Five therapies for borderline personality disorder (BPD)

Living with borderline personality disorder (BPD) can feel a bit like having your emotional volume
knob stuck on “max” while everyone else seems to be listening at a gentle background level.
Relationships swing from “you’re my favorite person” to “don’t ever talk to me again,” you may feel
constantly on edge, and even small conflicts can feel like the end of the world. The good news:
evidence-based therapies exist, and many people with BPD build stable relationships, meaningful
careers, and rich, satisfying lives.

In this guide, we’ll walk through five therapies that are commonly used to treat BPD:
dialectical behavior therapy (DBT), mentalization-based treatment (MBT), schema therapy,
transference-focused psychotherapy (TFP), and a structured group program called STEPPS.
We’ll break down what each one is, what actually happens in sessions, and how to figure out which
approach might fit you or your loved one.

Understanding borderline personality disorder

BPD is a mental health condition marked by intense emotions, fear of abandonment, unstable
relationships, a shifting sense of self, and sometimes self-harm or suicidal thoughts. These
experiences are not a personality “flaw” or a sign of being “too dramatic.” They’re symptoms of a
treatable condition that often develops from a mix of biological vulnerability, early life stress,
and invalidating or chaotic environments.

Because the core challenges in BPD involve emotions, relationships, and identity, psychotherapy
(talk therapy) is the main treatment. Medications may be used to target specific symptoms like
anxiety, depression, or mood swings, but they do not “cure” BPD on their own. Structured
therapiesespecially those designed specifically for BPDhelp people learn new skills, understand
patterns, and build a life that feels worth living.

Why therapy is the first-line treatment

BPD affects how you see yourself and others, how you regulate feelings, and how you react under
stress. Therapy directly targets these patterns. Instead of just numbing symptoms, it helps you:

• Notice and name emotions before they explode.
• Pause between feeling a surge of emotion and acting on it.
• Understand what’s going on in your own mind and the minds of others.
• Repair relationships instead of watching them repeatedly crash and burn.

Different therapies approach these goals in different ways. Think of them as different “roads” that
can lead to the same destination: more stability, more control, and more hope.

1. Dialectical behavior therapy (DBT): skills for big feelings

Dialectical behavior therapy is one of the best-known and most researched treatments for BPD. It was
developed by psychologist Marsha Linehan after she noticed that standard cognitive behavioral
therapy (CBT) didn’t quite fit people with intense emotional swings and chronic suicidal thoughts.
DBT adds a crucial ingredient: acceptance. The “dialectical” part means holding two things as true
at once, such as “I’m doing the best I can” and “I need to work hard to change.”

The four DBT skill modules

DBT is structured and practical, with four main sets of skills:

• Mindfulness: Learning to notice thoughts, feelings, and sensations in the present
  moment without instantly judging or reacting to them.
• Distress tolerance: Surviving emotional crises without making things worse, using
  tools like grounding, sensory strategies, and short-term distraction.
• Emotion regulation: Understanding what emotions are for, what triggers them, and
  how sleep, food, and activities influence themthen using targeted strategies to turn the
  emotional “volume” down.
• Interpersonal effectiveness: Asking for what you need, setting boundaries, and
  handling conflict without burning bridgesor yourself.

What DBT actually looks like

Classic DBT usually includes weekly individual therapy, a weekly skills group, and between-session
phone or text coaching (within agreed-upon limits) to help you use skills in real time. Sessions are
highly structured. You and your therapist might:

• Fill out “diary cards” tracking urges, emotions, and behaviors.
• Identify patterns in situations like self-harm, explosive anger, or sudden breakups.
• Practice specific skills you’ll use the next time a crisis hits.

Many people who complete a full DBT program report fewer suicide attempts and hospitalizations,
less self-harm, and improved relationships. It’s demanding, but it’s also very practicalmore like
emotional training than lying on a couch talking about your dreams.

Who DBT may be a good fit for

DBT can be especially helpful if you:

• Have frequent self-harm or suicidal thoughts.
• Experience intense, fast-changing emotions.
• Feel like you go from “totally fine” to “I can’t do this” in minutes.
• Struggle with chaotic or stormy relationships.

That said, DBT is not the only option, and it may not be available everywhere. If there’s no full
DBT program nearby, some therapists integrate DBT skills into more general treatment.

2. Mentalization-based treatment (MBT): making sense of minds

Mentalization-based treatment starts from a simple idea that’s surprisingly powerful: when we’re
stressed, we stop “mentalizing”that is, we stop seeing ourselves and others as people with complex,
changeable inner worlds. Instead, we may assume bad intentions (“She ignored my text because she
hates me”) or lose track of what we’re feeling at all.

People with BPD often lose this mentalizing ability under intense emotion. MBT helps rebuild and
strengthen it, especially in relationships.

How MBT works in practice

In MBT, you and your therapist zoom in on specific moments when things went wronglike a fight with
a partner or a sudden urge to self-harm. Instead of asking “Who’s right?” or “What’s wrong with
me?” the therapist asks questions like:

• “What do you think was going through your mind right then?”
• “What might have been going through theirs?”
• “What are some other possible explanations for what they did?”
• “How certain are you about that assumption?”

This process helps you move from emotional “all-or-nothing” stories (“Everyone always abandons me”)
to more nuanced, flexible interpretations. Over time, you’ll get better at staying curious about
your own and others’ inner experiences, even when you’re upset.

MBT settings and benefits

MBT is often offered in specialized clinics as a combination of individual and group therapy. The
pace tends to be steady and reflective rather than fast and skills-heavy. Research suggests that MBT
can reduce self-harm, suicide attempts, and overall symptom severity while improving attachment and
interpersonal functioning.

If you’re someone who often thinks, “I don’t even know why I react this way,” or “I can’t tell what
people really feel about me,” MBT’s focus on understanding mindsstarting with your ownmay be a
particularly good match.

3. Schema therapy: updating old life scripts

Schema therapy blends CBT, attachment theory, psychodynamic therapy, and experiential techniques. It
focuses on “schemas”deep, painful beliefs about yourself and the world, such as “I’m unlovable,”
“People always leave,” or “My needs don’t matter.” These beliefs often come from early experiences
of neglect, abuse, chaos, or chronic invalidation.

For people with BPD, schemas can feel like the director of an internal movie you didn’t sign up to
star in. Schema therapy helps you notice these scripts and rewrite them.

Schemas and modes

Schema therapists often talk about “modes”moment-to-moment emotional states and coping styles. For
example, someone with BPD might shift rapidly among:

• A vulnerable child mode: feeling small, scared, and desperate for reassurance.
• An angry or impulsive child mode: acting out, yelling, or engaging in risky
  behavior when overwhelmed.
• A detached protector mode: shutting down, dissociating, or pushing people away.
• A healthy adult mode: calm, grounded, able to set limits and care for yourself.

The goal of schema therapy is to strengthen that healthy adult part, so it can comfort the vulnerable
child, set limits on the angry child, and coax the detached protector out of hiding.

Tools used in schema therapy

Schema therapists use several techniques, including:

• Imagery work: Re-visiting painful memories in a safe way and offering your
  younger self the care and protection you didn’t receive at the time.
• Chair work: Speaking from different “modes” (for example, your angry part and
  your healthy adult) as if they were in separate chairs, so you can understand and integrate them.
• Limited reparenting: Within professional boundaries, the therapist offers a stable,
  reliably caring relationship to model what healthy support looks like.

Studies suggest that schema therapy can be particularly helpful for people with BPD who have
long-standing patterns rooted in early trauma or neglect and who benefit from a strong, consistent
therapeutic relationship over time.

4. Transference-focused psychotherapy (TFP): using the relationship as a mirror

Transference-focused psychotherapy is a psychodynamic treatment tailored for BPD. It zeroes in on
how you experience and relate to other peopleespecially your therapist. The idea is that the same
patterns that cause chaos in your daily life will eventually show up in the therapy relationship,
where they can be safely explored and understood.

How TFP works

In TFP, sessions are usually held once or twice per week. The therapist:

• Tracks shifts in how you view them and other people in your life.
• Notices when you move into “split” statesseeing someone as all good or all badand gently explores
  these shifts with you.
• Helps you link intense reactions in the present to earlier experiences and internal templates about
  relationships.

The goal is to help you integrate these split-off parts of yourself and others so you can hold a more
stable, nuanced view of relationships. Over time, that can reduce dramatic swings between idealizing
and devaluing others and help you feel more solid in your own identity.

Who might benefit from TFP

TFP may be particularly helpful if:

• Your main struggles revolve around relationships and identity.
• You notice intense shifts in how you see people (“They’re perfect” to “They’re evil”) and you want
  to understand why.
• You’re open to looking closely at your reactions to your therapist and using that as raw material
  for change.

Some people find TFP challenging because it asks you to look directly at uncomfortable feelings about
the therapist. But for many, that honest, in-the-moment exploration can be deeply transformative.

5. STEPPS: skills, structure, and support

Systems Training for Emotional Predictability and Problem Solving (STEPPS) is a group-based program
designed for people with BPD and their loved ones. It’s usually offered as a time-limited group (for
example, 20 weeks) rather than long-term individual therapy, and it often runs alongside other
treatments.

STEPPS in a nutshell

STEPPS focuses on:

• Teaching basic information about BPD and emotional regulation.
• Helping participants map their emotional triggers and patterns.
• Practicing practical coping skills and problem-solving strategies.
• Training families and friends to respond in ways that support recovery rather than unintentionally
  reinforcing crises.

You can think of STEPPS as a structured course: there’s a curriculum, handouts, homework, and a clear
start and end. Studies suggest that when combined with individual therapy and appropriate medication,
STEPPS can reduce symptoms and improve functioning for many people with BPD.

How STEPPS fits into a broader treatment plan

Because STEPPS is short-term and group-based, it’s often used as one piece of a larger treatment
puzzle. It can be especially useful when loved ones want concrete guidance on how to be helpful. For
someone already in DBT, MBT, schema therapy, or TFP, STEPPS may add another layer of skills and
support.

Choosing a therapy and getting started

Reading about all these approaches can feel overwhelminglike trying to pick a favorite ice cream
flavor while the display case has 40 options and you’re already emotionally overheated. A few
grounding points:

• Evidence-based therapy matters, but “good enough and available” beats “perfect on paper.”
  If you can’t access a full DBT or MBT program, a therapist with solid training in BPD-informed
  approaches is still extremely valuable.
• Relationship quality is huge. Feeling safe, respected, and understood in therapy is
  strongly tied to better outcomes, no matter which specific model is used.
• It’s okay if it takes time. BPD often develops over many years; it’s realistic that
  change will be gradual. That doesn’t mean therapy isn’t working.

Questions to ask a potential therapist

When you’re looking for a therapist or program, you might ask:

• “Do you have experience working with borderline personality disorder?”
• “Which treatment approaches do you use for BPD?”
• “How structured is your approach? What will sessions usually look like?”
• “How do you handle crises between sessions?”
• “What does progress typically look like for your clients?”

A good therapist will be transparent, realistic, and collaborative. If you feel shamed, dismissed, or
constantly confused about what’s happening in therapy, that’s important datayou’re allowed to look
for a better fit.

Real-world experiences with BPD therapies

Research data and fancy acronyms are helpful, but what does all of this look like in real life? While
everyone’s story is unique, certain experiences come up again and again when people describe
treatment for BPD.

Many people starting DBT, for example, talk about feeling skeptical at first. The worksheets can feel
“school-like,” and the language (“wise mind,” “emotion mind”) may seem cheesy. But over time, the
skills start to stick. Someone might notice that instead of instantly texting an ex after a fight,
they take ten minutes to do a distress-tolerance exercise, and the urge passes. That single pause can
be the start of a long chain of changes: fewer crises, fewer humiliating regrets, more trust in
themselves.

People in MBT often describe a different kind of “aha” moment: realizing that their interpretations of
others’ behavior are not facts. One person might notice, “When my friend doesn’t reply right away, I
jump straight to ‘She’s done with me.’ But in MBT I learned to ask, ‘What else could be true?’ Maybe
she’s at work, maybe she’s tired, maybe she’s actually thinking about how to respond kindly.”
That shift from certainty to curiosity can soften emotional storms before they fully form.

In schema therapy, some of the most powerful moments happen when people connect deeply with their
younger selves. A client might recall sitting alone in their bedroom as a child, listening to their
parents argue in the next room, and suddenly understand why adult arguments feel so threatening. When
the therapist guides them through comforting that “vulnerable child” partoffering words of safety and
protection they never heard thenit can be both painful and healing. Over time, the belief “I’m
helpless and no one cares” slowly shifts toward “I matter, and I can protect myself now.”

For those in TFP, the therapy room can feel like a laboratory for relationships. It can be jarring to
realize that the urge to abruptly quit therapy after a disagreement with the therapist mirrors the
urge to storm out of friendships or romantic relationships. When the therapist calmly invites the
person to talk about that urge instead of acting on it, something new becomes possible: staying in the
relationship and repairing rupture. People often describe this as learning, maybe for the first time,
that conflict doesn’t automatically mean abandonment.

STEPPS groups bring another kind of experience: community. It can be a relief to sit in a room (or
video call) where no one flinches when you mention self-harm urges or intense mood swings. Participants
often say that simply hearing “me too” makes them feel less broken. Families and partners who attend
STEPPS or similar programs frequently report that they finally have a map: instead of responding to
crises with panic, criticism, or overprotection, they learn specific strategies for staying calm,
setting boundaries, and offering support that actually helps.

Across all these therapies, progress rarely looks like a straight line. People may have weeks where
everything feels worse and they wonder if therapy is “working.” Then, a crisis that would have ended
in self-harm a year ago ends in a tearful but safe night on the couch using skills. An argument that
once would have destroyed a relationship becomes a tough conversation that eventually leads to deeper
trust. Over months and years, these small shifts add up.

One of the most encouraging themes from lived experience is this: people with BPD are not “hopeless”
or “too much.” With appropriate treatment and support, many describe building lives that felt
unimaginable when they first walked into therapylives with friendships that survive conflict,
relationships that don’t revolve around chaos, and a sense of self that feels more like a sturdy
house than a tent in a storm. The work is often hard and sometimes exhausting, but it is absolutely
not pointless.

When to seek urgent help

If you or someone you care about has BPD and is in immediate danger due to self-harm or suicidal
thoughts, this goes beyond what any article can help with. Contact your local emergency number,
crisis hotline, or go to the nearest emergency room right away. If it’s safe, let your treatment team
know what’s happening so they can help adjust your care.

Key takeaway

Borderline personality disorder can be intense, painful, and exhaustingbut it is treatable.
Evidence-based therapies like DBT, MBT, schema therapy, TFP, and STEPPS offer different paths toward
greater emotional stability, healthier relationships, and a more grounded sense of self. You don’t
have to pick the perfect therapy on the first try, and you don’t have to do it alone. Reaching out for
support, asking questions, and staying curious about your own growth are already important steps on
the path forward.