What the work is
Borderline personality disorder is a difficulty in regulating emotion and holding a stable sense of oneself, in which feelings arrive at full intensity, relationships swing between idealisation and rejection, and the fear of being abandoned organises a great deal of what happens. The name is unfortunate: nothing about the personality is broken, and the word disorder obscures how much of it is an intelligible response to what came before.
Treatment here works on two levels at once, and the reason for working on both is that neither is sufficient alone.
Two levels, at the same time
The first level is coping. What brings most people to this work is not a diagnostic question but a practical one: the emotional storms, and what gets done during them. Self-harm, spending, drinking, the message sent at two in the morning, the relationship ended in an afternoon. This is where dialectical behaviour therapy has genuinely earned its place, and where its skills are used: tolerating distress without acting on it, noticing the escalation early enough to interrupt it, and building a repertoire that is not only damage.
The second level is meaning. Skills stop the bleeding; they do not explain the wound. The deeper work asks what the symptom is made of and what it is doing, where the fear of abandonment was learned, whose voice the self-criticism is in, what the emptiness is standing in for. In a depth-psychological frame, a symptom is not simply an error to be corrected. It is a communication, and it usually made sense somewhere.
Work only on the first level and you get a person who is managing, competently, a life they still do not understand. Work only on the second and you get insight arriving faster than the capacity to survive the week. Neither is enough on its own.
Where DBT fits, and where it does not
This needs saying plainly, because the word is used loosely. Dr Jacquet is trained in dialectical behaviour therapy and draws on it, but does not offer a full DBT programme, no weekly skills group, no diary cards, no formal between-session coaching protocol. What is offered is integrative: DBT’s skills where they are the right tool, inside a long-term psychotherapy that also does the deeper work.
For some people a structured DBT programme is exactly right, and the honest thing is to say so rather than to sell something adjacent. If that is what you are looking for, say so in the first conversation.
The frame, and why it matters here
Something about the practical arrangements matters more in this work than in most, and it is worth being plain about it rather than discovering it later.
Sessions run to their time. There are patients before and after, so a session does not stretch because the material is hard. The cancellation terms are the ordinary ones set out on the fees and terms page: under twenty-four hours’ notice, the session is charged. What contact is possible between sessions is agreed at the start rather than improvised during a crisis.
None of that is administrative housekeeping. A frame that bends whenever feeling runs high is not a frame, and for someone whose relationships have largely been governed by the intensity of the moment, a boundary that holds without anger is often the new experience. The missed session, the wish for more time, the anger at being ended on the hour: these become the material rather than an interruption to it, and they are frequently the most useful thing in the month.
And underneath the arrangements, the thing that is doing most of the work: staying. The borderline patient tests, often without knowing it, whether this person will leave like the others did. The therapy begins in earnest on the day they find out that this one does not.
Something else should be said that rarely is. These are people who know how to laugh, and who are capable of a loyalty most people never manage. They are not difficult people. They are people ruled, for now, by emotion.
The prognosis, honestly
For most of the last century borderline personality disorder was treated as a life sentence, and that belief was wrong. Long-term follow-up studies have shown that most people meet progressively fewer criteria as the years pass, and that a large proportion stop meeting the diagnostic threshold altogether. Recovery here does not mean becoming someone else. It means the intensity ceasing to run the life.
What this asks of you
It is worth being direct about the commitment, because this is not brief work and it should not be started lightly.
Sessions are weekly and open-ended rather than a fixed course, and the useful unit of time is years rather than weeks. The work is privately funded. These are the same terms as for any long-term psychotherapy here; nothing about them is particular to this difficulty.
What the work asks is the ordinary thing it asks of anyone: that you keep coming during the stretches when you most want to stop. Nobody manages that perfectly, and it is not a test you pass or fail. But the willingness to keep turning up is the one part of this that cannot be supplied by the therapist, and it has to be yours.
Places for open-ended work are limited, as they are for everyone. Where there is no opening, that is said straight away rather than managed with a waiting list.
The team around the work
One condition matters more than any of the others, and it is not negotiable: this work is done alongside a team, not instead of one. In practice that means a GP who knows you, and in most cases a psychiatrist, someone who can review medication and who is there if things become acute between sessions.
This is not administrative caution. Work of this intensity is only safe when something is holding the week as well as the hour, and a single therapist seeing you once a week is not a container for a crisis. It is the support wall in Dr Jacquet’s model of growth: the part of the structure that makes the deeper work survivable rather than destabilising.
Where that support is not yet in place, building it is the first piece of work rather than a reason to be turned away, and it is said at the first conversation rather than discovered halfway through.
Who this is not for
This is not a crisis service and does not replace one. Where someone needs a crisis team, a psychiatric assessment, medication review or inpatient care, that is said at the assessment rather than discovered later. Where a formal DBT programme is the better fit, the same applies.
Where the work happens
Sessions take place in Fitzrovia and at Harley Street in central London, and online throughout the UK and internationally. This work is not offered outside those settings. Work of this kind is usually weekly and open-ended rather than a fixed number of sessions, and no GP referral is needed to begin. Fees vary by location and by whether you see Dr Jacquet or an associate; they are set out on the fees and terms page.
Getting started
The first appointment is a conversation rather than an assessment form. You will be asked what brings you, what has been tried, and what you want to be different; you should use it to ask whatever you need in order to judge whether this is the right person. If it is not, saying so is useful information rather than a failure.
Not sure whether any of this describes you? The ten-question BPD test is a tool for reflection rather than a diagnosis. For the fuller picture, and for the hope: the essay on borderline personality disorder. On the fear that usually sits underneath it: the fear of abandonment.
A first conversation is confidential and without commitment.
Dr Philippe Jacquet is a UKCP registered psychotherapist, a Jungian analyst and an HCPC registered art psychotherapist, with twenty-five years of clinical practice. His Professional Doctorate in Analytical Psychology at the University of Essex examined male eating disorders from the perspective of analytical psychology. Registration can be checked on either public register.
Common questions
Is this a DBT programme?
No, and that distinction matters. Dr Jacquet is trained in dialectical behaviour therapy and uses its skills work where it helps, but he does not run a full manualised DBT programme with the weekly skills group, the diary cards and the between-session coaching that a formal programme involves. If that structured programme is what you want, it is worth saying so at the first conversation and a referral can be discussed.
Can borderline personality disorder be treated?
Yes, and the old belief that it cannot has been overturned. Long-term follow-up studies find that most people meet fewer criteria over time, and many no longer meet the threshold at all. The difficulty is real and the prognosis is far better than was assumed for most of the last century.
Do I need to already have a psychiatrist or a GP involved?
A GP who knows you, yes, and in most cases a psychiatrist too. Work of this intensity is done alongside a team rather than instead of one: someone needs to be able to review medication and to respond if things become acute between sessions. Where that support is not yet in place, putting it in place is the first piece of work rather than a reason to be turned away.
Do I need a diagnosis before starting?
No. A formal diagnosis is not required to begin, and many people arrive with the pattern rather than the label. Where a psychiatric assessment or medication review would genuinely help, that is said plainly and a referral arranged.
What happens if I am in crisis between sessions?
That is discussed and agreed at the start rather than improvised later, and the arrangement is made explicit: what contact is possible, what is not, and which service to use when the need is urgent. This is not a crisis service, and where someone needs a crisis team or emergency care, that is said honestly and without judgement.