Love and Limits: Pastoral Care for Persons with Borderline Personality

Post Author: Rev. Miriam Diephouse-McMillan, BCC

This is part of a series on the intersections between pastoral care and mental health. Read the rest of the series by selecting the Mental Health and Ministry tag

In seminary, one of my mentors said, “Beware the first person to introduce themselves to you in a new congregation—they’re probably borderline.” I’ve heard similar refrains in clergy circles ever since: “They will take all your time and energy if you let them.” “Every church has got one.”  “Beware the borderlines!” Stereotypes and horror stories abound. People with BPD (Borderline Personality Disorder), whether formally diagnosed or not, have a reputation for being manipulative, unstable, overdramatic, and just plain difficult. There is a common assumption that they can’t change, or don’t want to, and that they intentionally make other people’s lives difficult.

These stereotypes are often reinforced by our personal experiences. Many clergy bear the scars of trying to care for people with BPD. Even the most compassionate pastor can reach a point of burnout or become victimized by the person they were trying to help. And yet, these people also bear the image of God; they are our siblings in Christ. So where does that leave us as ministers? How do we offer pastoral care without becoming completely drained? How do we welcome them in our congregations while protecting ourselves and maintaining a healthy community?

It helps to re-examine some of the very stereotypes that we project on people with BPD. What we perceive as “manipulation” is, at its heart, an attempt to get one’s needs met. When someone has frequently had their requests denied, they resort to more creative ways to get what they feel they need. Someone who seems “overdramatic” may in fact experience life at a higher intensity than others. They may be especially sensitive to painful emotions. The person who exhausts us with their “neediness” may never have learned the skills to manage life well on their own. They may feel insecure and seek external validation and support.  The “unstable” relationships that put us on a pedestal one day and vilify us the next may simply reflect a person‘s internal experience of volatile emotions.  When someone doesn’t have the tools to cope with their emotional distress, they may project their anger and fear onto someone else, and pastors are often a safe target.

A decorative image of a woman in a red top with her hand extended in a "stop" gesture

Once we have deconstructed these stereotypes, we can better see and respond to the needs underneath them. One of the most effective therapies for BPD, known as Dialectical Behavioral Therapy (DBT), is built on the principle of dialectics: holding two seemingly contrasting perspectives in tension and seeking a synthesis that transcends the initial opposites.1 While we are not and should not be therapists to our congregants, this principle can guide our pastoral care to persons with BPD.  We want to care for them and meet their needs, and yet we also fear their needs will exceed our capacity and negatively impact our larger ministry. This is our dialectic; both are true. People with BPD deserve to be loved and cared for in a way that meets their needs, and often their needs are beyond what a pastor or congregation can reasonably offer. Focusing on one side without the other will inevitably lead to hurt feelings and broken relationships. We need to find a synthesis—a balance between responding to needs and maintaining healthy limits. 

The exact details of how we find balance will vary based on our individual situations, but I offer the following guidelines based on my own experiences working as a chaplain on a DBT-informed psychiatric unit:

  1. Validate the needs being expressed. Even if the details of a request or behavior don’t make sense to you, look for what the deeper need is. Does the person want to feel connected because they’re lonely? Are they seeking control because their life feels out of control? Maybe their anger is masking a deeper fear that needs reassurance. Find a way to acknowledge that need, even if you can’t support the specific request or behavior.
  2. Be clear and consistent. Set limits ahead of time about when and how often you can be available, and then stick to the limits. Someone with BPD may push for more than you offer, but maintaining your original boundary shows you are honest and dependable. If you go out of your way once, they may expect you to keep overextending. When you need to set a limit, offer a clear reason so the person knows it’s not personal. Try to maintain the same limits with everyone you provide care to, so there’s no suspicion of favoritism. 
  3. Maintain good communication. It’s common for someone with BPD to present themselves differently to different people, which can lead to conflict. Some people in the congregation may see the person as a problem while others perceive them as a victim. Make sure those in leadership can talk openly about their perspectives and try to keep everyone on the same page about decisions and policies. 
  4. Take care of yourself. Notice and manage your own emotional responses to avoid reactive decisions. If left unchecked, both empathy and frustration can lead us to forget our intentions of clear, well-boundaried care. Make sure you have a support network in place that you can go to for advice or simply to vent your frustrations. It can help to seek an outside perspective from someone not connected to the congregation who can give you feedback on the balance between caring and maintaining boundaries.

The dialectic of faithful pastoral care to persons with BPD is rooted in the dialectic of God’s grace. God’s compassion and forgiveness are infinite, and at the same time, God does not condone selfish or self-destructive behaviors. God recognizes our needs and limitations while also encouraging us to grow and improve. Our calling as pastors is to model that balance of grace to all those in our care, including those with BPD. Showing compassion does not require us to sacrifice ourselves or meet every demand. Welcoming someone with BPD into the body of Christ does not mean allowing them to wound or control others. Showing love to a congregant with BPD must coincide with maintaining limits. 

To combat the stigma so many churches and pastors have towards people with BPD, I’d like to close with the following benediction. I pray it may inspire you to find your own balance of love and limits:

Blessed are the manipulators, for God’s love shall fill their emptiness.

Blessed are the unstable, for God shall be their rock.

Blessed are the dramatic, for God’s tears shall heal their pain.

Blessed are the needy, for God shall teach them strength.

Blessed are the Borderlines, for they are the children of God.

1Marsha Linehan, Cognitive Behavioral Treatment of Borderline Personality Disorder. NY: Guildford, 1993.

Rev. Miriam Diephouse-McMillan, BCC, is an ordained PC(USA) minister serving as a full-time Chaplain at Trenton Psychiatric Hospital in Trenton, NJ, where she has worked for over twelve years.  She completed a certificate in Dialectical Behavioral Therapy through Palo Alto University and works on a specialized unit for patients with personality disorders and substance use issues.  Her passion and calling are found in the intersection of spirituality and mental health.

Image by: Andrea Piacquadio via Pexels
Used with permission
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