful. I am feeling optimistic for both my child and our family. HH, Florida 

Families can play a vital role in recovery. Our evidence-based program, Family Connections™, helps loved ones learn DBT skills and better support individuals with BPD. Other DBT family and couples programs also exist, and research is growing in this area.

• Experience matters: Choose a therapist who is specifically trained in treating BPD or related issues like trauma, attachment difficulties, and emotional regulation.
• Treatment approach: Many therapists use a mix of methods. Ask how they work with people who have BPD and why they believe in that approach. Evidence-based treatments for BPD include Dialectical Behavior Therapy (DBT), Schema-Focused Therapy (SFT), Mentalization-Based Therapy (MBT), and Transference-Focused Psychotherapy (TFP).
• Licensing and credentials: Be sure your therapist is licensed and in good standing with their state board. You can look up whether complaints have ever been filed against them with your state licensing board.
• Trust your instincts: Even if the therapist looks great on paper, the connection matters most. You should feel respected, understood, and cared for—not judged, pressured, or dismissed.

Why Compassionate, Trained Care Matters

Compassionate, trained care is not “extra” for BPD—it is central.

When care is inconsistent, invalidating, crisis-only, or blame-focused, symptoms can escalate, especially because relational environments are emotionally activating.

In contrast, care that is consistent, validating (without necessarily agreeing), skills-based, and grounded in clear treatment principles can reduce shame, stabilize crises, and build long-term recovery pathways.

What “trained care” means 

Trained care typically includes:

• • understanding BPD through emotion dysregulation and attachment-informed frameworks
  • maintaining a steady, non-punitive therapeutic stance
  • using evidence-based approaches and structured risk management
  • treating self-harm/suicidality as signals of distress (not moral failures)
  • addressing co-occurring problems without losing the central pattern

Treatment Principles 

Effective care typically includes:

• Skills development for emotion regulation, distress tolerance, interpersonal effectiveness, and mindfulness
• Treatment structures that reduce crisis cycling and strengthen continuity
• A coherent case formulation that keeps emotion dysregulation at the center
• Care coordination when co-occurring conditions exist (substance use, eating disorders, trauma symptoms)
• A validating stance that reduces shame and increases engagement

Why Treatment Match Matters

Outcomes are best when treatment directly addresses the core mechanisms of BPD, particularly chronic emotion dysregulation. Approaches that focus only on managing surface behaviors without targeting underlying emotional processes tend to be less effective over time.

Structured, skills-based therapies that explicitly teach emotion regulation, distress tolerance, and interpersonal effectiveness are associated with stronger and more durable improvements.

Navigating the mental health system can feel overwhelming. Few people plan ahead for entering treatment, and services can look very different depending on the hospital, clinic, or program you access. To make matters more complex, many facilities offer multiple levels of care, which can be confusing if you don’t know what to expect.

The good news is that there are effective, evidence-based treatments for BPD. Knowing the differences between treatment settings can help you or your loved one choose the most appropriate level of care and increase the chances of recovery.

Why Openness Matters

The more open a person is to different treatment settings before entering care, the smoother the process tends to be. BPD treatment often requires flexibility, sometimes starting with a higher level of care for safety and stability, then transitioning to outpatient therapy for long-term recovery.

Types of Treatment Settings

If you or your loved one has BPD, the treatment journey may involve moving between different levels of care. The most important thing is to find programs and professionals with specialized training in BPD, since not all mental health settings are equipped to provide effective treatment.

Emergency Psychiatric Services

• • What it is: Crisis care provided in an emergency department or psychiatric emergency service.

  • What to expect: The focus is immediate stabilization through short observation, medication, or procedures. Time is usually limited, and staff are working to manage the crisis quickly rather than provide ongoing therapy.

  • For people with BPD: Emergency department visits can help in moments of crisis but are not designed for accurate diagnosis or long-term treatment.

  • Best for: Emergencies when there is immediate risk of harm.

General Psychiatric Ward (Inpatient Hospitalization)

• • What it is: A highly structured, locked facility designed for short-term crisis stabilization. Admission may be voluntary (“I don’t feel safe”) or involuntary (if someone poses a danger to themselves or others).

  • What to expect: The focus is stabilization, not long-term treatment. Clients usually see a therapist once a week, and medications are often prescribed. The stay is typically short—sometimes called “catch and release.”

  • For people with BPD: These units rarely provide specialized BPD treatment (like DBT or Schema-Focused Therapy). In fact, symptoms may sometimes worsen because of the environment and lack of tailored care.

  • Best for: Acute crisis situations when immediate safety is the priority.

Residential Treatment

• • What it is: A live-in program at an unlocked facility with staff available 24/7.

  • What to expect: Programs vary widely. Some are highly specialized with therapies like Dialectical Behavior Therapy (DBT), while others provide more general mental health care. Treatment typically includes individual therapy, group sessions, and skill-building.

  • Best for: People who need structured support and safety, but not hospital-level supervision. Often a good next step after inpatient stabilization, or when outpatient therapy isn’t enough.

Partial Hospitalization / Day Treatment / Intensive Outpatient (IOP)

• • What it is: A middle ground between inpatient and outpatient. Programs typically run 4–5 days a week, 3–6 hours per day.

  • What to expect: Structured schedules with individual therapy, group therapy, and skills training. When these programs specialize in BPD (for example, DBT or Schema Therapy–based), they can be highly effective.

  • Best for: People who need more support than weekly therapy but don’t require 24/7 residential care. Often used as a step down from inpatient or residential, or as a step up when outpatient isn’t enough.

Outpatient Therapy

• • What it is: Care while living at home. Outpatient can range from weekly individual therapy sessions to more structured programs with group therapy and skills training.

  • What to expect: Outpatient treatment can be general (any therapist) or specialized (for example, a DBT program specifically designed for BPD).

  • Best for: Most people with BPD once immediate crises are stabilized. Outpatient treatment allows for long-term, evidence-based therapy and the opportunity to practice skills in daily life.

Recovery is possible, and with the right care, many people with BPD go on to live stable, fulfilling lives.

The many different types of mental health providers and titles can feel overwhelming. Here’s a breakdown of the main ones, focusing on education, training, and the kind of services they usually provide:

Clinical Psychologists

• MS in Clinical Psychology
  A master’s degree which often prepares graduates for roles like psychological testing, research, or working under supervision. Alone, it usually does not confer independent licensure (varies by state).
• PhD in Clinical Psychology
  A doctoral degree (PhD) with a strong emphasis on research, theory, and clinical practice. PhD psychologists can provide therapy, testing, and research; they often work in universities, hospitals, or private practice.
• PsyD (Doctor of Psychology)
  Similar to PhD but more practice-oriented (focus on therapy and clinical work rather than research). PsyDs are trained to provide therapy, assessments, and clinical interventions.

Social Workers

• MSW (Master of Social Work)
  Graduate-level degree that provides training in therapy, case management, advocacy, and community support.
• LCSW (Licensed Clinical Social Worker)
  An MSW who has completed post-degree supervised clinical hours and passed a licensing exam. LCSWs can provide psychotherapy, crisis intervention, and connect clients with community resources.

Counselors / Therapists

• MHP (Mental Health Professional)
  A broad term that could refer to anyone licensed to provide therapy, including psychologists, social workers, counselors, or psychiatric nurses.
• Licensed Mental Health Counselor (LMHC, LPC, LPCC, etc.—varies by state)
  Master’s-level clinicians trained in counseling techniques. They focus on therapy, coping strategies, and emotional support (not medical interventions).

Medical Providers

• Psychiatrists (MD or DO)
  Medical doctors specializing in mental health. They can prescribe medication and sometimes also provide therapy, though many focus mainly on medication management.
• Psychiatric Nurse Practitioners (PMHNPs)
  Advanced practice nurses who can prescribe medication and provide therapy, often working under or alongside psychiatrists.
• General Practitioner (MD or DO)
  Medical doctors who provide comprehensive, general medical care. GPs are able to prescribe mediation and offer support and education. However, they are not typically mental health specialists. 

Other Roles

• Licensed Mental Health Provider
  A general legal term, varying by state, that usually refers to anyone authorized to diagnose and treat mental health conditions (psychologists, social workers, counselors, etc.).
• Coach (Life Coach, Wellness Coach, etc.)
  Typically not a licensed mental health professional. Coaches focus on personal growth, career, motivation, or lifestyle. They can be helpful for some goals but are not trained to treat mental illness.

Key Differences

• Education & Training: Ranges from master’s (MSW, MS Counseling) to doctorate (PhD, PsyD, MD).
• Licensing: Titles like LCSW, LPC, LMHC, psychologist, psychiatrist are protected and require exams + supervised hours.
• Scope of Practice:
  • Only psychiatrists, other medical doctors, and nurse practitioners prescribe medication.
  • Psychologists, some social workers, and counselors provide therapy.
  • Coaches do not diagnose or treat clinical conditions.
• Chart: Mental Health Provider Comparison

Quick Takeaways

• Medication: Only Psychiatrists (MD/DO), Psychiatric Nurse Practitioners (PMHNPs), and other medical doctors.
• Therapy: Psychologists (PhD/PsyD), LCSWs, Licensed Counselors (LPC/LMHC), some MSWs, some PMHNPs.
• Case management & resources: LCSWs, MSWs.
• Coaching: Not mental health treatment, but useful for goals/motivation.

Ask Therapists:

• How much experience do you have treating BPD?
  
• What approach do you use (DBT, Schema-Focused Therapy, MBT, etc.), and why?
  
• Have you had formal training or certification in treating BPD?
  
• How do you structure treatment: individual, group, or a combination?
  
• How long does therapy usually last?
  
• Do you involve family or significant others in treatment?

Ask Yourself:

• Do you feel that the therapist truly cares about you and your struggles?
  
• Could you be honest and open with this person about your most personal issues?
  
• Do you feel heard and understood when you talk?

Ask Treatment Facilities:

Choosing the right facility involves looking at credentials, services, staff qualifications, and practical issues like cost and insurance.

Credentials

• Does the facility have a valid license to operate?
  
• Who issued the license, and what specifically is it licensed for?
  
• Is the license up to date?
  
• How many years has the facility treated people with BPD?
  
• Which treatments are offered? (DBT, Schema Therapy, MBT, TFP, etc.)
  
• How is the staff trained, and by whom?
  

Staff & Programs

• What is the staff-to-client ratio?
  
• How many staff members are on-site, and what are their qualifications?
  
• What is the maximum number of clients in the program?
  
• What types of therapy are available (individual, group, family, medication management)?
  
• How often is each type of therapy offered?
  
• How long is the typical stay?
  
• What is the treatment orientation: behavioral, psychodynamic, integrative, etc.?
  
• How is family involvement handled?
  
• Are there local support groups available?
  
• How is discharge planning managed, and does the facility coordinate with previous or future providers?
  
• What happens if a client signs themselves out early?

Rules & Expectations

• Is there a written handbook explaining rules, program expectations, visiting hours, or attendance policies?
  
• How much family contact is encouraged or required?

Financial Considerations

• What is the cost? Are there flat or extra charges?
  
• How is billing handled? What are the terms of payment?
  
• Does the facility accept Medicaid, Medicare, private insurance, or self-pay?
  
• Is there a financial counselor available to explain charges?
  
• Could receiving treatment affect SSI or other benefits?
  
• Are there resources to help clients with financial challenges?

Potential Checklist PDF of Questions to Ask a Therapist / Facility

Visit the Understanding Insurance page for an in-depth guide to insurance terminology.