Why I Developed a New Treatment for Borderline Personality Disorder

The treatment landscape for borderline personality disorder (BPD) has changed dramatically in the past few decades. A condition that was once considered untreatable now has a favorable prognosis. Indeed, we have several effective, evidence-based treatments for BPD. The most well-known is Dialectical Behavior Therapy (DBT), but there is also strong support for Mentalization Based Therapy, Transference-Focused Psychotherapy, and Good Psychiatric Management.

So if effective treatments for BPD already exist, why would I dedicate a decade of my life to creating a new one?

The Access Gap

I started my clinical training as a co-leader of my graduate program’s DBT group. The group was in high demand; prospective clients called every day and, unfortunately, I had to tell them that our waitlist was over a year long. And even worse, there was nowhere else to refer these clients because, at that time, there was only one other DBT program in the entire state of Kentucky.

Today, twenty years later, access to care for people with BPD remains challenging. The treatments with the strongest evidence are long-term, intensive, and require specialized training for therapists.

This translates to not nearly enough therapists trained in BPD-specific interventions to meet the demand. And, even in communities with access to BPD specialists, clients must often wait over a year for a spot on their caseloads to open up. 

A Better Way Forward?

As a clinician and researcher, I wondered whether we could make effective treatment more accessible without sacrificing outcomes. 

One way to improve access would be to shorten treatment. If clients could make meaningful gains in a matter of months rather than a year or more, waitlists would move more quickly and therapists could help more people over the course of their careers. Moreover, shorter-term options would allow intensive specialty programs to reserve their limited capacity for the highest-risk patients who truly need that level of care.

So, I set out thinking about how we could make treatment for BPD more efficient without losing its effectiveness. I realized that the existing treatments for BPD were largely one-size-fits-all; they provide the same set of skills to all patients. 

But BPD is one of the most heterogeneous diagnoses in psychiatry. Two people can be diagnosed with this condition while sharing only a handful of symptoms. For example, one person may be primarily overwhelmed by intense emotions, another may struggle most with unstable relationships, and a third may be derailed by impulsive decisions. 

Although they all carry the same diagnosis, the underlying personality processes maintaining their difficulties can look remarkably different.

BPD Compass Bridges the Gap

My team developed BPD Compass around the idea that treatment should target the personality processes driving each person's symptoms rather than assuming everyone needs the same skills. 

For some clients, that means focusing on emotional sensitivity. For others, the priority is building healthier relationship patterns or improving impulse control. By matching treatment to the individual's greatest areas of difficulty, we can often help people make meaningful progress in a shorter period of time.

Beyond the skills included in the intervention, we wanted to develop a treatment that could fit into the reality of today's mental health system. BPD Compass was designed to be delivered in traditional once-weekly outpatient therapy by generalist clinicians, not just specialists. 

In our clinical trials, many of the therapists were trainees with relatively little experience treating BPD. That was intentional. There simply aren't enough specialists to meet the needs of the millions of people living with this diagnosis, and expanding access to effective care has to be part of the solution.

The Future of BPD Treatment

We didn’t develop BPD Compass to replace the effective treatments that already exist. It was about filling an important gap in the treatment landscape for this condition. My hope is that the future of BPD treatment continues to move toward care that is not only evidence-based, but also personalized and accessible to the people who need it.

If you or someone you care about is living with BPD, The BPD Compass Workbook translates this personalized approach into practical, evidence-based exercises that help you target the patterns driving your symptoms and build lasting change.