Guide to training in Borderline Personality Disorder

Working with clients who have Borderline Personality Disorder, henceforth referred to as BPD, presents its own set of challenges. This article aims to examine these issues and present a guide to training in this area.

Firstly, we will provide an overview of BPD and its symptoms, plus the challenges faced by clinicians in treatment directly relating to these symptoms. Then, we will take a look at the current training options for BPD.

What is BPD?

While it is difficult to reduce a complex psychological disorder to simplistic terms, at its core, BPD is a disorder of mood. It also affects how an individual interacts and forms relationships with others.

Given that a healthy relationship between the therapist and client is vital for successful treatment, it is important to look at these areas, and in this case, it is essential to go into greater detail about emotional instability and unstable relationships.

The difficulties faced by therapists

A common perception is that BPD is problematic, if not impossible, to treat and that patients are challenging. But why is this? Typically, it stems from building a relationship between the client and therapist. Those with BPD can have intense fears of abandonment and commitment and they may take a long time to establish such a relationship.

Once these boundaries have been overcome and a relationship is in place, maintaining this trust may become a battle. Clients may demonstrate behaviours such as calling regularly at unsociable hours or asking for additional appointments which the therapist may not be able to accommodate. The availability of therapists is often outside of the regular 9 to 5, but clients with BPD may take advantage of this to increase contact beyond what a therapist feels is manageable. There is also the potential for some sufferers to engage in disruptive behaviours to test the strength of the therapeutic alliance. These may include deliberately arriving late or missing appointments, to see if the therapist will continue.

What is widely agreed to be beneficial for both the client and therapist is setting clear and firm boundaries at the start of treatment. This may seem standoffish to the client, and in the worst-case scenario as a sign of rejection, but it is the first step in ensuring a healthy working relationship.

Treatment

Traditionally, treatment for BPD involves psychotherapy delivered by a trained professional. There are different forms that this therapy can take, but two of the most successful are Dialectical Behaviour Therapy (DBT) and Mentalisation-Based Therapy. DBT is intended to tackle the intense emotions felt by those with BPD. The therapy aims to reconcile how two different things that may seem to be opposed can both be true. Clients with BPD can often struggle with this, resulting in intense mood swings between two opposing emotions. An example would be love/hate. These intense emotions can lead to some of the actions previously mentioned, as well as poor impulse control.

MBT focuses more on the ability of clients to mentalise – that is, think about thinking. It takes the stance that clients with BPD do not have the ability to mentalise, and aims to develop this skill. A large part of this is understanding that others have mental states that are different from our own. Therefore, our initial interpretation of others’ actions may not necessarily be correct. This aims to encourage more introspection on whether unpleasant thoughts are helpful and avoid going straight to the worst possible outcome. This can be particularly helpful for issues relating to abandonment as such thoughts can often result in clients seeking constant reassurance to combat the discomfort it causes.

Training options

This article provides an overview of some of the challenges faced in treating those with BPD and some of the treatment available. However, as it is such a vast subject, we cannot hope to cover all aspects here.

What is required is thorough Borderline Personality Disorder training that allows for an in-depth examination of this topic. By analysing the underpinnings of BPD, from childhood causes and trauma, courses allow for therapists to gain a well-rounded appreciation of the complexity of issues surrounding BPD. A commitment to continually developing your understanding is key to developing effective treatment plans, and removing the stigma that can surround the disorder.

Overall, many of the reasons BPD is seen as a challenge for therapists are linked to symptoms of disorder of mood and forming relationships. These symptoms require firm boundaries to be set at the outset to ensure the client-therapist relationship remains beneficial. Courses in BPD allow you to arm yourself against some of the common pitfalls of treating a client. Following these steps will help to get a better understanding of treating clients with BPD.

Guide to Training in EMDR

Therapy

EMDR is an advanced form of psychotherapy that requires practitioners to have a high skill level, along with extensive training, to achieve accreditation. This guide will detail all of the important information you need when considering EMDR training in the UK.

What is EMDR?

EMDR stands for ‘eye movement desensitisation and reprocessing’ – a short-term exposure therapy primarily used to treat post-traumatic stress disorder (PTSD) and certain phobias.

EMDR was effectively founded in the 1980s by Francine Shapiro, who discovered that repetitive eye movements could reduce the intensity of distressing thoughts. This therapy seeks to remove the emotion associated with distressing memories to allow the brain to store it as a more logical event.

Put simply, EMDR rewires or retrains the brain to be able to recall the details of a traumatic event without the overwhelming sensations, feelings, and emotions, thus preventing the brain from storing the event as a traumatic sensory memory.

Although it originally started as just eye movements, EMDR today can entail the use of several different types of bilateral sensory stimulation in conjunction with recalling the distressing memory. This can include clients following a moving target with their eyes, a moving light machine, alternating knee taps, and vibrations.

Am I eligible for EMDR training?

To be eligible for EMDR training, you must have some background in mental health training, with a qualification that can be categorised into one of the headings below:

  • Mental health professionals

This includes Clinical Psychologists, Counselling Psychologists, Educational Psychologists, and Forensic Psychologists that are registered with HCPC, plus Psychiatrists holding an MRCPsych or SpR qualification.

You might also be eligible for EMDR training if you are a Registered Mental Health Nurse (NMC) or a Registered Social Worker who has previous mental health training, and at least two years of experience in providing psychotherapy.

  • Counsellors and psychotherapists

To be eligible for EMDR training, counsellors and psychotherapists must have accreditation by a recognised regulatory body such as UKCP, BABCP, BACP, IACP, and so on, or have provisional accreditation by BABCP.

  • General practitioners

This applies if you are registered with the General Medical Council (GMC), experienced in psychotherapy, and either accredited or working towards a psychotherapy accreditation.

  • Clinical and counselling psychologists

If you are still in training to be a clinical psychologist or a counselling psychologist, you might still undertake EMDR training with a letter of recommendation from your clinical supervisor.

  • Arts psychologists and occupational therapists

Art psychologists and occupational therapists can train in EMDR as long as they are registered with HCPC, have two years’ experience in providing psychotherapy, have previous mental health training, and can provide a reference from their clinical supervisor as proof of meeting the requirements.

  • Mental health professionals residing outside of the UK

Mental health professionals living and practising outside of the UK might still undertake EMDR training in the UK if they can provide a letter from their national EMDR association, meet the UK eligibility criteria, and are assured that this training will be transferable to their country of origin. 

The process of training

There are a number of qualifications and training programmes that you can receive to advance your studies in EMDR, all of which can help you to achieve different career goals within the field. Here are some of the training courses that you should consider:

  • Standard training

Standard EMDR training usually takes around seven days to complete to introduce you to the basics of EMDR. Depending on the provider, these elements might be referred to as Parts 1 to 3, Parts 1 to 4, or Level 1 and Level 2. In order to achieve certification, you must complete clinical practice with three clients during your training.

  • Supervised practice

After completing standard training, you can practise EMDR under supervision from an accredited EMDR consultant. Once sufficient experience has been gained, and you have clinical practice of at least 25 clients, you can apply to become an Accredited Practitioner.

  • Consultant training

Once you are registered as an Accredited Practitioner, you no longer need to be supervised. However, you can train to supervise others after three years of practice as an Accredited EMDR Consultant by taking an additional three-day course and achieving sufficient clinical supervision experience.

  • Specialised training

Standard EMDR training will give you the basic knowledge of EMDR and its general practical applications. If you wish to specialise in a particular area of EMDR, such as working with vulnerable children and young people, then you might consider completing specialised training programmes in addition to your standard training.

Although EMDR training can be intensive, it will ultimately reward you with the skills to successfully treat PTSD and specific phobias, making it a potentially very worthwhile investment if you are a professional with these aspirations.

Benefits of Doing a Mental Health Course Remotely

Therapist holding a notepad

The last 18 months have seen the world go into various lockdowns and other periods of societal restrictions in response to the coronavirus pandemic. As a consequence of this, educational provisions were widely moved to online classrooms, with both children and adults of all ages being taught via remote learning.

However, the fact that such restrictions have since eased in many parts of the globe does not mean remote learning is likely to go away. In fact, the popularity of online learning has boomed so much that it is widely expected to be a key part of the post-pandemic world. This is because there are many advantages to online learning.

So, if you are looking to obtain a mental health qualification, let us explore the benefits of choosing from the broad range of mental health courses online.

Ability to catch up or revise topics

Remote learning utilises ongoing advancements in digital technology and broadcasting, meaning that seminars, lectures, and workshops can be live streamed to students, and then recorded for later use. This allows students to easily revisit past topics if they ever miss a class, want to watch it again, or would like to use it as revision material when preparing for an exam.

This also means that students are able to pause, rewind, and fast-forward these lessons, taking the time to take notes, or skip to the point on which they require greater clarity and understanding.  

In this sense, doing your mental health course remotely can help improve your ability to stay up to date with teaching, and assist your revision in the event of an assessment. 

Learn at your own pace

Due to the freedoms mentioned above, doing a mental health course remotely allows you to learn at your own pace.

It goes without saying that everyone learns differently, and takes in information at different speeds, so this can be essential for making sure everyone effectively receives the same level of education. This can be particularly helpful for students who have additional learning needs or mild learning difficulties, such as dyslexia or ADHD.

Flexibility

Studying your mental health course remotely also gives you the flexibility to work from anywhere you like! In fact, you could even be in a different country to where the physical institution is located, and still benefit from the same level of teaching and support.

Remote learning can also give you the flexibility to tailor your studies around your current commitments, such as childcare or a full-time job. This gives everyone the best opportunity to learn, no matter their circumstances, while also potentially allowing many people to earn money alongside their studies. 

Accessibility

Unfortunately for some people with limited mobility, certain buildings and physical spaces are not accessible. This means that people with restricted mobility can suffer, missing out on receiving the education they desire and need.  

In contrast, remote learning opens up the system to people who might have otherwise missed out, allowing less-abled students to undertake a mental health course from a comfortable and accessible environment of their choice.

More options to choose from

The geographical flexibility and accessibility that remote learning can provide ultimately means that everyone can have more options to choose from when selecting a course provider.

Whereas you might have previously been limited to whatever the closest institution was to your home, now you can consider options from anywhere.

Save you time and money

Taking on your mental health course on a remote basis can also help save you time and money. This is mainly down to one important thing – there is no need to travel!

You no longer need to worry about finding the right bus or driving in rush hour traffic, plus any of the costs associated with doing that. As long as you have a functioning laptop and internet, you can just log in from the comfort of your home and access your learning materials.   

Digitised materials

Another way remote learning might save you a bit of money through the duration of the mental health course is that the learning materials will likely be digitised. Some course providers will be able to upload all of the materials that you need that week, thereby saving you from having to even purchase a physical textbook.  

Even if this is not the case, advances in technology and the increased popularity of online learning mean that most textbooks can be found online or in eBook format. This is often a fair bit cheaper than purchasing a hardcopy, which could ultimately save you a lot of money over the course of your studies.

Overall, there are many advantages that can come with studying on a mental health course remotely. Ultimately, the decision of whether to ‘go remote’ will be down to you, guided by such factors as your responsibilities, your physical requirements, and your learning needs.