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Author ORCID Identifier

0000-0002-5622-381

Date Available

5-11-2025

Year of Publication

2023

Document Type

Capstone

Degree Name

Doctor of Social Work (DSW)

Faculty

Dr. Laura Escobar-Ratliff

Abstract

Borderline personality disorder (BPD) and the characteristics that define it are often viewed negatively by therapists and other mental health providers. Terms to describe these clients commonly include “manipulative”, “attention-seeking”, and “always in crisis.” Because of this jargon, there is a deep-set stigma that surrounds the disorder. Therapists and treating clinicians base their decisions and treatment protocol on hearsay of the disorder and already have an image of their prospective BPD client before the client enters their office. This capstone project seeks to inform clinicians about the present stigma and provides tools that are proposed to reduce stigmatizing beliefs within the mental health community.

The first product is a systematic literature review that responds to the question “To what extent does the presence of a clinician’s stigmatizing beliefs impact their willingness to treat clients with borderline personality disorder?” The purpose of this literature review was to comprise a concise product that exemplifies what research currently reports. Findings from this review concluded that stigmatizing beliefs are present, and there are minimal interventions currently being implemented to mitigate this stigma. Among the recommendations, increased education about BPD, adequate supervision, and correct diagnosis were proposed; however, little research displayed any of these proposals in action. From these findings, the review provided recommendations to implement further research which focuses on the mitigation of stigma in addition to specific training for clinicians treating BPD.

The second product is a conceptual paper that explores the use of mentalization-based therapy (MBT) in conjunction with a relational model of practice as a way to mitigate stigma in the field. MBT was researched in comparison to dialectical behavior therapy (DBT) as these two modalities are most commonly used to treat the disorder: with DBT being the front-runner. Relational engagement theory was applied to the use of MBT and hypothesized to be more effective in treating symptoms of BPD that cause stigmatizing beliefs, thereby increasing the effectiveness of the therapeutic relationship. This model is also proposed to provide the therapist with space to reflect on their own practice and identify areas of countertransference that could be affecting the therapeutic relationship. This newfound approach invites the therapist to adopt a new way of treating BPD and is proposed to have more effective treatment outcomes.

The final product is the practice application, where training and new assessment tool are proposed. Clinicians are recommended to complete mentalization relational-engagement training (MREt) prior to beginning work with BPD clients in order to familiarize themselves with the model. Training is completed in two parts and renewed annually. The McLean Screening Instrument for BPD (MSI-BPD) was re-envisioned to provide clinicians with measurable data that takes into account the client’s trauma history and presenting condition. The RMSI-BPD is conducted three times over a 90-day period and results are used to make an informed diagnosis of BPD and address the abovementioned careful diagnosis. Together, the MREt and RMSI-BPD provide the treating clinician the tools to assess their clients symptomatology in an unbiased manner and make clinically sound diagnoses and treatment plans.

KEYWORDS: borderline personality disorder, stigma, treatment, relational engagement theory, mentalization-based therapy

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