Background
What is Borderline Personality Disorder?
Personality disorders are long-term and deeply ingrained patterns of behavior that affect many areas of life. They influence both the individuals themselves and the people around them. Personality disorders often begin in childhood or, at the latest, in early adulthood.
Borderline personality disorder (BPD) is one of the most common forms of personality disorders. It is a complex disorder of self-regulation that can significantly affect a person’s functioning. It typically appears as difficulties in emotion regulation and interpersonal relationships, as well as strong impulsivity. In addition to challenges in regulating emotions, BPD can affect the regulation of interaction and behavior as well as the experience of the self. In social interactions, individuals may be particularly sensitive to cues of rejection or abandonment. Patients’ self-image is often rigid, limited, or unstable, and negative emotions are present. Mood can fluctuate between sadness, anger, anxiety, and irritability. An individual’s view of themself and the way they speak to themself may change from moment to moment.
Borderline personality disorder is primarily treated with psychosocial interventions. The prognosis is good: more than half of patients recover within five years to the extent that they no longer meet the diagnostic criteria. With treatment, their level of functioning improves and depressive symptoms often decrease. Early support and treatment can make a meaningful difference for people living with borderline personality disorder.
Read more:
Aviram, R. B., Brodsky, B. S., & Stanley, B. (2006). Borderline Personality Disorder, Stigma, and Treatment Implications. Harvard Review of Psychiatry, 14(5), 249–256.
Beeney, J. E., Hallquist, M. N., Ellison, W. D., & Levy, K. N. (2016). Self-Other Disturbance in Borderline Personality Disorder: Neural, Self-Report, and Performance-Based Evidence. Personality Disorders, 7(1), 28–39.
Fonagy P., Luyten P. (2009). A developmental, mentalization-based approach to the understanding and treatment of borderline personality disorder. Dev Psychopathol. 21(4):1355−1381.
Fonagy, P., Luyten, P., & Bateman, A. (2017). Treating Borderline Personality Disorder With Psychotherapy: Where Do We Go From Here? JAMA Psychiatry (Chicago, Ill.), 74(4), 316–317.
Leichsenring F., Leibing E., Kruse J., New AS., Leweke F. (2011). Borderline personality disorder. Lancet 377(9759), 74−84.
Woodbridge, J., Townsend, M., Reis, S., Singh, S., & Grenyer, B. F. (2022). Non-response to psychotherapy for borderline personality disorder: A systematic review. Australian and New Zealand Journal of Psychiatry, 56(7)
What kind of therapy is VideoFacilitation?
VideoFacilitation (formerly known as VideoTalk) is a schema therapy method which utilizes home recorded videos. In schema therapy, patient’s problems are conceptualized primarily in terms of schemas and modes. In simple terms, the goal is to identify maladaptive schemas which are harmful beliefs about self and the world that cause harmful behavior. Modes, in turn, represent different aspects of one’s personality. Schema therapy distinguishes, for example, modes of vulnerable child, happy child, punitive parent, and healthy adult. By becoming more aware of their beliefs, behavior, and needs, patients can build healthier concepts of themselves.
The innovation in VideoFacilitation is that the patients video-record themselves talking about given topics at home between therapy sessions. Then during the sessions, the videos are viewed together with the group, analyzing the patients’ expressions and embodied behavior and contemplating constructive ways to cope in the situations. Using homemade videos is beneficial in the following ways: First, patients’ symptoms activate more easily when they are on their own, so the group gets a more accurate image of how the patient acts and reasons in their everyday environment. Second, according to patients, sharing highly personal content such as difficult childhood memories is less daunting to do at home than in the group therapy session. Third, the videos create an opportunity for the patients to monitor themselves from the outside, to see and hear themselves talking, which improves their self-awareness.
From the viewpoint of this study, the method also enables a comparison between self-presentation as self-talk (patient-made videos) and self-presentation in face-to-face interaction (therapy sessions): what do the patients change, correct, mitigate, or add, when they comment their video in the group?
VideoFacilitation was originally developed by psychotherapist Tarja Koffert, Professor of Psychiatry Jarmo Hietala, and Docent of Psychiatry Sinikka Luutonen in the University of Turku.
Read more:
Nietola, Miika; Peltomaa, Jari, Koffert, Tarja; Paananen, Jenny; Hietala, Jarmo; Karukivi, Max & Luutonen, Sinikka 2026: Video-facilitated group schema therapy for borderline personality disorder: a feasibility study. Journal of Contemporary Psychotherapy.
Koffert, T.; Luutonen, S. & Hietala, J. (in evaluation): Use of multisensory information as facilitator of group schema therapy for borderline personality disorder. Pre-print available.
Koffert, T.; Luutonen, S.; Niemi, P.M.; Tiuraniemi, J.; Nordström, E.; Keinänen M. & Hietala, J. 2019: Patient-made videos as a tool of self observation enhancing self-reflection in psychotherapy. Description of the method and a clinical case. Journal of Contemporary Psychotherapy 49, 187e195.
Nordström, E.; Luutonen, S.; Paananen, J.; Koffert, T.; Keinänen, M. & Hietala, J. 2021: Facilitation of psychotherapy with patient-made videos – A qualitative study of patient experiences. European Journal for Qualitative Research in Psychotherapy 11, 117−129.
Suomalainen, K.; Paananen, J.; Nordström, E. & Luutonen, S. 2023: Articulating the ‘Self.’ The use of referential expressions in Finnish psychotherapy sessions with client-made videos. Journal of Pragmatics 204, 50−66.
Young, J. E. 1990: Schema-focused cognitive therapy for personality disorders: A schema focused approach. Sarasota, FL: Professional Resource Exchange.
Young, J. E.; Klosko, J. S.; Weishaar, M. E. 2003: Schema therapy: a practitioner’s guide. New York: Guilford Press.
How does Borderlines of Self define ‘self’?
Drawing on a dialogistic viewpoint according to which the self presupposes the other, we understand selfhood as a social process that exists and is constructed in interaction with others. We also see self as multivoiced, consisting of many voices and identities. Thus, individuals can negotiate with themselves as well as with others, making conscious and unconscious decisions on what aspects of the self are presented. While interactional context and on-going activities create boundaries for self-presentation, self-presentation also depends on individual factors such as emotional status, confidence, experience of group membership, readiness, and trust. Therefore, mental health problems that disconnect an individual from their feelings and identity, can also challenge self-presentation.
Read more:
Bakhtin, M. (1981). The dialogic imagination. Four essays. University of Texas Press
Hermans, H. J. M. (2014). Self as a society of I-positions: A dialogical approach to counseling. Journal of Humanistic Counseling 53(2).
Linell, P. (2009). Rethinking language, mind and world dialogically. Interactional and contextual theories of human sensemaking. Charlotte, NC: Information Age Publishing.