Frequently Asked Questions

What is therapy?
The basic purpose of therapy is to help people use their existing problem-solving skills more effectively or to develop new or better coping skills. Your primary responsibility in psychotherapy is to work toward becoming more aware of your experiences, thoughts, feelings, and memories, and to talk about them during the therapy session. The awareness may be about any aspect of your present or past life. It may be about the therapy or the therapist, about night dreams, daydreams and fantasies. It may be about hopes, joys, sorrows, fears, and relationships-anything that may come to mind during the session. Although people new to psychotherapy often try to “prepare” for therapy sessions by creating an agenda or deciding in advance what to talk about, they end up trusting that the process itself will bring to mind highly useful material. Sometimes it is the sequence of topics that are mentioned or the recall of events that appear to have been “forgotten” that provide important clues to what is going on for you below the surface. It may take time for you to feel convinced that your therapist is vitally interested in hearing about your ordinary as well as unusual experiences, and that she or he will not be judgmental or shaming no matter what you reveal or talk about
What does the therapeutic process look like?
The ultimate goal of psychotherapy is for the client to become more aware of their feelings, thoughts, memories, and experiences, past and present. This is done through conversation about day to day occurrences, unusual experiences and even dreams. The therapist is there to act as a non-judgmental third party and to help shed some light on what may be happening below the surface that may even be uncomfortable or painful, but necessary in order to heal and move forward.
The therapeutic process can be broken down into 3 phases:

The beginning: The emphasis is placed on building an alliance and trusting relationship with your therapist.  This is where your therapist will learn vital information about the issue or problem bringing you into counseling.

The middle: you and your therapist will work together to set therapeutic goals. Once goals are decided, you and your therapist will develop ideas about how the client can reach those goals. During this period, the client will try certain things, and homework will be given. This homework will be processed in session.

The end: When you feel you have met the goals you have set out to meet, you and your therapist will prepare and work toward ending therapy.

What is Borderline Personality Disorder?

People with BPD have extreme difficulties regulating their emotions. Common problems include anger, chaotic relationships, impulsivity, unstable sense of self, suicidal attempts and thoughts, self-harm, shame, fears of abandonment, and chronic feelings of emptiness.

People with BPD often have intense and stormy relationships. Attitudes toward family, friends and loved ones may shift suddenly. Relationship problems are common and the behaviors are difficult for loved ones to manage effectively. Additionally, stress in relationships can make for even more challenges

Seemingly mundane events may trigger symptoms. For example, people with BPD may feel angry and distressed over minor separations—such as vacations, business trips, or sudden changes of plans—from people to whom they feel close. Studies show that people with this disorder may see anger in an emotionally neutral face and have a stronger reaction to words with negative meanings than people who do not have the disorder.

Borderline Personality Disorder can be viewed as difficult to treat, however with appropriate treatment many show improvement in one year. Over time, 80% of BPD sufferers reduce their symptoms.

Signs & Symptoms:

  • Extreme reactions—including panic, depression, rage, or frantic actions—to abandonment, whether real or perceived
  • A pattern of intense and stormy relationships with family, friends, and loved ones, often veering from extreme closeness and love (idealization) to extreme dislike or anger (devaluation)
  • Distorted and unstable self-image or sense of self, which can result in sudden changes in feelings, opinions, values, or plans and goals for the future (such as school or career choices)
  • Impulsive and often dangerous behaviors, such as spending sprees, unsafe sex, substance abuse, reckless driving, and binge eating
  • Recurring suicidal behaviors or threats or self-harming behavior, such as cutting
  • Intense and highly changeable moods, with each episode lasting from a few hours to a few days
  • Chronic feelings of emptiness and/or boredom
  • Inappropriate, intense anger or problems controlling anger
  • Having stress-related paranoid thoughts or severe dissociative symptoms, such as feeling cut off from oneself, observing oneself from outside the body, or losing touch with reality.

Suicide and Self-harm

Self-injurious behavior includes suicide and suicide attempts, as well as self-harming behaviors, described below. As many as 80 percent of people with BPD have suicidal behaviors, and about 4 to 9 percent commit suicide.

Suicide is one of the most tragic outcomes of any mental illness. Some treatments can help reduce suicidal behaviors in people with BPD. For example, one study showed that dialectical behavior therapy (DBT) reduced suicide attempts in women by half compared with other types of psychotherapy, or talk therapy. DBT also reduced use of emergency room and inpatient services and retained more participants in therapy, compared to other approaches to treatment.

Unlike suicide attempts, self-harming behaviors do not stem from a desire to die. However, some self-harming behaviors may be life threatening. Self-harming behaviors linked with BPD include cutting, burning, hitting, head banging, hair pulling, and other harmful acts. People with BPD may self-harm to help regulate their emotions, to punish themselves, or to express their pain. They do not always see these behaviors as harmful.


BPD is often viewed as difficult to treat. However, recent research shows that BPD can be treated effectively, and that many people with this illness improve over time.

BPD can be treated with psychotherapy, or “talk” therapy. In some cases, a mental health professional may also recommend medications to treat specific symptoms. When a person is under more than one professional’s care, it is essential for the professionals to coordinate with one another on the treatment plan.

The treatments described below are just some of the options that may be available to a person with BPD. However, the research on treatments is still in very early stages. More studies are needed to determine the effectiveness of these treatments, who may benefit the most, and how best to deliver treatments.


Psychotherapy is usually the first treatment for people with BPD. Current research suggests psychotherapy can relieve some symptoms, but further studies are needed to better understand how well psychotherapy works.

It is important that people in therapy get along with and trust their therapist. The very nature of BPD can make it difficult for people with this disorder to maintain this type of bond with their therapist.

Types of psychotherapy used to treat BPD include the following:

  1. Cognitive behavioral therapy (CBT). CBT can help people with BPD identify and change core beliefs and/or behaviors that underlie inaccurate perceptions of themselves and others and problems interacting with others. CBT may help reduce a range of mood and anxiety symptoms and reduce the number of suicidal or self-harming behaviors.
  2. Dialectical behavior therapy (DBT). This type of therapy focuses on the concept of mindfulness, or being aware of and attentive to the current situation. DBT teaches skills to control intense emotions, reduces self-destructive behaviors, and improves relationships. This therapy differs from CBT in that it seeks a balance between changing and accepting beliefs and behaviors.

How can I help a friend or relative who has BPD?

If you know someone who has BPD, it affects you too. The first and most important thing you can do is help your friend or relative get the right diagnosis and treatment. You may need to make an appointment and go with your friend or relative to see the doctor. Encourage him or her to stay in treatment or to seek different treatment if symptoms do not appear to improve with the current treatment.

To help a friend or relative you can:

Offer emotional support, understanding, patience, and encouragement—change can be difficult and frightening to people with BPD, but it is possible for them to get better over time

  • Learn about mental disorders, including BPD, so you can understand what your friend or relative is experiencing
  • With permission from your friend or relative, talk with his or her therapist to learn about therapies that may involve family members

Never ignore comments about someone’s intent or plan to harm himself or herself or someone else. Report such comments to the person’s therapist or doctor. In urgent or potentially life-threatening situations, you may need to call the police.

How can I help myself if I have BPD?

Taking that first step to help yourself may be hard. It is important to realize that, although it may take some time, you can get better with treatment.

To help yourself:

  • Talk to your doctor about treatment options and stick with treatment
  • Try to maintain a stable schedule of meals and sleep times
  • Engage in mild activity or exercise to help reduce stress
  • Set realistic goals for yourself
  • Break up large tasks into small ones, set some priorities, and do what you can, as you can
  • Try to spend time with other people and confide in a trusted friend or family member
  • Tell others about events or situations that may trigger symptoms
  • Expect your symptoms to improve gradually, not immediately
  • Identify and seek out comforting situations, places, and people
  • Continue to educate yourself about this disorder.

What are Eating Disorders?

Eating disorders affect millions of individuals and families. With the highest mortality rate of any mental illness, eating disorders continue to be a dangerous and insidious part of our culture. According to the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders, eating disorders are classified into four major categories: Anorexia, Bulimia, Binge Eating Disorder and Otherwise Specified Feeding or Eating Disorders.

Anorexia Anorexia Nervosa is a disorder in which preoccupation with restricting food intake and thinness leads to excessive weight loss. The individual typically has an intense fear of gaining weight, a distorted body image and weighs less than the 85% of ideal body weight.
Signs and Symptoms:
  • Refusal to maintain body weight at or above a minimally normal weight for age and height
  • Restrictive Eating
  • Intense fear of gaining weight or becoming fat, even though underweight.
  • Disturbance in way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.
  • Loss of period in women who have reached puberty
  • Exhibits much concern about weight
  • Complaints of “feeling” fat
  • Suffers from depression (including shame, anger and guilt)
  • Attributes social and professional successes/ failures to weight gain/loss
  • Denial of hunger
  • Loathing of body, hiding shape and weight


Bulimia Nervosa involves frequent episodes of binge eating, almost always followed by purging and intense feelings of guilt or shame. The individual feels out of control and may recognize that the behavior is not normal.

  • Recurrent episodes of binge eating. An episode of binge eating is eating a very large quantity of food in a short period of time, often accompanied by a sense of lack of control over eating during the episode (i.e. a feeling that one cannot stop eating or control what or how much one is eating).
  • Recurrent purging behavior such as self-induced vomiting; misuse of laxatives, diuretics, enemas, or other medications; fasting; or excessive exercise
  • Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.

Signs and Symptoms of Bulimia:

  • Exhibits much concern about weight
  • Complaints of “feeling” fat
  • Suffers from depression (including shame, anger and guilt)
  • Perfectionist personality
  • Attributes social and professional successes/ failures to weight gain/loss
  • Denial of hunger
  • Loathing of body, hiding shape and weight

Binge Eating Disorder

 Those struggling with Binge Eating Disorder experience uncontrollable eating, sometimes done in secret. The individual has feelings of disgust, depression and guilt about binge eating and eats when not physically hungry. Those who are obese may be struggling with binge eating disorder though body size is not always indicative of an eating disorder and those with binge eating disorder may be of average size or even underweight.
Signs and Symptoms of BED:
  • Eating large amounts of food when not physically hungry; bingeing or eating uncontrollably
  • Unable to stop eating voluntarily
  • Eating rapidly
  • Eating until feeling bloated or uncomfortably full
  • Eating alone
  • Hoarding or stealing food
  • Low self-esteem, feelings of worthlessness
  • Intense guilt about eating, self-disgust
  • Depressed moods, mood fluctuations, impatience, irritability
  • Loathing or hiding of the body under baggy clothes

What is CBT (Cognitive Behavioral Therapy)?

Cognitive behavioral Therapy is based on the presmise of “the way we perceive situations influences how we feel emotionally.” For example, one person reading this website might think, “Wow! This sounds good, it’s just what I’ve always been looking for!” and feels happy. Another person reading this information might think, “Well, this sounds good but I don’t think I can do it.” This person feels sad and discouraged. So it is not a situation that directly affects how people feel emotionally, but rather, their thoughts in that situation. When people are in distress, their perspective is often inaccurate and their thoughts may be unrealistic. Cognitive behavior therapy helps people identify their distressing thoughts and evaluate how realistic the thoughts are. Then they learn to change their distorted thinking. When they think more realistically, they feel better. The emphasis is also consistently on solving problems and initiating behavioral change.

Cognitive behavior therapy is one of the few forms of psychotherapy that has been scientifically tested and found to be effective in hundreds of clinical trials. In contrast to other forms of psychotherapy, cognitive therapy is usually more focused on the present, more time-limited, and more problem-solving oriented. In addition,clients learn specific skills that they can use for the rest of their lives. These skills involve identifying distorted thinking, modifying beliefs, relating to others in different ways, and changing behaviors.

What is DBT (Dialectical Behavioral Therapy)?

DBT is a cognitive-behavioral approach that emphasizes the psychosocial aspects of one’s life. The theory behind the approach is that some people are prone to have more intense reactions toward certain emotional situations, primarily those found in romantic, family and friend relationships. DBT theory suggests that some people’s arousal levels in such situations can increase far more quickly, attain a higher level of emotional stimulation, and take a significant amount of time to return to baseline arousal levels. Focused on validating the difficulties of life’s struggles, the apparent difficulty with conflicting and intense emotions, and the desire to make important changes, DBT is a highly practical and direct form of therapy. Rather than only focusing on overcoming misery, DBT also emphasizes working on creating a life you want to live. There are 4 modules to be addressed and worked on within DBT:

Mindfulness – A “core” DBT skill, mindfulness involves paying attention, in the moment, non- judgmentally to live your life in a deliberate manner.

Emotion Regulation – Learn the function of emotions and improve your ability to describe, change, and cope effectively, rather than let emotions control you.

Distress Tolerance – Manage crises without making your problems worse.

Interpersonal Effectiveness – Attend to your needs and improve relationships