Why Is It So Hard to Find a Therapist Who Will Work With Borderline Personality Disorder

For many people living with borderline personality disorder (BPD), one of the most painful and frustrating experiences is trying to find a therapist who is actually willing to treat them. Many people with BPD spend months or even years reaching out to providers, only to be told that the therapist is “not the right fit,” does not treat personality disorders, or has no experience working with BPD. Some people are turned away after disclosing their diagnosis. Others feel dismissed, misunderstood, or treated like they are “too much” for a provider to handle.

This can be incredibly discouraging—especially because people with BPD are often seeking therapy during times of intense emotional pain, relationship problems, self-harm urges, or crisis. Reaching out for help already requires vulnerability and courage. Being rejected in that process can deepen feelings of shame, abandonment, hopelessness, and mistrust (Aviram et al., 2006).

So why does this happen?

One major reason is stigma. Unfortunately, BPD remains one of the most misunderstood and stigmatized mental health diagnoses, even among mental health professionals. Some therapists are trained to see people with BPD as “manipulative,” “attention-seeking,” “treatment resistant,” or “too difficult.” These stereotypes are harmful, outdated, and often rooted in a lack of education about what BPD actually is (Aviram et al., 2006; Bodner et al., 2011).

In reality, BPD is a disorder that involves intense emotional pain, fear of abandonment, difficulty regulating emotions, unstable relationships, impulsivity, identity disturbance, and often a history of trauma or invalidating environments (American Psychiatric Association. & American Psychiatric Association. DSM-5 Task Force., 2013).  Many people with BPD are highly sensitive, deeply caring, and desperately want stable relationships and emotional safety. Their behaviors are often attempts to cope with overwhelming emotions rather than attempts to manipulate others.

Another reason it can be difficult to find treatment is that working with BPD can be emotionally demanding for therapists. Clients with BPD may experience intense emotional reactions, fear rejection, struggle with trust, or have crises that require more support. Therapists may worry about suicidality, self-harm, frequent contact between sessions, or the possibility of being idealized and then devalued (Gunderson et al., 2018).

Without proper training, some therapists may feel overwhelmed or afraid of making mistakes. Rather than admitting they are undertrained, they may simply say they do not treat BPD or avoid working with clients who have the diagnosis altogether. Research has shown that mental health professionals often report negative attitudes, lack of confidence, and feelings of frustration when working with BPD clients, particularly when they have not received specialized training (Commons Treloar & Lewis, 2008).

There is also a practical issue: many therapists are not trained in the evidence-based treatments that are most effective for BPD. Therapies such as Dialectical Behavior Therapy (DBT), Mentalization-Based Therapy, Transference-Focused Psychotherapy, and Schema Therapy require additional education and supervision (NICE, 2009). Not every therapist has received this training, and in some areas there are very few providers who specialize in BPD.

Dialectical Behavior Therapy (DBT) is one of the most well-known and researched treatments for BPD. It teaches skills related to emotional regulation, distress tolerance, mindfulness, and interpersonal effectiveness (Linehan, 2015). However, full DBT programs can be expensive, time-consuming, and difficult to access. Many communities simply do not have enough trained providers.

Insurance can also make the problem worse. Therapists who specialize in BPD or DBT often have long waitlists or do not accept insurance. This means people may have to choose between paying out of pocket, settling for a therapist who is not trained in BPD, or going without care altogether. In many areas, the shortage of specialists and lack of insurance coverage create major barriers to treatment access (Paris, 2013).

The shortage of trauma-informed care is another issue. Many people with BPD have histories of trauma, neglect, emotional invalidation, abuse, or attachment disruptions. Treating BPD effectively often means understanding trauma, nervous system dysregulation, and the impact of early relationships (Zanarini et al., 1997). Unfortunately, not every therapist has adequate training in trauma-informed approaches.

At the same time, it is important to remember that not all therapists avoid BPD. There are many compassionate, skilled providers who understand the diagnosis and genuinely enjoy working with people who have it. Many therapists recognize that clients with BPD are often insightful, resilient, emotionally intelligent, and capable of tremendous growth.

If you have BPD and have struggled to find a therapist, it is important not to internalize rejection as proof that you are “too difficult” or “too broken.” A therapist declining to work with BPD usually says more about their own training, comfort level, or limitations than it does about your worth or treatability.

You deserve a therapist who understands emotional pain without judgment, who sees your strengths as well as your struggles, and who believes that recovery is possible. People with BPD can and do improve. With the right treatment, many go on to have healthier relationships, greater emotional stability, less self-destructive behavior, and a stronger sense of self (Gunderson et al., 2018; Linehan, 2015).

Finding the right therapist may take time, but being difficult to treat is not the same thing as being impossible to help. You are worthy of care, worthy of understanding, and worthy of a therapist who is willing to start.

References

 

• American Psychiatric Association., & American Psychiatric Association. DSM-5 Task Force. (2013). Diagnostic and statistical manual of mental disorders : DSM-5 (5th ed.). American Psychiatric Association.

• Aviram, R. B., Brodsky, B. S., & Stanley, B. (2006). Borderline Personality Disorder, Stigma, and Treatment Implications. Harvard Review of Psychiatry, 14(5), 249-256. https://doi.org/10.1080/10673220600975121

• Bodner, E., Cohen-Fridel, S., & Iancu, I. (2011). Staff attitudes toward patients with borderline personality disorder. Compr Psychiatry, 52(5), 548-555. https://doi.org/10.1016/j.comppsych.2010.10.004

• Commons Treloar, A. J., & Lewis, A. J. (2008). Professional attitudes towards deliberate self-harm in patients with borderline personality disorder. Aust N Z J Psychiatry, 42(7), 578-584. https://doi.org/10.1080/00048670802119796

• Gunderson, J. G., Herpertz, S. C., Skodol, A. E., Torgersen, S., & Zanarini, M. C. (2018). Borderline personality disorder. Nat Rev Dis Primers, 4, 18029. https://doi.org/10.1038/nrdp.2018.29

• Linehan, M. (2015). DBT skills training manual (Second edition. ed.). The Guilford Press.

• NICE. (2009). Borderline personality disorder: Recognition and management. NICE National Institute for Health and Care Guidance. https://www.nice.org.uk/guidance/cg78

• Paris, J. (2013). Stepped care: an alternative to routine extended treatment for patients with borderline personality disorder. Psychiatr Serv, 64(10), 1035-1037. https://doi.org/10.1176/appi.ps.201200451

• Zanarini, M. C., Williams, A. A., Lewis, R. E., Reich, R. B., Vera, S. C., Marino, M. F., Levin, A., Yong, L., & Frankenburg, F. R. (1997). Reported pathological childhood experiences associated with the development of borderline personality disorder. Am J Psychiatry, 154(8), 1101-1106. https://doi.org/10.1176/ajp.154.8.1101