1. Contact should be structured and predictable with clear rules established. For the therapist, that would be with respect to meeting times, payment, fees, and policies and procedures. For the partner, that would be with respect to communication, chores, spending, and any number of other household affairs. Any changes are to be actively discussed and resolved. As implicit rules, assumed processes, and other unarticulated expectations are discovered, experienced, or felt, overt discussion must be instigated to resolve boundaries. All assumptions and interpretations must have any symbolic meanings revealed for consideration and boundaries established through negotiation. Appropriate communication could be "What does that mean to you? There's something real important… maybe hurtful about what that implies to you. What might that be? Let's make it clear… make expectations clear."2. The therapist should take an active role by making frequent comments that anchor the individual with borderline personality disorder in reality and minimizes his or her perceptual distortions in unstructured situations. The partner must be empowered through negotiation with the individual in therapy to take an active role to provide frequent reality checks to him or her. This serves to reduce borderline misinterpretations of intent and meaning of behaviors in the couple's dynamics and household. Appropriate communication may be "Do you think I don't care about you? That's not true. This is what I was actually thinking…" Or, "What did you think I was thinking or felt?"3. The therapist and the partner must learn how to handle borderline verbal assaults without retaliating or withdrawing. The hostility of the individual with borderline personality disorder should not be suppressed but examined as part of a more general pattern of relating to others. This includes the therapist, the partner, previous partners, friends, colleagues, and family. Hostility directed at the therapist becomes an opportunity for the therapist to model for the partner how to handle the individual's hostility without retaliation or withdrawal. The therapist helps the partner handle the individual's hostility in the session and coaches him or her for handling it at home, also without retaliation or withdrawing. Appropriate communication could be "I don't like how you said that, and my instinct is to snap back, but that won't be productive. So, I'll… instead."4. The therapist and the partner both must repeatedly point out to the individual the adverse effects of self-destructive behaviors including: drug or alcohol use, risky sexual behavior, manipulativeness, and inappropriate rageful outbursts. The individual may not be aware that such behavior is to gratify certain wishes and relieve anxiety. The focus should be on the negative consequences of the behaviors as opposed to the individual's motivations. Appropriate communication may be "I know you're upset, but that's not good for you or for us. Is that what you really want? Is there a better way to express yourself?"5. The therapist and the partner should help the individual recognize that his or her self-destructive behavior is often to avoid painful emotions. By seeing that his or her behavior is defensive and communication to others, the individual can learn to develop more autonomy and self-control to express differently. The therapist and partner can help the individual learn what the self-destructive behavior is attempting (poorly) to communicate. For example, suicidal behavior may be for revenge; to coerce someone, or paradoxically, to feel more alive by cutting through feelings of emptiness and meaninglessness. Appropriate communication may be "I see how much you're hurting. Find the strength… you can handle it as hard as it may feel." Or, "Don't do something to hurt yourself or to hurt me. That doesn't help. What do you really want? I might or might not be able to do it, but tell me."6. The therapist and the partner must set limits on behaviors that threaten the safety of the individual, the therapist, the partner, or anyone else. Appropriate communication might be "Don't threaten me or threaten to harm yourself. That's not how you or we can get better. I can't keep dealing with being threatened and keep trying to make it work with you. Explain what you feel, want, and need directly without threats. See what happens."7. The therapist and the partner should keep focus on the present when interpreting and clarifying behavior, as opposed to focusing on the past. Appropriate communication could be "What's going on with you right now? What happened before, happened before. We need to deal with what's going on now? What really is going on right now? What can you and I do now to make it better?"8. The therapist and the partner each must examine personal feelings about the individual. Because the individual can be frustrating and disruptive, the therapist and the partner must self-monitor reaction to avoid acting out- perhaps by retaliation or withdrawing. Appropriate communication may be "I really don't like how I feel when you do that, and I really don't like what I want to say back to you. As upset as I am, I still don't want to snap back at you. It won't help me… you… or us. Can you say that again in a different way that I can handle better? That I can hear and understand better without being so reactive?"
Clear boundaries,Reality commentary,Reactions with less retaliation or withdrawal,Identification and verbalization of the consequences of negative behavior and their connection to avoidance of painful feelings,Confrontation of threatening behavior,Clearer present-focused interpretation and clarification, andManagement of feelings toward the individual with less acting out.