Q. I am currently working with young chronically mentally ill males. We base much of our program on the Positive Peer Culture model. This model is successful, however, I continually try to find more information on how to treat BPD. I have had much difficulty in specific action plans. All the males do seek a psychiatrist and take medication as prescribed, however, what type of behavioral approach do you feel would be most effective?

A. I am not an expert on therapy, but I consider myself fairly adept at medication and therapy choices together, because not many other clinicians do both. Cognitive therapy is the best. I do believe BPD is a biological disorder, just like depression and schizophrenia, and that therapy should come after you fix what is biologically wrong. Thus, therapy comes after medications. It is very important, but needs to be done in the right order.

I happen to be very fond of Albert Ellis and rational emotive therapy (RET). RET is set up to help patients make black-white decisions, which is how borderlines think. It is a super form of cognitive therapy. Any of the other cognitive therapies should also work.