Training the Next Generation to Treat Borderline Personality Disorder

Alexandra Yogman, LICSW, recalls the first time she talked alone with a patient with borderline personality disorder (BPD). It was 2015, and as part of her social work master’s degree program, she was interning on McLean’s Short Term Unit. She had spent several months shadowing experienced clinicians, and her supervisor believed she was ready to sit down and converse alone with this patient.

“I felt a lot of anxiety and was hyperconscious about what would be the most therapeutic thing to say,” remembered Yogman. “I was struck by the unspoken energy and tension between us. I didn’t understand the way her treatment was playing out.” Although the experience was disconcerting, Yogman was intrigued, challenged, and compelled to know more.

Fast forward three years. Yogman, fellow social worker Justin Sean Gillis, and psychotherapist Leila Guller are the recipients of a singular opportunity for early career clinicians to gain expertise in a wide range of evidence-based treatments for BPD. Their training is supported by the Gunderson Legacy Fund, established several years ago with a $200,000 anonymous donation and $100,000 in matching gifts from other donors.

This past summer, the Gunderson Legacy Fund was bolstered by a generous gift made by philanthropist Charles S. Fradin that provided a new opportunity for advanced training in social work with a specific focus on family therapy.

“Properly educating the next generation of clinicians is a vital component of McLean’s mission,” said Mr. Fradin. “I am privileged to help fund a training program that emphasizes critical support for families as well as patients.”

When a person struggles with BPD, family members and loved ones often struggle as well. It is common for family members of those with mental health issues to feel overwhelmed by their loved ones’ symptoms. Oftentimes, parents and siblings need to learn and practice the same skills as their family member with the diagnosis. In the realm of BPD, family therapy can empower individuals and their families to work together in more effective ways, enabling better management of BPD symptoms and improvements in overall family functioning. This new opportunity leverages McLean’s substantial expertise in treating complex mental health conditions to train clinicians in providing comprehensive family services and support.

Often misdiagnosed, BPD is an illness characterized by emotional instability and self-injurious behaviors. Relationships, including with therapists, can be difficult, so clinicians often are reluctant to take on patients with this diagnosis. Thanks to the seminal work of John Gunderson, MD (see sidebar), McLean is a world leader in BPD treatment, training, and research.

Lois W. Choi-Kain, MD, MEd, director of McLean’s Adult Borderline Center and Training Institute, said she knows of no similar training opportunity in the country. “These young clinicians are fully immersed in learning to clinically manage BPD using the full-range of evidence-based treatments,” explained Dr. Choi-Kain. “They’re doing long-term case management to help patients rebuild their lives, as well as group, individual, and family therapy, and they’re being mentored by the top clinicians and investigators in the field. Thanks to philanthropy, we’re fostering the growth of the next generation of BPD experts.”

As advanced trainees, Yogman and Gillis are working in the Gunderson Residence and the Gunderson Outpatient Clinic as well as in three training clinics, including one that specializes in using dialectical behavior therapy—one of the gold standard treatments for BPD—with patients who also experience post-traumatic stress disorder. Guller, a post-doctoral fellow, spends half her time doing clinical work and the rest doing research, including systematizing the patient assessment process to glean more information for treatment and research.

“The experience has been fantastic,” said Yogman. “I am learning an amazing amount—four different evidence-based treatments as opposed to learning only one in other training programs. My long-term goal is to make these treatments accessible to more people in the community.”