What to do if a patient with borderline personality disorder becomes attached to their healthcare provider?

From the Guidelines

When a patient with borderline personality disorder becomes attached to their healthcare provider, the provider should maintain clear professional boundaries while continuing to provide compassionate care, as this approach is supported by the most recent and highest quality study on therapeutic relationships 1. This involves setting consistent limits on contact, appointment frequency, and communication methods, while documenting all interactions thoroughly. The healthcare provider should avoid special treatment or extending session times, and should regularly consult with colleagues or supervisors for support. Some key points to consider when dealing with attachment in patients with borderline personality disorder include:

• Setting clear boundaries and expectations for the therapeutic relationship
• Avoiding behaviors that may be perceived as special treatment or favoritism
• Fostering a sense of independence and self-efficacy in the patient
• Addressing the attachment directly in therapy, and helping the patient to understand these feelings as part of their treatment journey
• Modeling healthy relationships and preventing therapeutic ruptures that could harm the patient's progress or lead to feelings of rejection and abandonment. It's also important to note that dialectical-behavior therapy (DBT) has been shown to be effective in reducing suicidality in adults with borderline personality disorder, and may be a useful approach in addressing attachment issues 1. However, the most recent study on therapeutic relational connection in telehealth suggests that building relationships and maintaining clear professional boundaries are crucial in providing effective care 1.

From the Research

Managing Attachment in Borderline Personality Disorder

When a patient with borderline personality disorder becomes attached to their healthcare provider, it is essential to address this issue to maintain a healthy therapeutic relationship. Some key points to consider:

• The therapeutic relationship is a crucial aspect of treatment for borderline personality disorder, and a strong, validating relationship can be beneficial for treatment outcomes 2.
• However, excessive attachment can be a challenge, and clinicians must establish clear boundaries while still providing a supportive and non-judgmental environment.
• Dialectical behavior therapy (DBT) is an effective treatment for borderline personality disorder, and it can help patients develop emotional regulation skills and improve their relationships with others 3, 2.
• Clinicians should be aware of the potential for patients to become attached and take steps to manage this attachment, such as setting clear boundaries and encouraging patients to develop relationships with others outside of the therapeutic relationship.

Communication Strategies

Effective communication is critical when working with patients with borderline personality disorder. Some key strategies include:

• Open and honest communication about the diagnosis and treatment plan 4.
• Validation of the patient's feelings and experiences 2.
• Clear boundary setting to maintain a healthy therapeutic relationship.
• Encouraging patients to develop emotional regulation skills and coping strategies to manage their emotions and behaviors.

Treatment Approaches

While there is no single treatment approach that is effective for all patients with borderline personality disorder, some evidence-based treatments include:

• Dialectical behavior therapy (DBT) 3, 2.
• Psychodynamic therapy 5.
• Medications such as selective serotonin reuptake inhibitors (SSRIs) may be used to treat co-occurring conditions such as depression or anxiety, but they are not effective in treating the core symptoms of borderline personality disorder 5, 6.