Why Therapists Often Refuse to Treat Borderline Personality Disorder (BPD) Clients

It is not uncommon to hear that therapists often refuse to work with clients who have Borderline Personality Disorder (BPD). This article aims to shed light on the reasons behind this decision, while also highlighting the challenges and potential benefits in treating BPD patients.

The Reasons for Refusal

While not all therapists outright refuse to treat BPD clients, some have valid reasons to terminate the relationship if certain characteristics are present. Here are some of the factors that make managing BPD clients particularly challenging for therapists:

Challenging Behavior and Symptoms

Some BPD clients may exhibit behaviors and symptoms that are genuinely detrimental to the therapeutic process. These include impulsive actions, constant conflict, and a lack of commitment to therapy. While it is important to ethically provide support, it can be incredibly frustrating and exasperating for therapists to deal with such behaviors consistently. It is not uncommon for therapists to feel overwhelmed and desire to discontinue working with such clients.

Resistance to Change

A significant aspect of BPD is the difficulty in changing ingrained behaviors and thought patterns. Despite the therapist's best efforts and interventions, the client may consistently resist change. This resistance adds an extra layer of complexity to the therapeutic relationship, making it more challenging to achieve desired outcomes.

Limited Treatment Options

There is no definitive “cure” for BPD. Dialectical Behavior Therapy (DBT) is often recommended, but it may not be effective for all therapists or clients. If a therapist has not had success with DBT or feels that it is not the best approach for their own skills and experience, they may choose to limit their involvement with BPD clients.

Personal and Professional Boundaries

Therapists are humans with personal and professional boundaries. While they are trained to help and support, they cannot disregard their own well-being. Some therapists may feel emotionally drained or frustrated when dealing with clients who are not willing to adhere to the therapeutic process, leading to a desire to discontinue the treatment.

The Majority of BPD Clients Are Manageable

It is important to note that the majority of BPD clients are not as challenging as the ones often mentioned. In fact, many BPD clients can be perfectly good and reliable therapy clients, especially when their diagnosis is revealed. These clients do not exhibit the extreme symptoms that can make therapy incredibly difficult. A qualified psychologist should not discriminate based on diagnosis and should approach each client individually.

Scientific and Psychological Handling

When faced with a BPD client, it is crucial to conduct thorough assessments and qualitative analyses. Relying solely on quantitative measures or scores may not provide a comprehensive understanding of the client's needs. Instead, a more nuanced and individualized approach can lead to better outcomes and a more effective therapeutic relationship.

Setting Objectives and Affordability

Therapists should also consider the client's objectives and affordability when making decisions about managing the treatment. Some clients may have unique needs or financial constraints that affect the nature of their treatment plan.

Conclusion

While the challenges associated with treating BPD clients are real, it is essential for qualified therapists to approach such cases with sensitivity and professionalism. By understanding the unique needs of each client, therapists can provide effective and compassionate care, even in challenging situations. Refusal to treat should be a last resort, and therapists should have a valid, ethical reason before making such a decision.

Key Takeaways:

Many BPD clients can be good therapy clients when their diagnosis is revealed. Therapists should conduct thorough qualitative assessments before deciding to limit sessions or discontinue treatment. Refusal to treat should be based on valid ethical reasons, not personal preferences. A scientific and individualized approach is essential for effective BPD treatment.

References

While not included in this article, a detailed study on the treatment of BPD and therapist perspectives would provide further insight. Relevant resources and studies can be found in clinical psychology journals and professional literature.