ABSTRACTWe report the treatment experience of 164 subjects with BPD who participated in a randomized clinical trial testing the Systems Training for Emotional Predictability and Problem Solving group treatment programme. Participation in psychotherapy, use of psychotropic medication, use of emergency services and hospitalization were carefully tracked. Nearly all (96%) subjects were prescribed psychotropic medication; 74% took antidepressants at baseline; the figures were 41% for anxiolytics, 39% for mood stabilizers and 32% for antipsychotics. Sixty‐four percent reported taking ≥2 medications, and 39% took ≥3 medications. Most subjects (73%) participated in individual psychotherapy; 24% had been hospitalized at least once in the month prior to study entry. Importantly, medication usage at baseline was not associated with clinical severity. Medication usage declined during the 20‐week clinical trial and 1‐year follow‐up. Few patients (6%) had ever received electroconvulsive therapy. In conclusion, data show that many persons with BPD are prescribed multiple medications and frequently participate in individual and other types of psychotherapy. Medication usage at baseline does not explain variation in clinical symptoms. Implications of the findings are discussed. Copyright © 2011 John Wiley & Sons, Ltd.