Borderline Personality Disorder (BPD), often more accurately described as an “affect-dysregulation disorder,” presents unique challenges for couples and therapists alike. Individuals with BPD struggle with intense emotions and maintaining emotional self-regulation, which can significantly impact their relationships.1 However, by integrating Marsha Linehan’s Dialectical Behavior Therapy (DBT) followed by established couples therapy approaches like Gottman Couples Therapy and Emotionally Focused Therapy (EFT), therapists can effectively support couples navigating the complexities of BPD.2

Latest research findings

The association between the relationship issues and BPD may partly come from misunderstanding one or both partners’ behavior. Individuals with BPD tend to misinterpret their partner’s behavior, struggle with communication, and sometimes be verbally and physically aggressive. They often do not recognize that their intrapersonal processes influence their interpersonal struggles.3 

Having a partner with Borderline Personality Disorder (BPD) can be stressful for a relationship. However, couples found that working together to cope with the challenges and viewing BPD as an external issue, rather than blaming each other, were important for maintaining a healthy relationship.

Many couples said that therapy was a crucial outside support in their journey to deal with BPD in a positive way, both as individuals and as a couple. The real-life experiences of these couples help therapists better understand what resources and strategies can assist couples in effectively managing BPD together.4

Real-life relationship dynamics

One study5 looked at how much women with BPD trust their partners, especially after difficult conversations. Couples, including women with BPD and couples without BPD, talked about normal topics, personal fears, and reasons they might break up. Women with BPD trusted their partners about the same as women without BPD after normal conversations. However, they trusted their partners less after talking about fears or reasons to break up. They seemed to trust their partners even less after talking about breaking up compared to talking about fears.

Feeling loved and cared for in the relationship helped women with BPD trust their partners more. The researchers think that having trouble seeing their partners as trustworthy during tough times might be one reason why people with BPD have a hard time in relationships. Talking about possibly breaking up seems to make trusting their partners especially hard.

Enhancing communication: The D.E.A.R.M.A.N. Approach

The Dearman approach helps individuals with BPD express their needs effectively within a relationship.6 It involves:

DEAR helps you remember what to say:

  1. Describing the situation objectively and without criticism
  2. Expressing primary emotions like sadness or fear rather than secondary emotions like anger
  3. Asserting requests clearly and explaining their importance
  4. Reinforcing cooperation by highlighting mutual benefits

MAN is an acronym that helps you remember how to approach your request:

  1. Mindfully focus on your goals
  2. Appear confident, effective, and competent
  3. Negotiate and be willing to compromise

This protocol has been shown in clinical research to lower depression and anxiety, while improving interpersonal effectiveness and emotional regulation, improve stress tolerance, and decrease unhelpful coping skills.

Fostering positivity

The GIVE Protocol

DBT’s GIVE protocol promotes constructive conversations:7

  • Gentle Approach: Avoiding confrontational or judgmental stances
  • Interest in Perspective: Showing genuine curiosity about the partner’s viewpoint
  • Validation: Acknowledging what makes sense from their standpoint
  • Ease and Openness: Maintaining a softer approach and anticipating positive outcomes

Establishing clarity

The FAST Protocol

The FAST protocol helps maintain clarity while nurturing loving engagement:8

  • Fairness: Embracing fairness in interactions
  • Apologies: Recognizing the need for apologies without excessive guilt
  • Staying Firm Yet Calm: Sticking to what’s essential while avoiding confrontation
  • Truthfulness: Being honest about needs and emotions beyond anger

Mindfulness and skill development

Ultimately, successful couples therapy with BPD involves teaching mindfulness and cultivating new relational skills.9 These techniques help build the capacity to navigate differences while staying emotionally regulated. Rewiring thought processes and promoting tolerance, regulation, and harmony requires effort and dedication from both partners and the therapist.10

Practical Takeaways

  1. Approach conversations gently, showing interest in your partner’s perspective.
  2. Express primary emotions and needs clearly, reinforcing the benefits of cooperation.
  3. Practice mindfulness to stay emotionally regulated during difficult interactions.
  4. Embrace fairness, offer apologies when needed, and stick to what’s essential calmly.
  5. Seek support from a therapist experienced in integrating DBT with couples therapy.


Navigating couples therapy with BPD requires a skillful, compassionate approach that incorporates DBT techniques. By enhancing communication, fostering positivity, establishing clarity, and developing mindfulness skills, couples can build healthier, more harmonious relationships. With the guidance of an experienced therapist and a commitment to growth, love can thrive even in the face of complex emotional challenges.


[1] Gunderson, J. G. (2011). Borderline personality disorder. New England Journal of Medicine, 364(21), 2037-2042.
[2] Rizvi, S. L., & Steffel, L. M. (2014). A pilot study of 2 brief forms of dialectical behavior therapy skills training for emotion dysregulation in college students. Journal of American College Health, 62(6), 434-439.
[3] Ociskova, Marie & Prasko, Jan & Hodny, Frantisek & Holubova, Michaela & Vanek, Jakub & Minarikova, Kamila & Nesnidal, Vlastimil & Sollár, Tomáš & Slepecky, Milos & Kantor, Krystof. (2023). Black & white relations: Intimate relationships of patients with borderline personality disorder. Neuro endocrinology letters. 44. 321-331.
[4] O’Leary, A. M., Landers, A. L., & Jackson, J. B. (2024). “I’m fighting with BPD instead of my partner”: A dyadic interpretative phenomenological analysis of the lived experience of couples navigating borderline personality disorder. Journal of Marital and Family Therapy, 50, 45–70.
[5] Miano, A., Fertuck, E. A., Roepke, S., & Dziobek, I. (2017). Romantic relationship dysfunction in borderline personality disorder—a naturalistic approach to trustworthiness perception. Personality Disorders: Theory, Research, and Treatment, 8(3), 281-286.
[6] Linehan, M. M. (2014). DBT skills training manual. Guilford Publications.
[7] McKay, M., Wood, J. C., & Brantley, J. (2019). The dialectical behavior therapy skills workbook: Practical DBT exercises for learning mindfulness, interpersonal effectiveness, emotion regulation, and distress tolerance. New Harbinger Publications.
[8] Linehan, M. M. (2018). Cognitive-behavioral treatment of borderline personality disorder. Guilford Publications.
[9] Wels, M. A., Crowell, S. E., & Beauchaine, T. P. (2021). Dialectical behavior therapy for adolescents and their families. In M. A. Swales (Ed.), The Oxford handbook of dialectical behaviour therapy (pp. 533-554). Oxford University Press.
[10] Fruzzetti, A. E., & Payne, L. C. (2020). Mindfulness and emotion regulation in couples and families. In B. D. Ostafin, M. D. Robinson, & B. P. Meier (Eds.), Handbook of mindfulness and self-regulation (pp. 235-248). Springer.