Cultural intersections in the psychotherapy of borderline personality disorder

The psychotherapeutic management of borderline personality disorder (BPD) cannot escape the all-encompassing influence of culture. While culture affects also pathogenic, pathoplastic, diagnostic, and service aspects of BPD, it is in the psychotherapeutic arena where a number of potentially critical intersections can enhance or undermine BPD's treatment outcomes. The cultural perspective in the management of BPD applies to areas, such as choice of therapy, unfolding of the psychotherapeutic process, the issue of boundaries, defense mechanisms, treatment setting, intercurrent suicidal behavior, and use of adjunctive therapies. Ultimately, the therapist can only offer culturally acceptable premises on which BPD patients can build assumptions about, and explanations of, their plight.