Learn the principles and techniques of motivational interviewing (MI) that can help you engage and empower your clients with borderline personality disorder (BPD).

Establishing a trusting rapport is crucial in MI with clients with BPD, who may struggle with trust and fear of abandonment. Reflective listening is key to understanding the client's perspective without judgment eg, A client with BPD felt validated when their therapist reflected their emotions accurately during a session. Using affirmations to highlight strengths and efforts can empower clients with BPD. Avoiding judgment, confrontation, and advice-giving is essential to prevent defensiveness in clients with BPD. Real story: A client with BPD disengaged from therapy when they felt criticized by their counselor. Emphasizing freedom of choice and responsibility for change can empower clients with BPD to take ownership of their growth.

What are effective MI strategies for clients with borderline personality disorder?

Borderline personality disorder (BPD) is a complex and challenging mental health condition that affects how people relate to themselves and others. People with BPD often experience intense emotions, unstable relationships, impulsive behaviors, and a distorted sense of identity. They may also struggle with substance abuse, self-harm, or suicidal thoughts. Motivational interviewing (MI) is a client-centered and collaborative approach that helps people resolve ambivalence and enhance their motivation for change. MI can be an effective strategy for working with clients with BPD, as it respects their autonomy, validates their feelings, and supports their goals. In this article, we will explore some of the key principles and techniques of MI that can help you engage and empower your clients with BPD.

Key takeaways from this article

Establish a trusting rapport:

Reflective listening and affirmations are key. Show genuine interest in your client's perspective to build trust and avoid judgment to prevent defensiveness.### *Explore client ambivalence:Use open-ended questions to elicit mixed feelings about change. Help clients weigh pros and cons with scales or decisional balance exercises for better clarity.

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1 Establish rapport

One of the most important aspects of MI is to establish a trusting and empathic rapport with your client. This can be challenging with clients with BPD, who may have difficulty trusting others, fear abandonment, or react strongly to perceived criticism or rejection. To build rapport, you need to show genuine interest and curiosity in your client's perspective, use reflective listening to convey understanding, and express warmth and acceptance. You also need to avoid judgment, confrontation, or advice-giving, as these can trigger defensiveness or resistance. Instead, you can use affirmations to acknowledge your client's strengths, efforts, and values, and emphasize their freedom of choice and responsibility for change.

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Harvinder Singh

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Establishing a trusting rapport is crucial in MI with clients with BPD, who may struggle with trust and fear of abandonment. Reflective listening is key to understanding the client's perspective without judgment eg, A client with BPD felt validated when their therapist reflected their emotions accurately during a session. Using affirmations to highlight strengths and efforts can empower clients with BPD. Avoiding judgment, confrontation, and advice-giving is essential to prevent defensiveness in clients with BPD. Real story: A client with BPD disengaged from therapy when they felt criticized by their counselor. Emphasizing freedom of choice and responsibility for change can empower clients with BPD to take ownership of their growth.

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Karen Ratcliffe (Health and Wellbeing Coach) 💛

Building Resilience in Female Leaders | Use that Experience of Adversity | Let go of your Fears and Take Action | Know that you have your Life Philosophy.
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The most important point to consider here is that borderline personality disorder is a condition where a person experience sharp mood swings and may change their feelings towards you, themselves and the situation quickly. The defensiveness that they demonstrate towards you may not change and building rapport can be difficult. Motivational interviewing techniques may not be enough to break through that defensiveness. As the client/ patient feels a lot of uncertainty about who they are and what they want, patience and silence are useful tools. Time and space to reflect and feel calm and safe can lead to building some rapport for now. The client/patient should be assured of your qualifications and experience prior to any conversation.

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Dr.Ajay G.
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To interact with people with borderline personality disorder you need to listen to them effectively and also give warmth and support to them when they need it the most

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Victoria Manning MSW LCSW

LCSW Clinical Social Worker Psychotherapist at Mindfull Welness therapy group
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I found dialect-able behavioral therapy (DBT)to be a skill learned in order to avoid the pitfalls of borderline personality disregulation and difficulty in interpersonal relationships and a tendency to use addictions to manage stress.

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Nandhini Ramachandran

NBC-HWC, National Board Certified Health and Wellness Coach, A-CFHC, ADAPT certified Functional Health Coach | Empowering individuals to embrace holistic wellness| Nutrition,lifestyle,health behaviors & wellness guidance
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I believe acceptance and showcasing trust not only through verbal but also through our body language, not interrupting, genuinely understanding, being empathetic and respectful ensures and nurtures the coach- client relationship. Time and persistence are key. Being skills of MI would play crucial role in helping them.

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2 Explore ambivalence

Another key aspect of MI is to explore your client's ambivalence about changing their behavior. Ambivalence is a normal and common state of having mixed or conflicting feelings about something. Clients with BPD may experience ambivalence about their substance use, self-harm, or relationships, as they may see them as coping strategies, sources of relief, or expressions of identity, but also as harmful, risky, or unsatisfying. To explore ambivalence, you can use open-ended questions to elicit your client's reasons for and against change, and reflect back their ambivalence in a neutral and respectful way. You can also use scales or decisional balance exercises to help your client weigh the pros and cons of change.

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3 Evoke change talk

The next aspect of MI is to evoke change talk, which is any statement that expresses your client's desire, ability, reasons, need, or commitment to change. Change talk indicates that your client is moving toward resolving their ambivalence and increasing their motivation for change. Clients with BPD may have difficulty expressing change talk, as they may have low self-esteem, fear failure, or feel hopeless or helpless. To evoke change talk, you can use questions that invite your client to imagine a better future, explore the discrepancy between their current situation and their goals, or identify the benefits or costs of change. You can also use reflections, summaries, or affirmations to reinforce and amplify your client's change talk.

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Dr. “Ari” McGrew, LPCC,LPC-S,NPT-C®,C-PD,CCATP, CNP

ForbesBLK Founder & Chief Creative Officer of Tactful Disruption®️ | Licensed Psychotherapist | Clinical Director at Off•Script™️ | Transforming Mental Health with Science and Spirituality | Miss Black Utah 2010
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Boost clients' confidence in their ability to change by spotlighting their previous achievements and strengths. Particularly for those with Borderline Personality Disorder (BPD), it's vital to underscore their resilience in facing and overcoming intense emotional experiences and challenging situations. This recognition can significantly reinforce their belief in personal growth and transformation. If they continue to encounter obstacles in finding a sense of safety, it's essential to address this as part of their journey towards overcoming their inner conflicts. Offering support and strategies to navigate through these emotional challenges can pave the way for a more stable and self-directed path forward.

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4 Respond to sustain talk

The opposite of change talk is sustain talk, which is any statement that expresses your client's preference for maintaining the status quo, reluctance to change, or barriers to change. Sustain talk indicates that your client is still ambivalent or resistant to change, and needs more support and empathy. Clients with BPD may express a lot of sustain talk, as they may have strong attachments, habits, or beliefs that prevent them from changing, or face external challenges or pressures that hinder their progress. To respond to sustain talk, you can use reflections to acknowledge your client's feelings and concerns, and express understanding and empathy. You can also use strategic responses, such as shifting the focus, reframing, or agreeing with a twist, to gently challenge or redirect your client's sustain talk.

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5 Support self-efficacy

The final aspect of MI is to support your client's self-efficacy, which is their belief in their ability to change. Self-efficacy is a crucial factor for successful behavior change, as it influences your client's confidence, persistence, and resilience. Clients with BPD may have low self-efficacy, as they may have experienced trauma, abuse, or neglect, or have a history of failed attempts or setbacks. To support self-efficacy, you can use questions that elicit your client's past successes, current resources, or future plans, and reflect back their strengths and skills. You can also use affirmations to praise your client's efforts, achievements, or potential, and encourage them to take small and realistic steps toward change.

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6 Here’s what else to consider

This is a space to share examples, stories, or insights that don’t fit into any of the previous sections. What else would you like to add?

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Faezeh Elahi

Social worker
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Borderline personality disorder is a mental illness that severely impacts on patients ability to manage their emotions,BPD or emotionally unstable personality disorder EUPD has pattern of unstable interpersonal relationships &emotional reactions&disorder mood of interacts with others.Most effective MI strategies listening deeply to show empathy, encourage and empower patient to motivate, resistance against reflex.MI is a therapeutic conversation and help patient overcome his/her ambivalence by strengthening their own motivation to change.MI techniques &occupational therapy practitioners understand patients need to change& help them move forward to desired stage.MI skills provide respect trust & lead patient participate to solving disorder

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What are effective MI strategies for clients with borderline personality disorder?

1

2

3

4

5

6

1 Establish rapport

2 Explore ambivalence

3 Evoke change talk

4 Respond to sustain talk

5 Support self-efficacy

6 Here’s what else to consider

Motivational Interviewing

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What are effective MI strategies for clients with borderline personality disorder?

1

2

3

4

5

6

1 Establish rapport

2 Explore ambivalence

3 Evoke change talk

4 Respond to sustain talk

5 Support self-efficacy

6 Here’s what else to consider

Motivational Interviewing

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