DBT was developed by psychology Marsha Linehan in the 1980s. While it is most well-known for treating BPD, it has also been adapted to help with depression, eating disorders, substance use, and post-traumatic stress disorder (PTSD). Its structured, skills-based approach and emphasis on both acceptance and change make it a powerful tool for building resilience and improving mental health.

Features of DBT

• • It is the most widely available evidence-based treatment for BPD in the US.
  • Comprehensive DBT involves five key parts:
    • Weekly individual therapy (typically 45-60 minutes):
      • • Sessions are structured with the use of a Diary Card to ensure that the client’s targets are being addressed.
        • Ensure that the individual therapist has received intensive DBT training or is a DBT-LBC, Certified Clinician™ or supervised by someone who has been intensively trained or is a DBT-LBC, Certified Clinician™.
    • Weekly DBT skills training group (2 hours):
      • • The group is educational in nature,  not a processing group. New material is taught, and weekly homework is reviewed.
        • For Adult DBT, research indicates that outcomes for adult clients are best if they complete 2 full cycles of the program’s skills training curriculum.
        • For Adolescent DBT, the group is typically a Multi-Family Group where the client and caregivers attend together.
    • Between-session phone coaching helps the client use skills in daily life and avoid higher levels of care.
    • DBT therapists participate in a weekly Clinician Consultation Team meeting with other DBT-trained therapists to improve efficacy.
    • Family and/or school Involvement
  • Best outcomes are linked to a comprehensive DBT program including all five components.
  • Skills-only DBT is separate from comprehensive DBT, and may help with less severe problems.

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MBT was developed by psychologists Peter Fonagy and Anthony Bateman. 

Rather than focusing solely on symptom reduction, the therapy emphasizes slowing down, reflecting on mental states, and considering multiple perspectives before reacting. By developing these reflective capacities, patients become better equipped to regulate intense emotions, reduce impulsive and self-destructive behaviors, and form more stable, trusting relationships. Research has shown that MBT can reduce hospitalizations, improve emotional stability, and foster long-term recovery, making it a highly effective, compassionate treatment for BPD.

Features of MBT

• • Focuses on improving the ability to understand one’s own thoughts and feelings and those of others.
  • Solid evidence of effectiveness exists for adults; there is growing evidence for youth.
  • Availability in the U.S. is limited; it is more common in Europe and other countries.
    

Therapists use a wide range of tools: cognitive techniques to challenge distorted thinking, experiential exercises such as imagery and “chair work” to process emotions, and behavioral pattern-breaking to encourage new responses. The therapeutic relationship itself is also central—offering a safe, consistent space where healthy attachment and boundaries can be experienced directly.

SFT places strong emphasis on the client’s daily life and relationships while also addressing the traumatic childhood experiences that are common in BPD. Treatment is typically a long-term commitment, often lasting several years rather than months. This extended timeframe allows for the deep psychological restructuring needed to create real and lasting change.

Features of SFT

• Combines elements of cognitive, behavioral, and psychodynamic approaches.
• Strong research support in Europe; limited availability in the U.S.
• Particularly effective when delivered in structured, long-term programs.

Evidence on the effectiveness of TFP is mixed, and it is rarely available outside a few U.S. cities.

TFP focuses on revealing the underlying causes of a client’s BPD and working to build new, healthier ways for the client to think and behave. From the perspective of TFP, the client’s perceptions of self and of others are split into unrealistic extremes of bad and good. These conflicting dyads are thought to be expressed through the specific self-destructive symptoms of BPD. The term “transference” refers to the client’s experience of his or her moment-to-moment relationship with the therapist. The treatment focuses on transference because it is believed that clients will display their unhealthy dyadic perceptions not only in day-to-day life, but also in the interactions they have with their therapist. TFP focuses on using client-therapist communications to help the client integrate these different representations of self and, in the process, develop better methods of self-control.

General Psychiatric Management, also called Good Psychiatric Management (GPM) is a generalist and practical model that can be learned by a wide range of clinicians, including psychiatrists, primary care providers, nurse practitioners, and other mental health professionals. It can be used across outpatient, inpatient, and emergency settings, expanding access to informed and effective care.

At the core of GPM is a focus on interpersonal sensitivity—how emotional distress and behavioral reactions are often triggered by stress in relationships. Clinicians help patients connect emotions and behaviors to relational stressors while incorporating education, practical problem-solving, realistic goal setting, and support for improving daily functioning and stability.

At the heart of GPM are several evidence-based principles that guide treatment. GPM is grounded in the understanding that recovery does not require the same level of intensity for everyone; many people benefit most from consistent, well-informed, and “good enough” care delivered over time. Central to this approach is a focus on relationships, as emotional distress and impulsive behaviors are often triggered by interpersonal stress, perceived rejection, or fears of abandonment. By helping patients understand and respond more effectively to these relational triggers, GPM supports meaningful and lasting change.

GPM keeps attention on the patient’s life outside of therapy. Treatment emphasizes practical support through case management, including assistance with housing, work, insurance, and daily structure. GPM prioritizes engagement in meaningful activities such as employment, education, volunteering, and consistent routines, following the principle of “work before love.” Patients are encouraged to take an active role in their treatment and assume responsibility for their safety and quality of life, while still receiving consistent clinician support. The approach is flexible, allowing clinicians to integrate helpful elements from other evidence-based treatments, such as CBT strategies, DBT skills, or peer support, based on the individual patient’s needs.

Current research is not robust enough to support ketamine, Internal Family Systems (IFS), or Eye Movement Desensitization and Reprocessing (EMDR) as primary or stand-alone treatments for Borderline Personality Disorder. While emerging studies and clinical reports suggest these approaches may offer benefits for other mental health conditions—such as treatment-resistant depression, post-traumatic stress disorder, or complex trauma—there is insufficient evidence to conclude that they reliably address the core features of BPD itself.

That said, many individuals with BPD experience co-occurring conditions for which these treatments may be appropriate and helpful when used within a comprehensive treatment plan. In such cases, they are best viewed as adjunctive or supportive interventions rather than replacements for evidence-based BPD treatments.

Because of the current limits of the scientific literature and a commitment to minimizing frustration and cost for those seeking care, we have chosen not to include these approaches on our core list of recommended treatments for BPD at this time. As the evidence evolves, these treatment methods may warrant reconsideration, but for now, our recommendations prioritize treatments with the strongest and most consistent empirical support.

In many communities, evidence-based treatments may not be available. In these cases, people may receive more general therapy—sometimes called treatment as usual. Treatment as Usual (TAU) represents the conventional mental health care available to individuals with BPD, typically lacking the structure and targeted approach of evidence-based therapies. While TAU can provide essential support and stabilization, research shows that when clinicians have deep experience working with BPD, outcomes are often much better than with therapists who are unfamiliar with these challenges. 

If DBT, MBT, or Schema Therapy is not available, it is reasonable to seek out an experienced clinician and ask:

1. How many people with BPD have you worked with?
2. What outcomes do your clients with BPD typically experience after a year of treatment?

These simple questions can help identify therapists who may be a good fit, even if they are not trained in one of the major evidence-based models.

Compassionate, trained care is not “extra” for BPD—it is central. Trained care typically includes:

• understanding BPD through emotion dysregulation and attachment-informed frameworks
• maintaining a steady, non-punitive therapeutic stance
• using evidence-based approaches and structured risk management
• treating self-harm/suicidality as signals of distress (not moral failures)
• addressing co-occurring problems without losing the central pattern

An effective care approach typically includes:

• Skills development for emotion regulation, distress tolerance, interpersonal effectiveness, and mindfulness
• Treatment structures that reduce crisis cycling and strengthen continuity
• A coherent case formulation that keeps emotion dysregulation at the center
• Care coordination when co-occurring conditions exist (substance use, eating disorders, trauma symptoms)
• A validating stance that reduces shame and increases engagement

Outcomes are best when treatment directly addresses the core mechanisms of BPD, particularly chronic emotion dysregulation. Approaches that focus only on managing surface behaviors without targeting underlying emotional processes tend to be less effective over time.

Structured, skills-based therapies that explicitly teach emotion regulation, distress tolerance, and interpersonal effectiveness are associated with stronger and more durable improvements.