Organizing and Shaping a Treatment Toward Change

  • Brian Palmer
  • Brandon Unruh


This case captures several key principles of working with a patient with BPD. The first is to consider the interpersonal context for the symptoms. Symptoms reduce with increased support (though this can lead to regressive treatments), and they increase with transitions and interpersonal stressors. Grounding a treatment in the expectation of functional progress is a key principle, given the troubling data that most patients with BPD improve symptomatically but not functionally. Moreover, such an approach also helps steer clear of complicity with avoidance-based symptom improvement. Families are a key to treatment. They have many of the same concerns and reactions as treaters do, and helping them learn skills to decrease their own reactivity can be extremely helpful. The case also emphasizes practical, here-and-now approaches which are not incompatible with deeper interpretations but which are accessible and help anchor and stabilize the work.


Borderline personality disorder Treatment planning Goal setting Functional recovery Work Anger Interpersonal hypersensitivity Avoidance 


  1. 1.
    Zanarini MC, Frankenburg FR, Reich DB, Fitzmaurice G. Time to attainment of recovery from borderline personality disorder and stability of recovery: a 10-year prospective follow-up study. Am J Psychiatry. 2010;167(6):663–7.CrossRefGoogle Scholar
  2. 2.
    Zanarini MC, Frankenburg FR, Reich DB, Fitzmaurice G. The 10-year course of psychosocial functioning among patients with borderline personality disorder and axis II comparison subjects. Acta Psychiatr Scand. 2010;122(2):103–9.CrossRefGoogle Scholar
  3. 3.
    Gunderson JG, Stout RL, et al. Ten-year course of borderline personality disorder: psychopathology and function from the collaborative longitudinal personality disorders study. Arch Gen Psychiatry. 2011;68(8):827–37.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Brian Palmer
    • 1
  • Brandon Unruh
    • 2
  1. 1.Mayo Clinic, Department of Psychiatry and PsychologyRochesterUSA
  2. 2.McLean HospitalHarvard Medical SchoolBelmontUSA

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