Q. I work at a group home and have a 42 year old client with BPD. Her manipulation and lying are getting way too out of control and I was wondering if you could offer any advise on techniques to use with her and these problems? She really doesn't have any privileges so consequences are almost non existent and always meaningless. We try to use logical consequences with her but they are ineffective. I mean the logical consequence for lying is to not trust what she's saying to be true and to check her stories out. Problem is that her stories and are not always checkoutable.

Please if you have any ideas or suggestions on how to work with and help those with BPD please let me know. I am at my wits end!!

  A. Most everyone has an angle you can work on to motivate change. I let my patients know life is very simple. You do the right thing, or face consequences. If you can impose consequences, e.g. no smoking, than do it. If not, you are stuck. At age 42, if she is not motivated to change, it probably will not happen.