Avoiding Patient Distortions in Psychotherapy with Borderline Personality Disorder Patients

Patients with borderline personality disorder (BPD) have a reputation among psychotherapists for distorted thinking and misleading reports about their interpersonal relationships. This article discusses the difficulty in ascertaining whether seeming distortions are caused by true cognitive deficiencies or are instead caused by purposeful or subconscious manipulation of relationships. The tendency of BPD patients to use an impressionistic cognitive style that leaves out important details and leads to seemingly distorted reports may be related to the phenomenon of family invalidation. Empirical research into BPD distortions is reviewed. The article then describes techniques useful in psychotherapy for obtaining more factual and objective accounts of current relationship episodes. Transcripts from a therapy session are used to illustrate the techniques.