Borderline Personality Disorder (BPD) is a condition that affected about 1.4% of the adults between 2001 and 2003. This disorder is known for causing intense emotional experiences and unhealthy relationship patterns. They may struggle with impulsivity and their sense of identity. These symptoms can greatly affect a person’s quality of life and overall emotional well-being. Keep reading to unlock 8 Therapy Activities for Borderline Personality Disorder.
For many, signs and symptoms of borderline personality disorder begin to occur during their teen years. Some of the more common symptoms associated with this condition include:
- Experiencing multiple severe mood changes in a day
- Having intense anger that is difficult to control
- Pattern of hot-and-cold relationships
- Experiencing a deep-rooted fear of abandonment
- Struggling to develop a sense of self, which leads to changes in values, behaviors, and goals
- Dissociating or experiencing paranoia
- Feeling empty
- Engaging in self-destructive behaviors like drinking or drug use, disordered eating, unsafe driving, and engaging in unsafe sex
- Engaging in self-harm behaviors and a history of suicide attempts
BPD can present with co-occurring disorders such as anxiety disorders, mood disorders, impulse control disorders, and substance use disorders, respectively. Just under 85% of those living with BPD have a dual diagnosis. The National Institute of Mental Health (NIH) estimates that 42% of adults living with BPD in the U.S. received some form of mental health treatment within the last year.
While the exact cause of BPD is yet to be determined, research has indicated that genetics and a person’s environment can affect their risk of developing borderline personality disorder. Those who have family members living with BPD, experienced childhood trauma, abuse, or lived in a community with patterns of unhealthy relationships may be at an increased risk.
How Borderline Personality Disorder Activities Can Help Your Clients
Diagnosis for borderline personality disorder involves a comprehensive assessment that investigates the symptoms your client is experiencing. This information is then compared to the diagnostic criteria outlined in the DSM-5 to determine a diagnosis. Using the DSM-5 can help rule out differential diagnoses like bipolar disorder, major depressive disorder, PTSD, and histrionic personality disorder.
After your assessment, you can begin developing your client’s treatment plan. This should be unique to your client’s symptoms, history, and goals. You can incorporate therapy activities for borderline personality disorder to reinforce important topics like emotion regulation, distress tolerance, and interpersonal effectiveness. Dialectical Behavioral Therapy (DBT) is one of the most common therapeutic approaches used to treat BPD and has been proven effective.
When you’re using therapy activities for borderline personality disorder, you can help your client improve their emotion regulation skills, decrease impulsiveness, and strengthen their distress tolerance. This can be accomplished in individual or group settings, depending on what is available to you in your clinical setting. BPD therapeutic activities can introduce your client to mindfulness, improve their self-control, and improve their problem-solving skills.
As a clinician, you have the flexibility to tailor your sessions as needed. Many find that using clinical worksheets improves the flow of sessions and promotes client engagement. TherapyByPro is a leading professional resource for mental health professionals, offering a variety of resources, including clinical worksheets. Some of the popular borderline personality disorder worksheets include:
- DBT Worksheet Bundle
- 100 Borderline Personality Disorder Questions to Ask Your Client
- Psychodynamic Therapy Relationship Mapping Worksheet
- Compassion-Focused Therapy Worksheets Bundle
Borderline Personality Disorder Activities for Your Clients
Incorporating borderline personality disorder activities into your sessions can help reinforce topics that you have discussed and promote client engagement. Worksheets can also be a tangible reminder that your clients take home to recall what was discussed in sessions. As you read the list of activities for borderline personality disorder, begin brainstorming how you could modify them for your clients in your clinical setting.
- Mindfulness breathing exercises can help clients who struggle with emotion regulation and reactivity. You can guide your client as they breathe deeply and pace. Encourage them to pay attention to the bodily sensations they experience during the exercise without judgment. These exercises can range in duration from three to five minutes, or longer. Spend time reviewing how your client can incorporate breathing exercises into their daily routine and walking through the barriers they may encounter.
- A “Wise Mind” meditation can help your client recognize the differences between an emotional mind and a reasonable mind. This can be particularly helpful for clients who exhibit black-and-white thinking patterns, as well as those who struggle with decision-making. Or this activity, you will guide your client through a meditation using their wise mind. They can then begin applying this manner of thinking in real situations to improve trust in themselves and in their decision-making.
- Keeping an emotional journal entry or diary card during the day can be helpful for clients who experience mood swings and limited self-awareness. You can provide your client with a diary card or journal that they can use to keep track of their emotions, urges, and behaviors throughout the day. They can also write if they used coping skills, any triggers they experienced, or patterns they observed. You can review these entries in session, highlighting when they used coping skills effectively and made progress in managing their symptoms.
- Clients who struggle with impulsivity and risk-taking behaviors may benefit from STOP skill practice. STOP is an acronym for stop, take a step back, observe, and proceed mindfully. This can help your client learn to slow down in everyday life, improving self-control and reducing the prevalence of harmful behaviors. Spend time reviewing how it can be applied in real-life situations, and explore its use outside of therapy.
- Using the five senses can be a powerful grounding strategy for clients who struggle with anxiety and dissociation. For this, they can notice five things they see, four things they touch, three things they hear, two smells, and one taste. You can incorporate sensory props if you have access to them. Spend time exploring the benefits of grounding exercises and identifying situations in real life that they could make more manageable.
- TIP Skills are a common distress tolerance practice that can help clients who struggle to manage intense emotions and self-harm urges. For this activity, you will demonstrate the use of ice water for temperature changes, an intense exercise such as jumping jacks, paced breathing, and progressive muscle relaxation. You can then walk through this repetition together. Review situations where this would be an appropriate coping skill and how it can help reduce the use of unsafe coping strategies.
- Clients who experience difficulties calming their minds may benefit from creating a self-soothing box. This box can include calming music, soft fabric, a relaxing picture, or a scented lotion. Review situations in which this box could be particularly helpful, such as during sessions when discussing sensitive or challenging topics. This activity enables your client to create a personal toolbox, which can enhance their independence in managing distress.
- Roleplaying is a great exercise for clients who struggle with boundaries, navigating conflict, and an underlying fear of abandonment. You can incorporate specific skills, like DEAR MAN from DBT. Role-playing allows your client to practice essential skills, such as setting boundaries and engaging in healthy communication, that can enhance interpersonal relationships and reduce conflict.
Frequently Asked Clinical Questions
Below are FAQs clinicians are asking:
How does a clinician differentiate between standard emotional dysregulation and borderline personality disorder characteristics during activity planning?
Differentiate by evaluating whether the emotional reactivity involves transient responses to external stress or reflects a chronic, identity-shaking pattern tied to a deep-rooted fear of abandonment. Standard emotional dysregulation allows an individual to maintain a predictable baseline of values and goals over time, whereas borderline personality disorder triggers multiple severe mood changes daily, chronic feelings of emptiness, and an unstable sense of self that alters personal behaviors and goals based on their immediate social group.
What is the recommended clinical protocol if a live TIP skill intervention fails to down-regulate an inpatient client’s intense self-harm urge?
Cease the physical repetition immediately and transition the client into structured, external sensory grounding strategies. Avoid pushing the client to continue high-intensity exercises like jumping jacks if their autonomic nervous system remains frozen; instead, utilize progressive muscle relaxation or step-by-step 5-4-3-2-1 sensory tracking to safely reduce physiological distress and re-establish co-regulation within the clinical room.
How should a practitioner handle a client with borderline traits who refuses to track their mood swings using standard daily diary cards?
Acknowledge their resistance non-judgmentally and pivot the task away from complex documentation to a highly simplified, visual Wise Mind framework during the session. Explore whether the written homework triggers cognitive perfectionism or a fear of judgment, and collaboratively build a low-barrier self-soothing box in session to establish an immediate sense of control before asking them to independently log their emotional triggers at home.
When is it clinically appropriate to transition a client from basic mindfulness breathing exercises to interactive, conflict-focused role-playing?
Introduce interpersonal effectiveness role-playing and active boundary-setting exercises once the client can reliably deploy the STOP skill to slow down their impulsive responses during periods of moderate distress. Attempting to rehearse advanced interpersonal frameworks like DEAR MAN when a client suffers from acute emotional hyper-arousal or paranoia will backfire, triggering intense attachment fears and disrupting therapeutic rapport.
Can advanced dialectical behavior therapy activities be safely implemented with a client presenting with a dual diagnosis of BPD and an active substance use disorder?
Yes, provided the individual practitioner coordinates care with medical providers and structures the interventions to address both conditions simultaneously within a secure outpatient container. Because nearly 85% of individuals living with borderline personality disorder present with a dual diagnosis, clinical activities must prioritize stabilization and the reduction of self-destructive behaviors like drinking to numb pain before unpacking deep-seated childhood trauma or family history patterns.
Final Thoughts On Choosing The Right Therapy Activities for Borderline Personality Disorder
Borderline personality disorder activities can be an effective tool for helping your client increase self-awareness and improve their ability to cope with the daily challenges that previously challenged them. This can help boost their self-esteem and sense of identity. You can learn more about counseling strategies and therapies for treating borderline personality disorder with training and continuing education opportunities within your niche. While therapies like DBT are widely used to treat BPD, you may find other cases where certain activities would be helpful.
TherapyByPro is a trusted resource for mental health professionals worldwide. Our therapy tools are designed with one mission in mind: to save you time and help you focus on what truly matters-your clients. Every worksheet, counseling script, and therapy poster in our shop is professionally crafted to simplify your workflow, enhance your sessions, reduce stress, and most of all, help your clients.
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Resources:
- Borderline personality disorder. Johns Hopkins Medicine. (2024a, May 13). https://www.hopkinsmedicine.org/health/conditions-and-diseases/borderline-personality-disorder
- U.S. Department of Health and Human Services. (n.d.-b). Borderline personality disorder. National Institute of Mental Health. https://www.nimh.nih.gov/health/topics/borderline-personality-disorder
- U.S. Department of Health and Human Services. (n.d.-g). Personality disorders. National Institute of Mental Health. https://www.nimh.nih.gov/health/statistics/personality-disorders