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When people begin treatment for borderline personality disorder (BPD), the first conversation is often about what’s going wrong. Therapists ask about emotional outbursts, impulsive decisions, self-harm, unstable relationships, and any other symptoms that prompted their client to seek treatment. These questions are essential because they help us understand the person’s difficulties and determine how to keep them safe.
But once that assessment is complete, where should therapy begin?
Many evidence-based treatments naturally focus on reducing symptoms. That makes sense. After all, people seek treatment because they are suffering.
Yet as a researcher and clinician specializing in BPD, I’ve found that starting therapy by asking “Who do you want to become?” is a more powerful question than “Who do you want to stop being?”
A Different Starting Point
BPD Compass (2026) is an evidence-based treatment for BPD that my colleagues and I developed to match treatment to the underlying personality processes driving each person’s symptoms rather than assuming everyone needs the same intervention.
In clinical trials, participants showed meaningful improvements in BPD symptoms, co-occurring symptoms like depression and anxiety, and the personality traits maintaining their difficulties.
One of the features that often surprises clinicians is that we begin treatment with values clarification before introducing any coping skills. It’s not that values are more important than symptom reduction. Rather, values give symptom reduction a purpose. In other words, it’s motivating to envision the person you want to be.
Values identification is the process of clarifying the kind of person you want to be and the life you want to create. Rather than focusing on what you want to stop feeling or doing, it asks what you want to move toward. In therapy, this often means exploring the qualities you hope to bring to different areas of your life.
“Who do you want to be?” is a big question. So we break it down into important domains of life. For example, what kind of partner do you want to be? What qualities do you hope your friends would use to describe you? What makes work feel meaningful? How do you see spirituality, community service, or wellness showing up in your life? There are no right or wrong answers. The goal isn’t to identify what you should value but to clarify what genuinely matters to you.
A More Useful Way to Think About Behavior
Beginning with values also changes how we evaluate behavior in therapy. I don’t believe it’s a therapist’s job to decide whether a behavior is inherently good or bad. Behaviors almost always make sense in context, especially when they developed as ways of coping with overwhelming emotions or difficult life experiences.
Instead of asking clients to simply stop engaging in behaviors I think are problematic, we ask, “Does this behavior move you closer to the person you want to be or farther away?”
Take something as simple as not answering the phone. For one person, letting the call go to voicemail may be an act of avoidance that pulls them away from their value of maintaining close relationships. For someone else, silencing their phone during family dinner may reflect their value of being fully present with their children. The behavior looks the same, but its function and whether it aligns with that person’s values are different.
Values Can Help Build a Stronger Sense of Identity
One of the defining features of BPD is identity disturbance. Many people describe feeling unsure of who they are or noticing that their sense of self changes dramatically depending on the situation, the emotions they’re experiencing, or the people around them.
Values are more stable. Unlike emotions, values don’t have to change from one day to the next.
You may not always feel confident, but you can consistently value courage. You may not always feel trusting, but you can still value intimacy. You may not always feel patient, but you can value being the kind of parent who responds thoughtfully rather than reactively.
Most people, with BPD or not, have never sat down and defined their values. This process is really powerful; most of my clients describe it as difficult, surprising, and enlightening. Moreover, repeatedly acting in line with those values over time helps people develop a more coherent sense of self.
Values Make Change Worth the Effort
Changing long-standing personality patterns is hard work. Speaking up after years of avoiding conflict feels uncomfortable. Trusting someone after repeated disappointments feels risky. Resisting impulsive urges can feel nearly impossible in the moment.
If the goal is simply to stop doing something, it’s easy to lose motivation when change becomes difficult.
Values provide a reason to persist. They remind us that personality change isn’t about becoming someone with “better” traits. It’s about becoming more like the person we aspire to be. When treatment begins with that vision, every difficult step has a destination, and every new skill becomes a tool for building the life you want.
