Borderline Personality Disorder

When I founded Willow Tree Counselling in Vancouver, I made a conscious decision to welcome people with diagnosed or suspected borderline personality disorder (BPD).

From my years of experience working in public mental health, I learnt that clients living with borderline personality were chronically over-served by emergency psychiatric services and under-served when it came to skilled, ongoing therapeutic support and counselling.

When clients with BPD contact Willow Tree Counselling, the most common comment I receive is, “It is so hard to find a counsellor who treats borderline personality disorder.”  I also hear, “I’ve been looking for such a long time for a therapist who would be willing to see me.”  Or, “I’ve been told by other therapists that I need to see someone who specializes in borderline personality.”

What is Borderline Personality Disorder?

Borderline personality disorder is perhaps one of the most controversial of all mental health diagnoses.  To begin with there is debate on whether BPD actually exists at all.  Some feel that it is an extension of sexism, given that it is a diagnosis almost exclusively applied to women while others are relieved that the chaos in their lives, or loved ones’ lives, finally make sense.

Regardless of what side you stand on in this debate, you may notice the presence of the following symptoms:

  • Longstanding difficulties with interpersonal relationships (e.g. romantic, family, work). Relationships are often intense, chaotic, dramatic.  Sufferers may alternate between overvaluing or devaluing others and may make desperate attempts to avoid real or perceived emotional abandonment.
  • Cognitive distortions, primarily black and white thinking.  For example, a person may judge another as “bad” or “good” at different times but not at the same time.
  • Engaging in risky behaviour, such as excessive drinking, drugging, binging, unsafe sex, gambling, reckless driving, extreme sports.
  • Chronic Suicidal thoughts accompanied by either suicide attempts or self-harming behaviours such as cutting, burning, punching self, banging one’s head, harming self with objects.
  • Lack of a cohesive sense of self.  Sufferers may feel a chronic sense of emptiness, nothingness or boredom.  When asked to describe themselves, sufferers will often comment, “I don’t know who I am—I never have.”
  • Anger outbursts – Can manifest as verbal lashing out, self-harming, breaking objects, risky behaviour.
  • Mood instability – Mood is reactive to environmental events and can fluctuate significantly in the course of a day.  Depression and anxiety commonly co-occur with borderline symptoms.
  • Pervasive low self-worth
  • Impulsivity in decision making or behaviours.
  • Acute sensitivity to stresswhich can result in the individual shutting down emotionally and disassociating,or alternatively, experiencingparanoid thoughts

Clients with BPD, or suspected BPD seek out my services for a variety of reasons, including:

  • They are unable to access counselling or therapy within the public mental health system
  • They choose not to receive treatment at a public mental health team
  • They are seeking therapy to complement the care they are receiving from their private psychiatrist
  • They are seeking a therapist with significant experience in treating BPD and their preference is a one-on-one approach
  • They identify needing a safe, accepting therapeutic environment and also understand, and appreciate the necessity of being challenged to work through their difficulties
  • Are open to learning new coping and life-enriching skills and are willing to have difficult discussions about personal behaviour, choices, thoughts and emotions
  • They are a family member of a sufferer seeking support, understanding and skills

My Approach

At my downtown Vancouver therapy office, I see clients both with and without a diagnosis of BPD.  A diagnosis is not critical: we examine the problems and or/symptoms that bring you to therapy, which guide the choice of therapeutic approach.

American psychologist Marsha Linehan developed dialectical behaviour therapy (DBT) for use with chronically suicidal patients as she found that the standard cognitive behavioural treatment that she was using did not go far enough to help with this population of people.  As I work in  a private (solo) practice setting, I offer a modified DBT approach (in traditional DBT treatment, for example, concurrent skills-training groups are also a mandatory part of the therapy).  Depending on your personality and goals for therapy, I also draw on other therapeutic approaches including cognitive behavioural therapy, solution focused therapy, mindfulness training and humanistic therapies.  I always work within a strengths-based perspective.

While some of my clients with borderline personality disorder are also under the care of a private psychiatrist, I am unfortunately not able to work with clients who are currently under the care of a community mental health team, as my involvement could inadvertently complicate or interfere with the treatment you are receiving. Additionally, if you are actively suicidal and/or are in need of frequent emergency services to ensure your safety, my private practice is not an appropriate resource as it does not afford enough support to assist in managing such symptoms effectively. Please contact 9-1-1, 1-800-SUICIDE, or, if you are a Vancouver resident, the AAC at Vancouver Hospital. If you struggle with such symptoms chronically, I recommend a traditional, intensive DBT treatment program which also includes weekly group therapy and 24-7 access to a therapist, services not available in my private practice.

While I am touched to receive messages from folks across Canada, regrettably, I am only able to work with BC residents, as I am authorized to practice social work in British Columbia only.

A Message to Family Members

I am also passionate about helping family members who have a loved one with borderline personality.  Often family members wait until they are at the end of their rope before seeking help and support.  Most commonly, families request my guidance when it comes to setting boundaries, improving communication, learning more about BPD and developing avenues for self-care.  Loving someone with borderline personality can be a gruelling experience.  It may be enough at first to survive, but ultimately you can thrive!

If you or a loved on is experiencing some or most of these symptoms, help and support are available. Borderline Personality Disorder is treatable!  I am continually impressed by clients’ growth and movement; BPD is not a static state, particularly if the motivation and willingness to change is present.  I welcome you to call or email me to arrange a consultation or to discuss any questions you may have about my psychotherapy practice, approach or experience. My office is located in downtown Vancouver, BC. I look forward to hearing from you!