Learn More About Borderline Personality Disorder Symptoms & Treatment

By Kristalyn Salters-Pedneault, PhD

Updated June 06, 2017

Borderline personality symptoms are confusing, frustrating, and hard for loved ones to understand. This is particularly the case for parents or caregivers dealing with teens who have borderline personality disorder (BPD). While we know a great deal about how borderline personality symptoms look in adults, we know much less about how the disorder presents in teens. In fact, there is still controversy over whether it is appropriate to diagnose teens with BPD. Still, many experts argue that teens can have BPD, and adolescent BPD is now recognized as an official diagnosis.

Many parents have questions about borderline personality in adolescents. Some are worried that their teen is exhibiting the signs of borderline personality disorder (BPD), such as intense and frequent mood swings, impulsive behaviors, self-harm or difficulties in relationships. Others have BPD themselves and are worried that their kids will also have the disorder. The good news is that there has been a major surge in research on borderline personality in adolescents and there are new discoveries every day that are helping us better understand teens with BPD.

 

Overview

This is a hotly debated question; many experts have argued that borderline personality should not be diagnosed in anyone younger than 18 since technically, their personality is not yet fully formed. In the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5, though, there is a provision that allows for the diagnosis of borderline personality before the age of 18.

Technically, this provision also allows for the diagnosis of BPD in children under 13, but this is very rare.

 

Diagnosing Borderline Adolescents

Symptoms

While the symptoms of BPD as listed in the official DSM-IV diagnostic criteria are no different for teens and adults, some experts have suggested that there are differences in adolescent BPD symptoms. Symptoms, such as instability in interpersonal relationships, impulsive behavior, chronic emptiness and unstable sense of self, may look different in teens.

 

Symptoms of Borderline Personality in Adolescents

Prognosis

At one time, BPD was considered a life-long disorder; if you had BPD, experts believed you would have it for your entire life and that treatment would be unlikely to lead to recovery. Research has shown, however, that these experts were way off the mark: In adults, about 35% of people with BPD will no longer meet criteria for the disorder in two years. In adolescents, the remission rates are even higher; studies estimate that between 66 and 85% of adolescents with BPD will no longer meet diagnostic criteria for two years.

 

Prognosis of Borderline Personality in Adolescents

Prevalence

There is some evidence to suggest that there are higher rates of borderline personality in teens than in adults. This may be related to the fact that some teenagers display BPD in reaction to stressful events, but many are more likely to recover.

For example, studies of patients in inpatient psychiatric hospitals have shown that about 20% of adult patients meet diagnostic criteria for BPD, while 43 to 53% of teenage patients meet BPD criteria.

In the general population, rates of borderline personality in adolescents are much lower than they are in inpatient populations. Studies have estimated general community rates of BPD in teens from 3 to 14%. This is still somewhat higher than the estimated general community rates of BPD in adults (estimated at about 1.4%).

Risk Factors

The risk factors for borderline personality in adolescents are very similar to the risk factors in adults. In fact, many of the environmental risk factors for BPD occur during childhood. For example, childhood abuse and neglect, as well as parental separation or loss, have been linked to borderline personality in adults and teens.

Research has also found that kids whose parents have serious mental health conditions (e.g., depression, substance abuse or antisocial personality) are also at greater risk for BPD. In addition, there are likely biological risk factors for BPD, such as a genetic component of the disorder that is inherited.

 

Borderline Personality Disorder Causes

The Possible Causes of Borderline Personality Disorder

If you or a loved one has borderline personality disorder (BPD), you may be wondering what caused it or if you are to blame. The development of this disorder is complex, and there are likely a variety of borderline personality disorder causes—and you should rest assured that no one person or thing is at fault. Most experts believe that BPD develops as a result of biological, genetic, and environmental factors.

However, it is important to keep in mind that the exact causes of BPD are not known yet. Right now, these are theories that have some support in support but are by no means conclusive. More research is needed to determine how and why the factors discussed below are related to BPD.

Potential Environmental Borderline Personality Disorder Causes

There is strong evidence to support a link between distressing childhood experiences, particularly involving caregivers, and BPD. The types of experiences that may be associated with BPD include:

• Physical and sexual abuse
• Early separation from caregivers
• Emotional or physical neglect
• Parental insensitivity

It is thought that an interaction between biological factors (discussed below) and an invalidating childhood environment may work together in predisposing a person to develop BPD. An emotionally invalidating environment is one in which a child’s emotional needs are not met.

 An invalidating environment is not always obvious to those who have experienced it or to others around them. These painful experiences can be hidden and even disguised as praise.

It is important to remember, however, that not everyone who has BPD has had these types of childhood experiences (although a large number have).

Further, even if a person does have these types of experiences, it does not mean that they will have BPD. Again, it is likely that a combination of factors, rather than a single cause, is responsible for most cases of borderline personality disorder.

Potential Genetic and Biological Borderline Personality Disorder Causes

While early studies showed that BPD does tend to run in families, for some time it was not known whether this was because of environmental influences or because of genetics. There is now some evidence that in addition to environment, genetic factors plays a significant role.

In particular, studies have shown that a variation in a gene which controls the way the brain uses serotonin (a natural chemical in the brain) may be related to BPD. It appears that individuals who have this specific variation of the serotonin gene may be more likely to develop BPD if they also experience difficult childhood events (for example, separation from supportive caregivers). One study found that monkeys with the serotonin gene variation developed symptoms that looked similar to BPD, but only when they were taken from their mothers and raised in less nurturing environments. Monkeys with the gene variation who were raised by nurturing mothers were much less likely to develop BPD-like symptoms.

In addition, a number of studies have shown that people with BPD have differences in both the structure of their brain and in brain function. BPD has been associated with excessive activity in parts of the brain that control the experience and expression of emotion. For example, people with BPD have more activation of the limbic system, an area in the brain that controls fear, anger, and aggression, than people without BPD. This may be related to the emotional instability symptoms of BPD. Newer studies are also findings associated between the hormone oxytocin and the development of BPD.

Bottom Line on the Causes of Borderline Personality Disorder

As noted above, there is much to be learned about the causes of BPD and it’s likely that it is a combination of factors rather than any one specific finding which can lead to the disorder.

Research is in progress and hopefully we will learn more in the coming years.

Understanding the causes may help prevent the onset of disorder, especially in those who have a genetic or biological predisposition to the disorder. As it is, an invalidating environment is harmful for a child whether or not it raises the likelihood of BPD in the future, and it is important for therapists to be alert for this setting in children. Since an invalidating environment can be hidden, with many comments appearing to be comments of praise on the surface, emotions can easily be mistaken as an oversensitivity on the part of the child rather than a lack of sensitivity on the part of the parent. It’s important for adults who experienced emotional invalidation as a child to learn to recognize the difference between validating and invalidating remarks from others to protect themselves from further hurt.

 

_Sources:

_{Brune, M. On the Role of Oxytocin in Borderline Personality Disorder. British Journal of Clinical Psychology. 2016. 55(3):287-304.}

_{Ruocco, A., and D. Carcone. A Neurobiological Model of Borderline Personality Disorder: Systematic and Integrative Review. Harvard Review of Psychiatry. 2016. 24(5):311-29.}

Child Abuse and BPD

The Link Between Abuse and Borderline Personality Disorder (BPD)

By Kristalyn Salters-Pedneault, PhD

Updated December 31, 2016

Does child abuse cause borderline personality disorder (BPD)? There is no simple answer; we don’t yet know exactly what causes BPD, though it is believed to be a mix of biological and environmental factors. There is evidence that people with BPD are more likely to report a history of some type of child abuse or other distressing childhood experiences. Yet many people who have experienced child abuse do not have BPD and many people with BPD were not abused or maltreated as children.

What Is Child Abuse?

The term “child abuse” covers a wide range of mental and physical injuries done to a minor. Experts generally assign a set of experiences to this category:

• Physical abuse: Physically hurt or injured, such as bruising or broken bones
• Sexual Abuse: Being subjected to a sexual experience or exploited in a sexual manner by someone older
• Emotional abuse: Undergoing emotional attacks, such as verbal abuse or degradation

Other forms of abuse can be more passive, such as in the case of physical neglect where the child is denied basic necessities, like food or water. There is also emotional neglect, where a child’s emotional needs are ignored. No form of abuse is considered more severe than another; all forms of abuse can have long-lasting implications for the person and can shape their mental state.

Both child abuse and neglect can be related to the development of psychological disorders.

 Sometimes the term “child maltreatment” is used to describe both abuse and neglect of children.

Research on Child Abuse and Borderline Personality Disorder (BPD)

Research does indicate that there is a relationship between child abuse and borderline personality disorder (BPD). People with BPD report high rates of childhood sexual abuse, emotional abuse, and/or physical abuse.

Forty to 76 percent of people with BPD report that they were sexually abused as children, and 25 to 73 percent report that they were physically abused. So, while there is a good deal of research that links childhood abuse to BPD, there is also evidence that about a third of people with BPD report no abuse.

There is also evidence to link BPD to other forms of child maltreatment, such as emotional and physical neglect. In fact, some research suggests that emotional and physical neglect may be even more closely related to the development of BPD than physical or sexual abuse. However, this is difficult to determine, since children who experience abuse also often experience some form of neglect.

How Childhood Abuse Might Lead to Borderline Personality Disorder

If childhood abuse is a risk factor for BPD, what are the way in which these childhood experiences lead to the development of BPD? A 2016 study found that emotional abuse was the most significant type of abuse in later BPD and that preoccupied adult attachment may be a mediator between the abuse and BPD. Other studies have likewise investigated the role of emotional abuse in later BPD. While these studies are important in looking for causes that may be preventable, they are also helpful in determining how treatment may help people currently coping with the disease, in particular, appproaches involving emotion regulation.

In addition to emotional abuse, emotional invalidation has also been tied to BPD, though it could be argued that an invalidating environment is a form of emotional abuse.

Is BPD Different in Those Who Suffered Childhood Abuse?

When comparing the symptoms of BPD in those who were abused as children and those who were not, it’s been found that sexual abuse in childhood specifically appears to be linked to an increased risk of suicidal attempts in people with BPD.

The Bottom Line on Child Abuse and BPD

Research has fairly conclusively demonstrated a relationship between BPD and child maltreatment. That said, there is no clear evidence that maltreatment causes BPD.

Research that demonstrates an association between two things doesn’t necessarily prove that there is a cause between them. Clearly, with child abuse statistics indicating that abuse is much more common than we would think, it is important to determine whether or not it is one of the causes of borderline personality disorder.

More research is needed to evaluate the precise relationships between childhood abuse and BPD, and if abuse is a cause, what types of child maltreatment are most closely associated with the development of BPD.  It’s likely that BPD is related to the combination of a number of different factors, including genetic factors, temperament, biology, and other environmental considerations.

BPD is a highly misunderstood disease. If you are living with BPD or know someone living with the disorder, take the time to learn what you can. Contrary to popular opinion, BPD is treatable, and those living with the disease can live meaningful lives. While there can be significant problems with interpersonal relationships, this aspect as well can be improved greatly with understanding on the part of both the person living with the disorder and those who care about him or her.

 

_Sources:

_{Bornovalova, M., Gratz, K., Delany-Brumsey, A., Paulson, A., and  Lejuez. Temperamental and.Environmental Risk Factors for Borderline Personality Disorder Among Inner-City Substance Users in Residential Treatment. Journal of Personality Disorders. 2006. 20(3):218-31.}

_{Frias, A., Palma, C., Farriols, N., Gonzalez, L., and A. Horta. Anxious Adult Attachment May Mediate the Relationship Between Childhood Emotional Abuse and Borderline Personality Disorder. Personality and Mental Health. 2016. 10(4):274-284.}

_{Kuo, J., Khoury, J., Metcalfe, R., Fitzpatrick, S., and A. Goodwill. An Examination of the Relationship Between Childhood Emotional Abuse and Borderline Personality Disorder Features: The Role of Difficulties with Emotion Regulation. Child Abuse and Neglect. 2015. 39:147-55.}

_{Soloff, P., Feske, U., and A. Fabio. Mediators of the Relationship Between Childhood Sexual Abuse and Suicidal Behavior in Borderline Personality Disorder. Journal of Personality Disorders. 2008. 22(3):221-32.}

_{Westbrook, J., and H. Berenbaum. Emotional Awareness Moderates the Relationship Between Childhood Abuse and Borderline Personality Disorder Symptom Factors. Journal of Clinical Psychology. 2016 Oct 4. (Epub ahead of print).}

If you have BPD, your children most likely will not get borderline personality disorder. It’s true that if you have BPD, your kids are at greater risk of having the condition themselves. But, there is also a good chance that they will not have it. And, there are things you can do to reduce their risk.

Is Borderline Personality Disorder Inherited?

There is research showing that borderline personality disorder runs in families.

This is likely due to a number of factors. First, some part of BPD is due to genetics; if these are your biological kids and they have inherited a certain combination of genes from you, they may be more at risk to develop BPD.

Second, the types of environments that can put children at risk of developing BPD also run in families. For example, someone who is maltreated as a child is at greater risk to develop BPD. That person is also at greater risk of having difficulty parenting. It is hard to be an effective parent when you are struggling with BPD symptoms, and it does not help if you did not have good parenting models yourself.

However, none of this means that your children will have BPD. While there is nothing you can do about genetics, if your kids live with you, there is a great deal you can do about environmental factors. And, there is evidence that environment has a very strong influence on whether or not people with the genes for BPD actually develop the disorder.

How to Lower the Odds

The first thing that you can do is to get treatment for yourself. People who undergo an effective treatment for borderline personality disorder under the guidance of a mental health professional can improve significantly. Some people no longer meet diagnostic criteria for BPD after they finish treatment.

Having fewer symptoms means having more resources for effective parenting.

Once you are in treatment, you can also express your concerns about your children to your care provider, and ask them for help. Your provider can help you to evaluate your home environment and whether your symptoms could be affecting your parenting skills.

Your therapist may even be able to refer you to programs that help people build skills to be more effective parents. People with borderline personality disorder can be very effective and nurturing parents, but because the symptoms of BPD can be very intense, for many people this does take some work.

_Source:

_{Lis E, Greenfield B, Henry M, Guile JM, Dougherty G. “Neuroimaging and Genetics in Borderline Personality Disorder: A Review.” Journal of Psychiatry and Neuroscience, 32:162-173, 2007.}

_{Zanarini MC, and Frenkenburg FR. “Pathways to the Development of Borderline Personality Disorder.” Journal of Personality Disorders, 11:93-104, 1997.}

Psychotherapy, Medications, Hospitalization, and Self-Help for BPD

By Kristalyn Salters-Pedneault, PhD

Updated November 12, 2016

There are a variety of effective treatments for borderline personality disorder (BPD). What treatments seem to work best, and what should I know about the options available?

Treatment Options for Borderline Personality Disorder (BPD)

Usually, BPD is treated with a combination of medication and psychotherapy, although during times of crisis, individuals with BPD may require brief periods of hospitalization to remain safe.

More recently, self-help tools have been developed to supplement traditional treatments for BPD.

Psychotherapy – Borderline Personality Disorder Treatment Options

Long-term outpatient psychotherapy, or “talk therapy,” is an important part of any treatment for BPD. Research has shown that several types of psychotherapy are effective in reducing the symptoms of BPD, including:

• Dialectical Behavior Therapy (DBT)
  Dialectical behavior therapy (DBT) was the first form of psychotherapy found to be effective for people with borderline personality disorder (BPD.) DBT is a form of cognitive behavior therapy which focuses on how thoughts and beliefs can lead to actions and behaviors. In this therapy, people learn how to manage conflict, and learn skills to help them cope with strong emotions. Mindfulness meditation is also often included.
• Schema Focused Therapy
  Schema focused therapy is also a form of cognitive behavior therapy for BPD. Schema focused therapy operates with the thought that unmet needs from childhood can lead to unhealthy ways of thinking about the world. This therapy focuses on confronting these maladaptive beliefs and behaviors and instead focus on healthy ways of thinking and coping.

• Mentalization Based Therapy
  Mentalization based therapy has been studied to some degree for BPD and may help with anxiety and depression as well as social functioning. This therapy focuses on helping the client to recognize mental states—her own thoughts and feelings, as well as the thoughts and feelings of others she communicates with. Through recognition she is then able to see how these thoughts contribute to her behavior or the behavior of others.

• Transference Focused Psychotherapy
  Transference focused psychotherapy has been studied for BPD and may be as good or better than dialectical behavior therapy according to these studies. This therapy uses the concept of transference—transferring emotions from one person to another, which is a key concept in psychodyamic therapies. Transference focused psychotherapy utilizes the relationship between the client and the therapist so that the therapist can see how a client relates to others. The therapist can then use this awareness to help a person respond more effectively in their other relationships.

Medications for Borderline Personality Disorder

Although there are currently no medications for borderline personality disorder approved by the FDA, research has shown that some medications do reduce certain symptoms of the disorder. Medication may be particularly effective for BPD when it is used in conjunction with psychotherapy. In addition to helping with BPD symptoms, medications may help with co-existing mental health conditions such as anxiety or depression.

Some of the most commonly prescribed medications for BPD include:

• Antidepressants – Antidepressants may help with feelings such as sadness, but do not appear to be helpful for symptoms such as anger.

• Antipsychotics – Antipsychotics were some of the first medications used to treat BPD and may be particularly helpful for some of the more problematic symptoms of BPD such as anger, impulsivity, and paranoid thinking.
• Anxiolytics (anti-anxiety medicaitons) – Anxiety can go hand in hand with BPD making some of these medications helpful, yet some of these are a double edged sword due to their addictive potential.
• Mood stablizers/anticonvulsants – Mood stabilizers may help with the impulsive thinking common with BPD.

Other potential treatments, such as omega-3-fatty acids, are also being explored. In fact, studies to date have not found significant benefit from most medications for BPD with the exception of atypical antipsychotics (second generations antipsychotics), mood stabilzers, and omega-3-fatty acids.

Hospitalization – Intensive Borderline Personality Disorder Treatment

Borderline personality disorder is associated with very intense emotional experiences. As a result, people with BPD may need intensive BPD treatment.Sometimes people with BPD are admitted to a psychiatric hospital for intensive inpatient treatment. Inpatient treatment requires you to stay overnight in the hospital.

Another treatment option is partial hospitalization or day treatment. These are programs that are more intensive than traditional outpatient psychotherapy, but do not require you to stay overnight. You may be enrolled in a partial hospital or day program if you may be headed toward a crisis, or if you have just been discharged from inpatient hospitalization and need a period of more intensive treatment to make sure the crisis does not reemerge.

Self Help – Self-Guided Borderline Personality Disorder Treatment

Self-help strategies for BPD are an essential part of any treatment program. Of course, these should be used to supplement care from a qualified therapist and not alone. An ideal plan includes learning as much as you can about your disorder through self-help education, learning healthy coping skills for BPD, and finding ways to help you express and manage your emotions.

There are valuable self-help resources available for BPD that can be used in conjunction with more traditional forms of treatment. Books and online resources offer information about BPD and suggest ways to cope with the symptoms.

Treatment in a Crisis

If you or someone you love is experiencing a mental health emergency, it is critical that you get help immediately. Call 911 or go to your nearest emergency room. If there is evidence that you (or your loved one) are a danger to yourself or others, you may be admitted for a brief hospital stay on an inpatient psychiatric unit until the crisis has passed. It’s recommended that anyone living with BPD put together a safety plan for BPD. In this plan you can anticipate a crisis and make a plan about exactly how you will address your feelings before they become an emergency.

_Sources:

_{Combs, G., and L. Oshman. Pearls for Working with People Who Have Personality Disorder Diagnoses. Primary Care. 2016. 43(2):263-8.}

_{Stoffers, J., and K. Lieb. Pharmacotherapy for Borderline Personality Disorder – Current Evidence and Recent Trends. Current Psychiatry Reports. 2015. 17(1):534.}

_{Stoffers, J., Vollm, B., Rucker, G., Timmer, A., Huband, N., and K. Lieb. Psychological Therapies for People with Borderline Personality Disorder. Cochrane Database of Systematic Reviews. 2012. 8:CD005652.}

Medications for Borderline Personality Disorder

Learn more about borderline personality disorder medications

By Kristalyn Salters-Pedneault, PhD

Updated March 15, 2017

Borderline personality disorder is sometimes treated with medications for anxiety or depression, which have been shown to reduce some of the symptoms of borderline personality disorder (BPD). While there are currently no medications approved by the FDA to treat BPD, they have been found to be effective in some cases. Also, medications may be used to treat psychological conditions that frequently co-occur with BPD, such as major depressive disorder.

Medications may be particularly effective for BPD when they are used in conjunction with psychotherapy and other treatments.

Antidepressants

While antidepressants were specifically developed for individuals with major depressive disorder and other disorders characterized by low mood, many individuals with BPD are treated with these medications.

There are several types of antidepressants that have been studied for use with BPD, including tricyclic and tetracyclic antidepressants, monoamine oxidase inhibitors (MAOIs), and selective serotonin reuptake inhibitors (SSRIs). Research has shown that these medications may help with the sadness, low mood, anxiety, and emotional reactivity often experienced by people with BPD, but they do not seem to have a strong effect on other symptoms of the disorder (e.g., anger, impulsivity).

Common antidepressants include:

• Nardil (phenelzine)
• Prozac (fluoxetine)
• Zoloft (sertraline)
• Effexor (venlafaxine)
• Wellbutrin (bupropion)

Antipsychotics

The term “borderline” was coined because early psychiatrists believed that the symptoms of BPD were “on the border” between neurosis and psychosis. For this reason, some of the first medications tested for BPD were antipsychotics. Since this time, it has been found that antipsychotics can have a positive effect on a variety of non-psychotic disorders, including BPD.

Antipsychotics have been shown to reduce anxiety, paranoid thinking, anger/hostility, and impulsivity in patients with BPD.

Common antipsychotics include:

• Haldol (haloperidol)
• Zyprexa (olanzapine)
• Clozaril (clozapine)
• Seroquel (quetiapine)
• Risperdal (risperidone) (Risperdal)

Mood Stabilizers/Anticonvulsants

Medications with mood stabilizing properties, such as lithium, and some anticonvulsant (anti-seizure) medications, have been used to treat the impulsive behavior and rapid changes in emotion that are associated with BPD. There is research to suggest that these classes of drugs may be useful in BPD.

Common mood stabilizers/anticonvulsants include:

• Lithobid (lithium carbonate)
• Depakote (valproate)
• Lamictal (lamotrigine)
• Tegretol or Carbatrol (carbamazepine)

Anxiolytics (Anti-Anxiety)

Because individuals with BPD also often experience intense anxiety, medications to reduce anxiety are sometimes prescribed. Unfortunately, there is very little research to support the use of anti-anxiety medication to treat BPD. Also, there is some evidence that use of a particular class of anxiolytics, benzodiazepines (e.g., Ativan, Klonopin), may actually cause a worsening of symptoms for some individuals with BPD, and should be prescribed with caution.

Benzodiazepines are particularly dangerous for use by individuals with co-occurring substance use disorders because they can be habit-forming. Buspar, an anxiolytic that is not habit-forming, is an alternative to medications from the benzodiazepine family.

Common anxiolytics include:

• Ativan (lorazepam)
• Klonopin (clonazepam)
• Xanax (alprazolam)
• Valium (diazepam)
• Buspar (buspirone)

Other Borderline Personality Disorder Medications

As we learn more about the biological causes of BPD, new medications are being developed and tested for the disorder. For example, findings from a recent study suggest that an omega-3-fatty acid supplement can lead to decreased aggression and feelings of hostility in people with BPD.

 

_Sources:

_{American Psychiatric Association. “Practice Guidelines for the Treatment of Patients with Borderline Personality Disorder.” American Journal of Psychiatry, 158: 1-52, October 2001.}

_{Triebwasser, J, and Siever, LJ. “Pharmacotherapy of Personality Disorders.” Journal of Mental Health, 16: 5-50, February 2007.}

_{Zanarini, MC, Frankenburg, FR. “Omega-3 fatty acid treatment of women with borderline personality disorder: A double-blind, placebo-controlled pilot study.” American Journal of Psychiatry, 160: 167-169, 2003.}

How to Find a Therapist

By Kristalyn Salters-Pedneault, PhD

Updated June 29, 2017

If you’ve ever tried to find a therapist, you know that it is no easy task. With so many different types of providers to choose from, it can be confusing, time-consuming, and frustrating. But, armed with a little bit of information, you can start psychotherapy with someone who is just right for you.

Know What You Are Looking For

Before you even try to find a therapist, the first step is knowing exactly what you are looking for.

Spend some time researching and thinking about each of the factors listed below. Make sure to jot down notes so that you can communicate your needs effectively when you start to actively search. Here are some factors to consider:

Your Needs
First, consider where you are in your process of seeking treatment and what you need right now. If you are seeking help because you are in a crisis (you are having thoughts of harming yourself or someone else, for example), disregard the rest of this list, and either call 911, go to the nearest emergency room, or call the National Suicide Hotline at 1-800-273-TALK (if you are in the United States.)

If you are not in a crisis but have never seen a mental health provider before, you will need to first see someone for a full assessment to understand your diagnosis and develop a clear treatment plan. If you have already had a diagnosis, maybe you are looking for someone who can do long-term psychotherapy.

 Or, maybe you already have a long-term therapist and just want to find a therapist for some short-term work on a very particular issue; if the latter, you should also talk to your current therapist about it if this.

Location and Availability
Make sure that the therapist has availability that matches with your schedule.

Also, consider his location. How far are you willing to travel? Do you need a therapist who is accessible by public transportation? Are you willing to travel farther for a therapist who has special expertise or is an especially good match personality wise? Or, is the convenience of the utmost importance? Remember, therapy only works if you are able to make it to appointments consistently, so scheduling and location may be more important than you think.

Therapist Payment
Psychotherapists can accept different payment options, so it is important to know how and how much you would like to pay. If you have health insurance, start by calling your insurance company and inquiring about your mental health benefits. Do they cover outpatient treatment? Is there a co-payment involved? How many sessions are covered? If your insurance only covers certain therapists, the insurance company will be able to provide you with a list of approved providers.

Some therapists only accept patients who are paying out-of-pocket. In this case, most will provide a receipt so that you can submit it to your insurance company for reimbursement, if possible. You can inquire about whether they will consider a lower fee if the cost is above your means.

Type and Level of Expertise
Another factor to consider before you set out to find a therapist is what type and level of expertise you are looking for. Think about the problems you want help with. There may be therapists who specialize in these concerns. If you’re not sure of exactly what you want to work on (and this is something a therapist can help you figure out), try to have a general idea of your goals for therapy. You should know, though, that expertise can often be related to higher costs of service. Although this is not always the case, you should expect to pay more if you are only willing to work with a therapist of very high-level expertise.

When considering the level of expertise, remember that there are a wide variety of types of mental health providers with different types of training. More training does not necessarily mean that a therapist is more skillful, but consider whether you have a preference, and learn more about the types of mental health providers available.

Therapist Orientation
Different therapists come from different schools of thought about how therapy works and what methods produce the best outcomes. These schools of thought are called “orientations.” For example, someone with a cognitive-behavioral orientation believes that thoughts and behaviors are tied to symptoms, and will conduct therapy aimed at changing problematic behaviors and ways of thinking directly (usually through homework and in-session exercises). In contrast, someone with a psychodynamic orientation believes that symptoms are related to processes outside of the patient’s awareness that comes to light through interactions with the therapist.

There are many other orientations, and some therapists subscribe to more than one. Think a little about what might be most comfortable or the best match for you, and be sure to ask any potential therapist about their orientation and how they would describe their approach to therapy.

Start Your Search

Once you have a good idea about what you are looking for, it is time to find a therapist. In addition to your insurance company, you can ask for referrals from friends, family, your primary care physician, or other treatment providers. There are excellent online resources to help you find a therapist, including UCompare Healthcare Psychiatrist Search, the Association for Behavioral and Cognitive Therapies, and the American Psychological Association.

When you call potential therapists, have your prepared list of questions/notes on hand. Try to ask all of the questions, even if you are feeling intimidated. Don’t forget to ask about fee payment, scheduling, training, expertise, and experience in the area you would like to work on, etc.

Therapist “Shopping”

It is important to remember that it does take the time to find a therapist. You need to talk to several potential candidates on the phone and get a feel for whether they meet your needs. You may also need to meet with several therapists before you find the one that will work best for you. Many people don’t know that therapist “shopping” is a perfectly acceptable practice. You must choose the therapist that is right for you.

Types of BPD Providers

What Is a Psychotherapist?

By Jenev Caddell, PsyD

Updated February 22, 2017

There are countless forms of mental health professionals, with new degrees, professional licenses and titles cropping up every day. A psychotherapist is the umbrella term that any mental health professional who provides what is known as “talk therapy” falls under.

Psychotherapy

Psychotherapy is a process in which a client, couple or family meets with a mental health professional to discuss mental or emotional problems.

There are just as many forms of psychotherapy as there are types of psychotherapists, if not more. Cognitive Behavioral Therapy, Psychodynamic Psychotherapy, Emotionally Focused Therapy, Solution Focused Therapy and Narrative Therapy are all forms of psychotherapy.

How does one become a psychotherapist?

To become a psychotherapist, one generally needs a graduate degree of some kind as well as a professional license to practice psychotherapy in the United States. Many states have professional boards in which it is possible to verify someone’s license.

Some of the older mental health professions such as psychology and social work are recognized across states in the U.S., though have state specific licenses. There are some other professions that are unique to individual states. For example, New York has a profession called the “Licensed Mental Health Counselor,” (LMHC), whereas Connecticut recognizes a similar professional known as the “Licensed Professional Counselor,” (LPC).

What types of psychotherapists exist?

There are enough different types of mental health professionals out there to make anyone dizzy. The following list is by no means a comprehensive and includes mental health professionals that can provide psychotherapy.

• Psychiatrist – A psychiatrist is a Medical Doctor who specialized in psychiatry. A psychiatrist can prescribe medication. Psychiatrists are qualified to provide psychotherapy but often only offer psychiatric evaluations to determine someone’s diagnosis and provide follow-up medication management appointments that are briefer than traditional psychotherapy.

• Psychologist – A psychologist has earned a Doctor of Philosophy (Ph.D.) in Psychology or a Doctor of Psychology (Psy.D.) and holds a license to practice psychology. Not all psychologists practice psychotherapy but many do.
• Clinical Social Worker – A clinical social worker has earned a Doctorate of Social Work (DSW) or Master’s of Social Work (MSW) and holds a license to practice clinical social work, which includes psychotherapy.
• Marriage and Family Therapist – A Marriage and Family Therapist (MFT) has earned a Master’s Degree in Marriage and Family Therapy, as well as a license to practice marriage and family therapy in his or her state. A Licensed Marriage and Family Therapist (LMFT) most often provides psychotherapy to a family or couple.
• Professional Counselor – Depending on the state, there are different types of professional counselors. Generally, a professional counselor requires a Master’s Degree in some form of counseling as well as a state license to professionally practice counseling or psychotherapy.
• Pastoral Counselor – A pastoral counselor requires a Master’s Degree. Some states offer a license to practice pastoral counseling but others do not. Pastoral counselors also provide psychotherapy.

Numerous other titles for psychotherapists exist as well, in addition to the above sampling of professions.

Thinking of seeing a psychotherapist?

Psychotherapy has been life-saving for some. If you are considering psychotherapy, make an informed decision about the person you decide to see. It is less important what your psychotherapist’s degree is, and more important that you feel comfortable with him or her.

Source: About Borderline Personality Disorder in Teenagers