Therapeutic Alliance in Borderline Personality Disorder

therapist talking to patient

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If you have a mental illness like borderline personality disorder (BPD), you are likely used to a whole way of feeling and reacting. For those with BPD, that may mean intense emotions, destructive actions, rapid mood swings, and feelings of abandonment. You may have gone years feeling this way and do not know any other way of living.

If you are considering going to therapy, it can be overwhelming, scary, and frustrating. Psychotherapy sessions ask you to completely change how you think and rationalize behaviors. It can be a stressful and emotional experience, but a strong therapeutic alliance can help you through it.

What Is a Therapeutic Alliance?

The foundation for any course of therapy is the therapeutic alliance, the strong bond designed to help you through your recovery. It is the relationship you have with your therapist and the level of trust you have in her. This is what keeps you moving during therapy, even when it's difficult or painful, because you know she has your best interests in mind. This connection may be hard to build but involves the following components:

  • Genuine interest: A good therapist gives you her undivided attention. She listens to what you have to say and asks clarifying questions. She does not seem preoccupied, does not sift through emails and she doesn't only give you her thoughts or opinions.
  • Specialization: Your therapist needs to have an understanding of what you're going through in order to help you. This means she should have a background in studying BPD and working with patients who have BPD.
  • Comfort: You need to be comfortable telling your therapist anything, even if it's embarrassing. She should put you at ease and ensure you know your conversations are confidential.
  • Common goals: You both should have the same goals so that you are working towards the same endpoint.

Building a Therapeutic Alliance

A strong therapeutic alliance does not happen overnight and may not be possible with just any therapist. Many people with BPD will visit several healthcare providers or psychiatrists before they find one they can "click" with.

When you are beginning therapy, it's perfectly okay to have consultations with several mental health professionals. Ask questions about their approaches to therapy, what techniques and theories they often use, and their background in treating BPD and other personality disorders. It's also a good idea to inquire how available they are as many people with BPD who engage in self-harm or have suicidal thoughts may need to be able to call their therapist at odd hours during an emergency.

If you are having suicidal thoughts, contact the National Suicide Prevention Lifeline at 1-800-273-8255 for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.

For more mental health resources, see our National Helpline Database.

Your potential therapist should be happy to answer your questions. If he seems annoyed, impatient, defensive, or keeps checking his watch, it's time to move on and find someone else. A good therapist is worth the extra homework in order to help you on the path to long-term recovery.

A Word From Verywell

If you're having trouble finding a therapist with a background with BPD, talk to your general practitioner or primary care physician to see if he has any recommendations. He will likely have many different therapists, counselors, psychiatrists, and psychologists on the file he can refer you to.

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  • Meyers, L. (August 2014). American Counseling Association. Counseling Today: "Connecting With Clients"