In our opening module, DBT specialist Eboni Webb introduces what continues to be labelled Borderline Personality Disorder as an attachment and developmentally based condition, deepening our compassion for clients whose dysregulation is not an innate deficit but a learned survival response.

We gain an overview of the intense emotions, sudden mood swings, unstable relationships and self-harming behaviours associated with BPD that can make therapy so challenging – for therapist and client alike.

Having a coherent strategy is vital with such a complex condition. Biosocial theory can guide our interventions, with a focus on validation, emotion regulation, mindfulness and distress tolerance.

Fear of abandonment and fear of attack – two differently organised stress response systems that motivate contradictory responses. In infants, we see the gridlocked movements of a defenceless creature caught between fight, flight or freeze and seeking contact. In adults, we see the apparently chaotic behaviours and relational patterns that can lead to a diagnosis of BPD.

In module 2, leading BPD researcher and Professor of Psychology Karlen Lyons-Ruth will focus on trajectories toward dissociation, suicidality and ‘borderline’ presentations, in the context of a 30-year longitudinal study.

Karlen also brings the good news: when it comes to early intervention in attachment relationships, evolution is on our side.

Chaotic relationships are a hallmark of BPD. This pattern quickly makes itself known in the consulting room. In module 3, Linda Cundy explains how Attachment Theory can help us break the trauma cycle – to get down to the truly transformative underlying work.

This involves developing our knowledge of ‘preoccupied’ and ‘disorganised’ or ‘unresolved’ attachment patterns. We will also learn how to address the dysregulated affect and distorted mentalising associated with BPD.

For clients whose difficulties develop in inconsistent, neglectful or abusive early environments, we shouldn’t underestimate the power of dependable presence, co-regulation and a coherent mind.

Enactments are an inevitable part of therapy with trauma survivors – and one of the most challenging features of working with BPD. Unintegrated relational experience in the client’s past can elicit strong emotional, somatic or imaginal responses in the therapist, including feeling like a failure as a therapist.

Whatever the experience, enactments involve our own relational tendencies, and elicit in us a powerful urge to either act or to withdraw.

In module 4, Kathy Steele will guide us instead to sit with, explore and gradually make sense of our countertransference responses with challenging clients. We’ll learn why, far from derailing therapy, enactments can help us to direct the work where it most needs to go.

‘The world is dangerous and malevolent and the self is powerless and vulnerable’. If this is a client’s core belief, it can lead to strategies such as hypervigilance to threat, control and manipulation.

In module 5 John Ludgate, clinical psychologist and Founding Fellow of the Academy of Cognitive Therapy, explains how a cognitive conceptualisation of BPD can help clients make sense of their distressing symptoms, develop self-control and reduce self-destructive behaviours.

Drawing on Schema Therapy and DBT, John’s ‘CBT-Plus’ approach incorporates bottom-up interventions, and we learn which sensory self-soothing strategies work best with BPD. When the skills are self-directed, CBT can also help therapists meet relational challenges.

Misdiagnosis can easily arise due to the similarities in symptoms between BPD and other conditions. The treatment for BPD, bipolar disorder, DID (dissociative identity disorder) and psychotic disorders is very different, so accurate assessment is essential.

In module 6, assessment and trauma specialist Bethany Brand reviews the link between attachment and dissociation, before presenting research-based methods of distinguishing between diagnoses of ‘BPD’, bipolar, DID and schizophrenia.

Whatever our view of diagnosis, this can also help us to support and empower clients who may arrive in therapy with an ill-fitting psychiatric label.

Chronic and consistent invalidation is at the heart of the ‘borderline’ experience. Marginalised individuals may be both more likely to be given a BPD diagnosis – and more likely to be stigmatised and revictimised by the systems that are supposed to help.

In module 7, we return to Eboni Webb to hear how DBT’s biosocial model and an understanding of attachment trauma applies to work with specific populations, taking in sex, gender, race, ethnicity and socioeconomic class.

When trauma symptoms are stripped of their context, they can start to look like personality, like family traits, or even like culture. If therapists overlook systemic oppression, we are in danger of becoming part of the problem.

Why are women more likely to receive a diagnosis of BPD? And what can clinicians do to reduce the shame and stigma inherent in this highly problematic diagnosis?

In our concluding module Janina Fisher, specialist in the neurobiology of trauma, reviews the attachment learning, revisits the neuroscience of affect dysregulation and triggering, and listens to the wordless story being told by BPD symptoms.

Janina draws the inevitable conclusion: Borderline Personality Disorder needs to be reframed as traumatic attachment. The good news is that, understood in this way, BPD also becomes much easier to treat.