Navigating the Emotional Depths: Treating Clients with BPD and the Power of Therapeutic Intensity

Have you found treating clients with BPD to be engaging or challenging? As a therapist, working with individuals with Borderline Personality Disorder (BPD) can be both rewarding and intense. I often find that the emotional intensity of these clients to be engaging and fun to work with, rather than a challenge. This article explores the advantages and challenges of treating BPD, the impact of therapeutic intensity on therapy outcomes, and how adaptability in managing time management improves the effectiveness of such sessions.

Engaging with Intensity: The Allure of BPD Therapy

One of the most compelling reasons for my attraction to BPD clients is the intense emotional engagement they bring to therapy sessions. Unlike clients seen in a busy schedule, where maintaining focus and presence can be difficult, BPD clients tend to have a high level of energy and a clear passion for their issues. Their emotional intensity can be very engaging, making it easier to stay fully present during sessions.

However, this intensity also poses a challenge in terms of time management. Deep and profound conversations can sometimes lead to the session extending beyond the scheduled time. Managing the session time effectively, while still covering all necessary aspects of the therapy, is a critical skill. I have learned to set better boundaries and adapt to the flow of a session as it progresses. Ending a trauma-focused session abruptly can be harmful, so leaving sufficient time at the end to wrap things up is essential for the client’s emotional well-being.

Acceptance and Change: DBT’s Core Principle

The experience of treating BPD clients aligns closely with DBT (Dialectical Behavioral Therapy), an evidence-based treatment specifically designed for borderline personality disorder. DBT addresses the paradox of self-acceptance and change, emphasizing that it is possible to accept oneself while still working towards change. This concept, as expressed by Carl Rogers, states that:

“The curious paradox is that when I accept myself just as I am, then I can change.”

This idea challenges the notion of “all or nothing” thinking, where one must fully accept oneself or work towards change. Instead, it suggests that both acceptance and change can coexist, enhancing the therapeutic process.

Identifying and Communicating Emotions

BPD clients often struggle to express their emotions in a direct and appropriate manner. They may not be able to identify the emotions, the reasons behind them, or what they need. This leads to intense emotional outbursts or breakdowns, both externally and internally. It is a major part of therapy to help these clients identify and accept their emotions, and then learn how to communicate them effectively.

For example, imagine a roommate with BPD returning home after a date. They seem happy and possibly even liked someone they just met. However, they wake you up in the morning with tears streaming down their face, seemingly upset by something that is not apparent to you. They may have no idea what they are feeling, only that they are upset. Through therapy, they can learn to explore their emotions and understand what is driving their reactions, leading to a more balanced and communicative relationship.

The intensity in BPD therapy can be powerful for both the therapist and the client. Validating a client's emotions in real time can be profoundly satisfying. As a therapist, you can witness the client’s “a-ha” moment, where they start to understand their own emotions more clearly. Gradually, this skill transfers to their daily life, making a significant difference in their emotional well-being.

Conclusion

While treating clients with BPD can be challenging, the therapeutic intensity can also be highly rewarding. The ability to help clients identify and manage their emotions effectively can lead to significant improvements in their quality of life. Embracing the paradox of self-acceptance and change with DBT and adapting to the therapeutic intensity can transform challenging sessions into meaningful and impactful experiences.