Lines of Advance in Treating People of Color with Borderline Personality Disorder: Alloying the “gold” of Vocational Rehabilitation with the “Copper” of Psychodynamic Psychotherapy

Abstract

People of color with borderline personality disorder (PoCwBPD), in particular African-Americans and Latinxs in the inner city, present a special population at risk for unemployment and long-term impairment in psychiatric and psychosocial recovery. A growing literature points to the need for comprehensive care that addresses the symptoms of the borderline syndrome alongside social, vocational, and educational achievement. This article paints a picture of the individual, communal, and systemic complexities involved in aiding PoCwBPD achieve psychosocial recovery. After contextualizing the historical and systemic forces that impact recovery for PoCwBPD, I discuss principles of intervention to assist clinicians tailor treatment to this population. Drawing on insights from Transference-Focused Psychotherapy, an evidence-based psychodynamic therapy for BPD, I offer a theoretical cultural adaptation for people of color. This article provides clinical vignettes to illustrate the resulting model, and shows that helping the patient engage in productive activity provides the foundation for exploratory work, which in turn addresses intrapsychic obstacles to psychosocial success.

Keywords:

• borderline personality disorder
• vocational rehabilitation
• transference
• race
• psychotherapy
• employment