An evidence-based model anyone can learn.

Many clinicians are taught that you need super-sub-specialized training to treat patients with borderline personality disorder.

You don’t need that.

Clinicians can be overwhelmed at the prospect of treating patients with BPD, often out of fear they won’t be able to manage the patient’s mood swings, suicidal impluses, and intense volatile interpersonal relationships.

What if I told you there is a general psychiatric approach for the treatment of patients with borderline personality that is equal in its effectiveness as DBT; that’s easier than DBT to learn, and doesn’t require years of training? Let me introduce you to a different approach: General Psychiatric Management (GPM).

Developed by John Gunderson, General Psychiatric Management (GPM) produces outcomes equivalent to highly structured treatments like DBT (McMain et al., 2009 and 2012).

What Is GPM?

GPM is not a rigid protocol. It organizes treatment around a small number of clear principles:

• Building and maintaining a strong working alliance
• Getting the patient back to work, volunteering, or enrolled to school
• Managing the patient’s interpersonal hypersensitivity
• Preventing suicide risk and self-harm
• Addressing co-occurring conditions

This is a direct, practical, and real-world focus.

Describe the Diagnosis — Why It Helps

Patient’s with borderline personality disorder can have so many different symptoms that they are confused about what is wrong with them. Sharing the specific DSM-TR criteria of the diagnosis with a patient, bring coherence to their problem. They learn that they have a single diagnosis that is well described, and one that we know how to treat. This education goes a long way to legitimatize and destigmatize their disorder, reduces shame, explains to family they can collaborate in the treatment, while also offering hope that the prognosis is favorable.

The Therapeutic Stance

The therapist provides a real relationship which is active, pragmatic, flexible, encouraging the patient to change, but is realistic. Revealing your humanness and acknowledging mistakes allows patient to see you as a “good enough parent” — one who listens, doesn’t react negatively, helps to contain overwhelming feelings, who is genuinely caring and involved.

Work Before Love

Why?

Because, at the beginning, discussing intimate or personal relationships can leads to emotional storms that can consume the treatment and destabilize the patient. Finding meaningful work, such as a part time job, volunteering, or back to school provides a daily structure, bolsters self-confidence, and offers some social connections minimizing the stressful aspects of love.

Managing Suicidality in GPM

The risk of suicide is real for patients with BPD. The lifetime estimate for suicide of patient with BPD is 5–10%. GPM recommends a structured approach:

• Assess risk carefully
• Be genuine when expressing concern — don’t be too clinical or distant
• Clarify precipitants through chain analysis or timeline review
• Utilize family supports when appropriate
• Set clear boundaries — neither dismissing nor catastrophizing
• Use the ER and hospitalization as a last resort

Hospitalization may be requires as a temporary safety solution. Brief, strategic inpatient care for safety stabilization and treatment of co-morbid conditions can be appropriate. Long-term hospitalization in BPD rarely helps and often harms by reinforcing crisis behavior and disrupting the outpatient continuity that is actually the most therapeutic.
Treating patients with borderline personality disorder does not need to be frightening. GMP provides a structured effective approach to treatment that can be learned in a one-day course. Be a resource for this troubled group of people who need your help.

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Robert E. Feinstein, MD

Professor of Clinical Psychiatry, Northwell/Zucker School of Medicine. He has devoted his entire career to integrating psychotherapies, clinical expertise, research evidence, human understanding, and organizational leadership for the benefits of clinicians and patients.

Owner & Founder Empathian LLC ( An Online Mental Health Education Company) Empathian.com