Young Women Treating Men with Borderline Personality Disorder: A Challenge for Psychotherapy Integration

Abstract

Young female therapists may struggle with treating heterosexual men who adhere to traditional masculine role norms. This challenge is exacerbated when these men present with borderline personality disorder. Certain evidence-based therapeutic interventions such as irreverent humor, confrontation, and teaching mentalization may require female therapists to violate typical female gender role expectations, which could be intimidating for some women. The authors use a clinical case study to demonstrate ways in which a young female therapist confronts her client’s devaluing behaviors while working through her conflicted feelings about gender role norms. A qualitative analysis revealed that through integrating therapeutic interventions the therapist addressed the client’s out of control sexual behaviors and interpersonal problems. Outcomes showed that over the course of treatment the client’s presenting problem shifted from managing his out of control sexual behaviors to self-reflecting and understanding his character flaws that interfere with the possibility of maintaining a healthy romantic relationship. The authors conclude with recommendations for new clinicians and supervisors, highlighting the importance of considering gender and implicit biases within the therapeutic relationship.