Systemic management of Borderline Personality Disorder

Conceptual frame

In the field of psychology, Borderline Personality Disorder (BPD) represents a complex challenge for both patients and practitioners. Faced with this reality, strategic brief therapy (SBT) is emerging as a promising approach to help individuals manage the symptoms and behaviors associated with this disorder. How can TBS be successfully applied in the treatment of BPD?

Practitioners in systemic psychology are confronted with patients presenting borderline tendencies in their daily practice. Would it be possible to improve their care by understanding their functioning in more depth and applying TBS in this particular context?

Definition of Borderline Personality Disorder

BPD is characterized by emotional instability, tumultuous interpersonal relationships, and marked impulsivity. These symptoms can lead to significant difficulties in daily life and social interactions. By focusing on the management of dysfunctional emotions and behaviors, TBS provides a relevant approach to helping patients overcome these challenges.

Brief Strategic Therapy (BST) approach

TBS is based on principles of problem solving and rapid change. By identifying dysfunctional thought and behavior patterns, the therapist helps the patient develop effective strategies to overcome their difficulties. Through targeted interventions and clear objectives, TBS aims to achieve tangible results in a minimum of time.

Managing emotional oscillations

Patients with borderline tendencies often experience intense emotional oscillations, which can alter the perception of self and others, going from idealization to devaluation in an instant. TBS allows the development of specific interventions, offers tools to regulate these emotional fluctuations and encourages more appropriate responses to stressful situations. By working on self-awareness and frustration tolerance, patients can gradually improve their emotional stability.

Therapeutic practice strategies

The application of TBS with borderline functioning patients requires an adaptable and flexible approach . Sessions are structured around active collaboration between therapist and patient, fostering a sense of empowerment and self-determination. Techniques such as recording sessions, regular assessment of progress and constructive feedback are essential to maintain engagement and maximize therapeutic outcomes.

Requirements and adaptations

Although TBS is considered a brief approach, its effectiveness with patients with borderline tendencies requires a thorough understanding of the underlying mechanisms of the disorder, as well as increased sensitivity to individual needs and reactions and may require longer follow-up. term. By recognizing the complexity of their needs and the need for ongoing support, therapists can adjust the therapeutic framework to meet the specific needs of each individual. Clarity of therapeutic goals, adaptations of the therapeutic approach and close collaboration with the patient are essential to maintain motivation and promote change. are essential to guarantee effective and respectful care.

Future prospects

Exploring the effect of Strategic Brief Therapy on Borderline Personality Disorder offers interesting perspectives for the treatment of this complex disorder. By focusing on problem-solving strategies and emotional regulation, adjusting the therapeutic framework to meet patients' individual needs, TBS can offer hope for lasting and meaningful change. for those who struggle with borderline functioning.

The therapeutic link

Strategic Brief Therapy provides an effective framework for working with patients with Borderline Personality Disorder.

In this therapeutic support, the transformation begins with the meticulous construction of the framework where emotions intertwine with reason. The therapist sketches the contours of a safe space where the shadows of anxiety can be transformed into bursts of light.

Setting the framework for the intervention

The initial framework of the intervention is much more than a simple formality to establish a solid foundation. The therapist shapes the contours of the relationship, building solid foundations of mutual trust. It includes explaining monitoring arrangements, such as video recording of sessions, use of questionnaires, frequency and duration of meetings, and the importance of implementing task prescriptions between sessions. . It builds the pillars of engagement, leading the way through open communication and full transparency.

Exploring the problem

A strategic approach begins with a deep understanding of the problem as it manifests in the present, and which afflicts the patient's mind. This involves identifying undesirable behaviors, persistent resolution tactics and interactional sequences that punctuate the situation. This exploration aims to reveal the underlying dynamics fueling the disorder.

The minimum therapeutic objective, SMART

Setting specific, measurable, achievable, reasonable, and time-defined (SMART) treatment goals is a collaborative step. These objectives are developed taking into account the patient's resources and aspirations, while promoting a positive vision of the future.

In the quest for therapeutic purpose, the light of hope is crucial. Together, therapist and patient trace the contours of a possible and visionary future.

In transformation, therapist and patient work together. They define a clear objective, woven from past trials and a positive future. They forge a common, stable vision where hopes come to life.

Prescription of tasks

Task prescription constitutes a pivot of intervention, combining strategic intervention with problem resolution. Moving away from the central theme of the disorder, these tasks aim to disrupt the patient's habitual patterns of thought and action. By interrupting unsuccessful attempts at solutions, we open the way to new perspectives and significant changes to free the patient from the chains that hinder their development.

The transformation observatory

Regular evaluation of the effects of therapeutic prescriptions makes it possible to readjust the therapeutic strategy according to the patient's progress. We examine the emotional, behavioral, cognitive and interactional changes induced by the prescribed tasks, to better understand the contours of the transformation, in order to optimize the effectiveness of the treatment.

Continuous adaptation of the strategy

Continuous adaptation of the therapeutic strategy is essential to support the patient towards lasting change. Taking into account the patient's responses and the results observed, the therapist adjusts his interventions to consolidate the progress made and overcome persistent obstacles. Therapist and patient move forward with confidence, aware that each movement brings them a little closer to the desired balance.

Closure of the intervention

The end of therapy marks the transition to a phase of consolidation of acquired knowledge, the beginning of a new chapter, the epilogue of a profound transformation. This step includes putting in place measures to maintain the progress made, such as prescribing reflections on the risks of regression and scheduling medium- and long-term follow-up appointments. Therapist and patient weave the threads of resilience and reconciliation.

Long-term brief intervention

For patients with borderline tendencies, the intervention often extends over several phases. Initially focused on a rapid change in symptoms, it gradually evolves towards a consolidation of psychological and behavioral balance, then towards the strengthening of self-esteem and personal autonomy.

Specific goals for patients

In the specific case of borderline functioning patients, therapeutic goals include the construction of a structured identity, the management of explosive behaviors, progressive development through experience, and the establishment of a therapeutic alliance based on the right distance and empathetic understanding.

By combining a comprehensive strategic approach with specific adaptations to the needs of borderline functioning patients, strategic brief therapy provides an effective framework for addressing the complex challenges associated with this personality disorder.

Intervention strategies for resistance to change

In the process of therapy, resistance obstacles can manifest themselves in different forms . When resistance to change arises in a therapeutic context, professionals take different approaches to help patients overcome these obstacles. Here is an overview of the strategies used:

The patient collaborating, structuring and guiding

This type of patient is willing to change, is motivated, but may lack clarity or skills. And he may need clear guidelines. Therapists establish a solid framework for therapy, providing specific instructions on the steps to follow.

Communication is informative and directive, aimed at educating the patient about the change process. It must be transparent, educational and rational, establishing a relationship of symmetry where the patient feels free to express their needs.

The therapeutic relationship is based on mutual trust, with a balance between support and patient autonomy.

Interventions are direct and focused on problem solving, guiding the patient towards their goal while providing them with the tools necessary for their autonomy.

The patient prevented, overcoming emotional obstacles

Some patients are motivated but face emotional obstacles that hinder their ability to act. This patient, eager to change but hampered by oppressive emotions or sensations, requires a more directive approach. Therapists take an empathetic approach, helping the patient identify and overcome these blockages. Communication focuses on expressing emotions and validating the patient's experiences. The therapeutic relationship is warm and supportive, providing emotional support while encouraging progress.

This patient wants to change but is held back by intense emotions. Therapists take a directive approach to providing practical support. The framework is conducted in such a way as to offer clear guidance, while the communication, based on metaphors and evocations, aims to free the patient from their emotional constraints. This communication is focused on emotions and uses concrete examples to help the patient overcome their blockages.

The relationship is warm and empathetic, aiming to create a safe environment for the patient. The relationship is built on attunement, allowing the therapist to subtly guide the patient towards change without the patient being fully aware of it.

The opposing patient, managing open resistance

In some cases, patients actively resist change, making the treatment process more difficult. Therapists use a directive, non-authoritarian approach. but respectful, establishing clear boundaries while acknowledging the patient's concerns.

Communication emphasizes the consequences of resistance to change, while the therapeutic relationship remains professional but open to discussion.

The relationship, although complementary, remains imbued with benevolence, allowing the therapist to prescribe paradoxical interventions which neutralize the patient's resistance by amplifying his symptoms.

Interventions are sometimes paradoxical, aiming to defuse resistance by highlighting inconsistencies in behavior. Paradoxical interventions can be used to help the patient question their beliefs and behaviors.

The ideological patient, exploring deep beliefs

Some patients are strongly attached to their beliefs, locked into their convictions, which can hinder their ability to change. Therapists adapt the framework to align with the patient's beliefs, have an exploratory approach, helping the patient to critically examine their beliefs and values.

Communication is exploratory, open and non-directive, encouraging the patient to reflect on their own thoughts and motivations. It aims to understand the motivations behind rigid ideologies. Communication explores underlying beliefs and values.

The therapeutic relationship is characterized by respect and acceptance, allowing the patient to feel safe to explore alternative perspectives. This relationship is empathetic but also encourages questioning.

Paradoxical interventions can be used to challenge the patient's rigid thought patterns and pave the way for mental flexibility.

TBS is an effective therapeutic tool in the management of BPD. By taking a holistic, adaptive approach, practitioners can help patients overcome the challenges of this complex disorder and envision a more stable and fulfilling future.

Training in brief systemic and strategic therapy 

LACT offers several live certified web training courses with 50 international trainers:

• Generalist systemic training
• DU relationship clinic with the University of Paris 8
• Clinical Master of Giorgio Nardone LACT/CTS
• Systemic Coach Training

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