Therapy for Borderline Personality Disorder (BPD)
BPD Therapy in Kansas City and greater Missouri
In-person and online Dialectical Behavior Therapy (DBT) for adults and teens to help with Borderline Personality Disorder (BPD) and related emotional regulation and interpersonal symptoms.
Signs & Symptoms of Borderline Personality Disorder
Like many of my BPD clients, maybe you’ve experienced the following:
Extreme sensitivity to and/or fear of abandonment, rejection, or neglect by significant others
Unstable relationships with characteristics of love/hate dynamics, idealization/devaluation, or frequent on again/off again
History of damaging impulsivity (e.g. substance abuse, excessive spending, gambling, unsafe sex/promiscuity, reckless driving, binge-eating, or other reckless behavior)
Recurrent suicidal thoughts, attempts, or self-harm
Chronic instability of emotions with intense moods that can cycle in a period of hours or less between (anxiety, depression, elation, panic, or anger) or experiencing “emotional meltdowns”
Chronic feelings of emptiness
Intense period of anger with difficulty controlling that anger
Intermittent sense of paranoia or dissociation under stress
Have been told that you are ‘too sensitive,’ ‘too dramatic,’ ‘too much’ or ‘too volatile’
Often feel misunderstood or alone in the world
My Approach to BPD Treatment
When I work with Borderline Personality Disorder in therapy, I often incorporate all of the components of DBT, which is commonly known as the “gold standard treatment for BPD.” (For more information on my approach to the DBT model, see my DBT page.) We will do Dialectical thought work, emotion regulation, mindfulness, interpersonal skills, and distress tolerance skills. I also find it helpful to look specifically at the BPD symptoms my client are most affected by and treatment to each specific symptom. See below for examples:
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If you’re struggling with fear of abandonment, we will likely work on attachment style. This includes looking at interpersonal skills and interpersonal skills to heal the relationship with self and others. We will also work on emotion regulation and distress tolerance skills to help with managing intense panic that can often accompany fear of abandonment.
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If you are struggling with unstable relationships, we will likely look at your contributions to the relationship instability as well as your partner’s/friend’s contribution. We will work on interpersonal skills of choosing compatible relationships/friendships as well as boundary-setting, assertive communication, and conflict resolution to assist with meeting needs and minimizing relationship conflict.
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If we work on self-image and identity in therapy, we will likely complete personality assessment and values identification. This will help you to better understand your personality traits in relation to other people and what is important to you in life. We may also develop a stable story of self that incorporates your trauma history along with an understanding of your resiliency and strengths.
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IteIf you are struggling with impulsive behavior, we would often start by identifying what function these behaviors serve for you. Often, I find that my BPD clients have a high need for sensation. They are easily bored and crave stimulation. We will look at ways to fulfill this need in less damaging ways and even do behavioral modification work or addictions work as needed to help replace addictive behaviors.
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If you are struggling with suicidal behavior or self harm, we would start by looking at what function these behaviors serve for you. Often suicidal behavior, can feel like a means of escaping incredibly difficult/confusing situations or a means of communicating the amount of pain you are in to the world. And self-harm, is often a means of achieving numbness or increased stimulation (it can be both or either), a form of self-punishment, or even a means for handling difficult emotions. Once we know what functions these behaviors are serving, we can determine healthier, less-damaging behaviors that serves a similar function.
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If you have a difficult time regulating your emotions and moods, you are not alone. Many of my BPD clients say they just want to feel “normal” or “at peace.” They are tired of cycling through so many emotions all the time. We will work with you on emotion regulation skills which helps to set you up for less emotional instability on a regular basis. We will also work on distress tolerance skills, which will help you to manage better during the inevitable crisis that might arise.
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Many of my clients have complained about feeling “too empty” or “too numb.” This often goes along with having an unstable sense of self and not having enough stimulation. If this is something you struggle with, we will work together on identifying what kind of relationships, situations, and activities make you feel stimulated and “full.” This often goes along with values and identity work and also gets into better defining what you would like to do with your life.
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I actually don’t love the term “inappropriate” here even though this is what most of the BPD literature calls it. Many of my BPD clients have had friends, family, or partners tell them that they get angry at things that don’t make sense. However, often the anger does make sense if we understand past traumas and triggers. When we work on this type of anger, we will often explore the situation that caused the anger in light of past traumatic experiences and triggers. This often illuminates the boundary that was crossed when the anger happened. We then also work on emotion regulation skills to better manage the anger response and interpersonal skills to set boundaries and communicate them more effectively.
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This can be one of the scariest and most uncomfortable symptoms of BPD. Often, paranoia or dissociation will surprise my clients and their significant others when it occurs. Typically this will occur in a moment of severe stress or panic (like when there is a threat of a break-up or relationship ending or some other type of crisis). This can look like true psychosis at its worst but it is not truly psychosis. It is simply a severe “fight or flight” response. When we work on this, we will often work on better understanding the “fight or flight” response of the nervous system and applying emotion regulation and distress tolerance skills to bring down “fight or flight activation.”
FAQs about BPD
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Many of my clients come in asking this question. We will definitely evaluate you for this during the course of therapy! The DSM criteria for BPD can be found here. I usually look for a pervasive instability of moods, relationships, behaviors, and identity that have existed across a variety of contexts. Some of my clients simply find out that they are highly sensitive people or struggling with another mental health difficulty. Others, end up with a BPD diagnosis that makes them feel like everything finally makes sense.
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There is much debate going on now about the overlaps and differences between being highly sensitive, autistic and/or having BPD. To read more on this topic, I recommend exploring the articles here and here and here. The short version of the story is that there are similarities and differences between being highly sensitive, having BPD, and being on the autism spectrum. Through the course of therapy, we will determine which - if any - of these concepts best describes your symptoms and lived experience and how best to treat any difficulties that might come along with these diagnoses. Also, it’s worth noting that I don’t do full autism testing, but we will do some initial assessment to determine if Autism testing is required. I do test for most other diagnoses myself.
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As a therapist, I evaluate my client’s for mental health diagnoses throughout their course of treatment with me. I always screen for signs of BPD, high sensitivity, ADHD, Autism Spectrum, and other mental health conditions. However, additional neuropsych testing is required to receive a conclusive diagnosis of ADHD or Autism Spectrum. I don’t provide this neuropsych testing but can give you an initial screening to help determine if further testing is needed. You can find additional resources for Autism & ADHD neuropsych testing here and here as well as many other testing facilities in the Kansas City area. If you have further questions about this, don’t hesitate to reach out.
Why choose me for DBT Counseling?
I love working with BPD clients! I’m a highly sensitive person and high sensation seeker, like many of my clients with BPD. and am quite familiar with the highs and lows of living on an emotional roller-coaster. I’m not here to judge you; I’m here to level with you, help you find your power, and restore peace and calm in your life!
I’ve been working with Borderline Personality Disorder for over 15 years now. This has been an area of interest of mine ever since I was first trained in DBT back in 2011. I am not just a talk therapist. I will teach you new skills that will help you manage your life more effectively.
Many of my clients have provided feedback that their work with me has helped them incorporate new skills into their daily lives in a way that feels simple and achievable.
