Cognitive Behavioural Therapy (CBT)

CBT can help you to change how you think (‘cognitive’) and what you do (‘behaviour’), which are both linked to how you feel. CBT looks at problems and difficulties in the ‘here and now’ more than your past or childhood. CBT can help you understand how you think about yourself, the world and other people and how that affects how you deal with things in your life.

Dialectical behaviour therapy (DBT)

Dialectical behaviour therapy (DBT) can help you learn to spot and control your emotions and behaviour. It is adapted from CBT.

It helps you recognise then change unhelpful behaviour by learning new skills. Unhelpful behaviour might include thinking about suicide, self-harming, drinking alcohol or using drugs to cope with your emotions.

The National Institute for Health and Care Excellence (NICE) says DBT can be helpful if you have borderline personality disorder. Normally, you get one-to-one and group therapy appointments, education groups and telephone support. A course of BDT usually takes between 12 and 18 months to complete.

Cognitive Analytical Therapy (CAT)

Cognitive analytical therapy (CAT) helps you recognise relationship patterns that can cause you problems and are difficult to change. You may have learnt these patterns while growing up to cope with difficult emotions. You and the therapist will work together to recognise these patterns and then to try and change them. This type of therapy usually lasts 16-20 sessions. You and your therapist will agree the end goal at the start of the therapy.

Mentalisation-Based Therapy

Mentalising is about making sense of what other people think, need, or want. It is about being aware of what’s going on in your own mind and in the minds of others. Mentalising refers to the fact that sometimes when you feel distressed, it can be harder to ‘mentalise.’
You would attend group and one-to-one therapy. This may help you better understand yourself and others, and learn how to mentalise.

Psychodynamic / psychoanalytic therapy

This type of therapy gives you time to talk about how you feel about yourself and other people. This might include:
• what has happened in the past,
• what’s happening in your life now, and
• how the past can affect how you are feeling, thinking and behaving now.
You would usually have weekly or fortnightly sessions on a one-to-one basis. This type of therapy can be ongoing.

Schema therapy

Schema therapy is a newer type of therapy that combines aspects of cognitive behavioural methods with other forms of psychotherapy to develop positive and healthy patterns in the individual’s life while breaking negative ones.
Schema therapy focuses on reframing self-image and self-defeating schemas that have been obstacles for accomplishing one’s goals. Schemas are unhelpful patterns that some people develop if their emotional needs aren’t met as a child. These schemas can affect you throughout life and contribute to problematic coping methods and behaviours if they aren’t addressed.
Schema therapy involves working with a coach to identify negative patterns of thought and behaviour, challenge them, and develop new, more positive schemas.
It’s an integrative approach that aims to treat personality disorders and other mental health concerns that don’t always respond to other treatment options. It can be particularly useful for treating borderline personality disorder.

Acceptance and Commitment Therapy (ACT)

ACT uses strategies of acceptance and mindfulness (living in the moment and experiencing things without judgment), along with commitment and behavior change, as a way to cope with unwanted thoughts, feelings, and sensations. ACT imparts skills to accept these experiences, place them in a different context, develop greater clarity about personal values, and commit to needed behavior change.

Compassion-Focussed Therapy (CFT)

Compassion-focused therapy (CFT) is a therapeutic approach that aims to help those who struggle with shame and self-criticism, often resulting from early experiences of abuse or neglect.
CFT can be used to help manage many long-term emotional problems related to persistent shame, self-criticism, and an inability to view one’s self and one’s behaviours kindly and compassionately.
CFT helps to cultivate the skills of self-compassion and other-oriented compassion, which are thought to help regulate mood and lead to feelings of safety, self-acceptance, and comfort. The technique is similar to mindfulness-based cognitive therapy and how to practice mind and body awareness.

Transferrence-Focussed Psychotherapy (TFP)

TFP is one type of psychodynamically-based therapy that has been found to help people with BPD. TFP is a one-to-one therapy that specifically focuses on the split in people with BPD between, on the one hand, their wish for idealised, perfect care from another person, and their experience, which is often of very disappointing, neglectful or abusive treatment. TFP makes a point of recognising and addressing the aggression and rage which may be felt very acutely by people with BPD, and the ways in which this may be a response to disappointment in relationships.

Other types of treatment & support

Arts therapies

There are different forms of arts therapy, most common are art therapy, music therapy, drama therapy and dance movement therapy. They usually take place in a group and service users do not need any prior experience, skills, or abilities in the particular art. They are all based on the principle of creating a safe and trusting environment where an individual can access and express strong emotions. They enable people to express emotions non-verbally that they might not otherwise feel able to express.

Medication

There is no medication to treat PD itself, but if you experience anger, anxiety or depression, your doctor may give you medication to help with these symptoms. These may include antidepressants or antipsychotics. If you are offered medication, your doctor should tell you how the medicine should help you, and any side effects you might experience.

Crisis support

Some people with personality disorders have trouble coping with stressful events, and may need support in a crisis. It is recommended to develop of a crisis plan identifying potential triggers that could lead to a crisis, and specifying self-management strategies likely to be effective and establishes how to access services (including a list of support numbers for out-of-hours teams and crisis teams) when self-management strategies alone are not enough.

Next: Supporting someone with complex emotional needs