Therapy for Personality Disorders: What Treatment Looks Like

Therapy for personality disorders is the main form of treatment, and many people see real improvement with the right approach and enough time. Talk therapy helps people understand long-standing patterns, manage intense emotions and build steadier relationships. Approaches such as dialectical behavior therapy were developed specifically for some personality disorders, and medication is sometimes added for particular symptoms.

This article is for adults who have been told they may have a personality disorder, people who recognize lifelong patterns in how they relate to others, and family members looking for a hopeful, practical explanation. It covers how therapy works, which approaches are used, what to expect, how to choose a therapist in Texas and when to seek help sooner.

This article is general information, not a medical recommendation. Do not start, stop or change any medication without talking to your prescriber.

If you are still trying to work out whether a personality disorder fits what you are experiencing, start with our article on signs of a personality disorder. This guide focuses on treatment.

What is the main treatment for personality disorders?

Talk therapy is the main treatment for personality disorders. MedlinePlus, from the National Library of Medicine, states that talk therapy is the main treatment, and medicines may help with certain symptoms.

MedlinePlus also explains that personality disorders involve long-term patterns of thoughts and behaviors that cause serious problems with relationships and work, and that the cause is unknown, with genes and childhood experiences thought to play a role. Because the patterns are long-standing, therapy usually takes time, but change is possible. A diagnosis describes patterns that cause distress; it is not a judgment about your character or worth, and it can point toward treatment that fits.

For an overview of how personality disorders are grouped, see our article on the different types of personality disorders.

How does dialectical behavior therapy help?

Dialectical behavior therapy (DBT) teaches skills for managing intense emotions, reducing self-destructive behavior and improving relationships. The National Institute of Mental Health (NIMH) explains that DBT was developed specifically for borderline personality disorder and draws on mindfulness to teach skills for intense emotions, self-destructive behaviors and relationships.

Standard DBT has several parts. The University of Washington's Behavioral Research and Therapy Clinics describe four modes: weekly individual therapy of about 60 minutes, a weekly skills group of about 2.5 hours, phone coaching and a therapist consultation team. Some programs offer adapted versions, so ask exactly what is included.

What other therapies are used for personality disorders?

Besides DBT, therapists use cognitive behavioral approaches and other structured therapies, matched to the person's main difficulties. NIMH notes that cognitive behavioral therapy can help reduce mood swings, anxiety symptoms and self-harming behaviors in people with borderline personality disorder.

Different personality disorders call for different emphases. For example, MedlinePlus notes that for schizotypal personality disorder, talk therapy is an important part of treatment, and that people with the condition stay in touch with reality while having unusual beliefs or fears. Common goals across approaches include:

• Recognizing patterns that repeat in relationships
• Tolerating distress without acting on urges
• Communicating needs more directly
• Building a more stable sense of self
• Reducing self-harm and crisis episodes

Our article on CBT vs. DBT explains the difference between two of these approaches.

What can you expect when starting therapy? Step by step

Starting therapy usually begins with an assessment, followed by agreeing on goals and a plan. NIMH notes that rapport and trust are essential in psychotherapy, which can feel especially important when relationships themselves are part of the difficulty.

1. Assessment: the therapist asks about your history, current symptoms, relationships and safety.
2. Shared understanding: you talk through what patterns seem to be causing the most distress.
3. Goals: you agree on what you want to change, such as fewer crises or less conflict.
4. Treatment plan: the therapist explains the approach, session schedule and any group or coaching parts.
5. Early weeks: you begin learning skills and tracking urges, emotions and situations.
6. Review: you and the therapist check progress regularly and adjust the plan.

Expect ups and downs. Therapy often brings up hard feelings before things get easier, and that is part of the work, not a sign it is failing.

It can also help to tell your therapist early on how you tend to react when relationships feel threatened. For example, a hypothetical client might say, "When I feel criticized, I usually want to quit." Naming that pattern at the start gives you both a plan for the moment it shows up in therapy, which it often does.

Many people find a written skills card useful between sessions. List two or three skills that help you get through intense moments, and keep the card somewhere easy to reach.

Does medication help personality disorders?

Medication is not the main treatment for personality disorders, but it can help with specific symptoms or co-occurring conditions. MedlinePlus notes that medicines may help with certain symptoms, such as depression, anxiety or mood swings that occur alongside a personality disorder.

A psychiatric clinician can evaluate whether a co-occurring condition is present and whether medication from a particular class makes sense. These decisions are individual and should be made and reviewed with a prescriber, ideally in coordination with your therapist.

If you already take medication, tell your therapist which ones and why, and let your prescriber know what you are working on in therapy. Shared information, with your permission, helps both clinicians notice changes sooner.

How do you choose a therapist for a personality disorder? A checklist

Choose a therapist who has specific training in the approach you need and who explains clearly how treatment works. In Texas, the Behavioral Health Executive Council oversees licensed professional counselors, marriage and family therapists, psychologists and social workers, and its lookup shows license status and public disciplinary history.

Questions to ask:

• "What training do you have in DBT or other therapies for personality disorders?"
• "Do you offer the full DBT program, or individual sessions using DBT skills?"
• "How often would we meet, and is there a skills group?"
• "How do you handle crises between sessions?"
• "How will we measure progress?"
• "Can you coordinate with a psychiatric clinician if needed?"

How can family members support someone in treatment?

Family members can support treatment by learning about the condition, encouraging steady attendance and setting clear, kind boundaries. The 988 Suicide & Crisis Lifeline notes that anyone can contact 988 for help when a friend or family member is struggling.

Helpful steps include:

• Avoiding labels and focusing on specific behaviors and feelings
• Learning a few of the same skills, if the program offers family sessions
• Staying calm during conflict and returning to the conversation later
• Looking after your own mental health with your own support

When should you get help sooner?

Get help right away if there is self-harm, thoughts of suicide or a risk of harm to others. NIMH notes that borderline personality disorder severely affects a person's ability to regulate emotions and advises calling or texting 988, or calling 911 in an emergency.

Other reasons to seek help promptly include:

• Frequent crises, emergency visits or hospital stays
• Risky impulsive behavior, such as reckless driving or substance misuse
• Feeling unreal or detached from yourself much of the time
• A sudden change in mood or behavior that worries people close to you

What should Texans know about finding personality disorder treatment?

Texans can find therapy for personality disorders through private practices, community mental health centers and university clinics, though specialized programs such as full DBT may be limited in some areas. Availability, costs and waitlists vary widely across the state.

Telehealth can widen your options, since a Texas-licensed therapist can often see you by video while you are in Texas. If you are looking for a full DBT program with a skills group, ask whether groups are offered online or in person, and how often.

If you are a student, your college counseling center may be able to offer short-term support or referrals, and your health plan can list in-network therapists. Keep notes on who you contacted and when, since searching can take a few tries. Our article on living with borderline personality disorder offers more day-to-day guidance.

Getting support in Texas

Therapy for personality disorders takes commitment, but people do get better. Whether a particular approach, such as full DBT, is available at a given practice requires confirmation, so ask before you book.

Lyte Psychiatry offers therapy, psychiatric evaluation and medication management in Texas. In-person visits are available at Lyte Psychiatry's clinic in Pantego, in the Dallas–Fort Worth area. Lyte Psychiatry offers telehealth visits to patients who are physically located in Texas at the time of the visit.

Most new patients are seen within 1–2 business days. Weekend appointments are limited. All Lyte Psychiatry services are available in Spanish. Availability, insurance and clinician fit require confirmation, so ask about them when you reach out.

Learn about therapy services, or contact the practice to ask about evaluation and therapy options.

If you are in a mental-health crisis in the United States, call or text 988. Call 911 for immediate danger.

Educational information, not a diagnosis or individual treatment plan.