This book describes an integrated, evidence-based approach to the treatment of borderline personality disorder. My intention is to state as simply as possible the basic principles needed for comprehensive treatment by trying to strip the treatment of borderline personality disorder to its essentials and describe these essentials in straightforward, common-sense language that is as free as possible from jargon and unnecessary theoretical speculation. The volume is intended to be read by anyone with an interest in treating borderline personality disorder. Although designed primarily for mental health professionals from all disciplines ranging from those with modest training to seasoned therapists, the volume may also be of interest to informed family members, significant others, and those with the disorder.

For some time now, I have been convinced of the need to radically rethink how borderline personality disorder is treated. The development of effective treatments for this disorder is one of the unheralded successes of contemporary mental health. It is easy to forget that less than a generation ago, it was widely assumed that personality disorder was untreatable. We now know that this is not the case – patients can be helped with appropriate treatment and some improve without. However, we still do not know the optimal way to treat borderline personality disorder, and even after successful treatment, many patients continue to have substantial residual difficulties.

Until the early 1990s, treatment was largely dominated by psychoanalytic therapies, and few empirical studies were available to guide psychotherapists who wanted to pursue evidence-based treatment. The situation has changed dramatically over that last two decades, with the publication of more than half-a-dozen manualized treatments and the emergence of randomized controlled trials testifying to their efficacy. These achievements encouraged the idea that treatment should be based on one of the specialized therapies shown to be effective. I have never found this idea convincing. None of these therapies offers comprehensive coverage of the diverse problems of most patients. Each therapy is based on a theory of the disorder that shapes the treatment methods used. The problem is that most theories focus on a limited aspect of borderline problems and hence current treatments are not comprehensive. Also, each treatment contains effective interventions.