A Guide to General Psychiatric Management for Borderline Personality Disorder

Developed to connect emotions and behaviors to stressors, GPM can be learned easily and can help most BPD patients

May 2, 2022

General psychiatric management (GPM), also known as good psychiatric management, is a treatment for borderline personality disorder (BPD).

BPD is a complex condition that can make everything about a person’s life feel unstable, including their emotions, sense of self, and relationships. While BPD is a serious illness, it is also highly treatable.

Because of its generalist approach, GPM is easily learned by most clinicians and effective for treating most BPD patients. At the heart of GPM is the idea that most people with BPD will get better over time, and lasting change does not require intensive treatment.

GPM therapists focus on patients’ hypersensitivity to interpersonal relationships.

Therapists connect the patient’s emotions and behaviors to relationship stressors. They incorporate practical problem-solving (case management), education, and realistic goal setting into treatment.

With GPM, more therapists can become qualified to help people with BPD. More people with BPD can then receive the help they need.

Keep Reading To Learn

  • Why GPM was developed
  • How GPM helps people with BPD
  • Who can provide GPM—and how to find care

Understanding General Psychiatric Management

People with borderline personality disorder make up about 1.6% of the general population. In clinical settings, 20% of patients have BPD.

There are many excellent treatments for borderline personality disorder. These include dialectical behavior therapy (DBT), mentalization-based treatment (MBT), and transference-focused psychotherapy (TFP). These treatments generally take years to master and are only offered by therapists or treatment programs specializing in BPD.

Given the high number of BPD patients who seek care, most clinicians will treat people with the condition at some point. However, many therapists do not have the resources to pursue intensive training and many patients cannot access specialized treatments.

As a result, people with BPD do not have enough options for treatment and they may receive inadequate care.

General psychiatric management addresses this need for more BPD treatment partly because it is more easily learned and offered by clinicians. The training can be delivered in as little as one day of additional training for mental health professionals already in practice and is increasingly being integrated into psychiatric training as the “first-line” treatment for BPD.

The late John Gunderson, MD, developed GPM. Gunderson, a professor at Harvard Medical School and psychiatrist at McLean Hospital, was a pioneer in the diagnosis, treatment, and research of borderline personality disorder. He believed that most clinicians could learn to treat BPD using GPM techniques that could be taught efficiently and delivered to patients at less cost than specialized BPD treatments.

While Gunderson believed some BPD patients needed specialized treatments, he maintained that GPM could help most of them lead healthy and productive lives.

Everything You Need To Know About BPD

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BPD, misunderstood by many, is a common disorder with a variety of treatments available.

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How Effective Is GPM?

Research shows that GPM is an effective treatment for borderline personality disorder.

A large 2009 study in the American Journal of Psychiatry followed 180 BPD patients who had experienced at least two suicidal or non-suicidal self-injurious episodes in the previous five years.

For one year, half the patients received GPM, and the other half received dialectical behavior therapy, the most extensively researched treatment for BPD.

At the end of the study, both groups showed significant reductions in self-injurious behavior, depression, anger, and other BPD symptoms.

The study found no large differences in the group treated with DBT and the group treated with GPM. This finding suggests that GPM is as effective as DBT for most patients, despite being less intensive for both clinicians and patients.

How GPM Works

Gunderson believed several previous approaches used to treat BPD were unhelpful. These included complicated medication regimens, repeated hospitalizations, unfocused treatments, and traditional psychoanalytic treatments.

Part of GPM involves addressing and undoing these problematic approaches. Another aspect of the treatment includes its organization around the interpersonal hypersensitivity model of BPD.

Addressing Interpersonal Hypersensitivity in BPD

People with BPD have heightened interpersonal sensitivity. Because of this, they can struggle with intense feelings that affect personal relationships, such as being quick to react in anger to perceived rejection and abandonment.

The GPM therapist teaches the patient to understand and manage their symptoms and behavior through the lens of the interpersonal hypersensitivity model. Specific BPD symptoms such as self-harming or suicidal behavior are understood as arising from experiences of connection or disconnection regarding others.

For example, a patient who perceives rejection might experience shame, despair, and then push other people away. The therapist would help the patient understand this pattern and then help him or her approach relationships and interactions differently.

Believing Most BPD Patients Get Better Over Time

Another core premise of GPM is that most BPD patients get better over time. This expectation is based on large long-term studies, such as the McLean Study of Adult Development and the Collaborative Longitudinal Study of Personality Disorders, which show that many BPD patients even improve without specialized or long-term treatment.

Gunderson believed that GPM could optimize BPD patients’ natural tendency to heal by helping them set and reach realistic goals based on BPD’s typical course of improvement.

GPM Training for Clinicians

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McLean Hospital offers training courses for clinicians, including a self-paced, 8-hour online GPM course designed for therapists, physicians, psychologists, social workers, nurses, pharmacists, and other health professionals.

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Understanding the GPM Process

General psychiatric management has a flexible approach applicable to patients in many walks of life. Because the treatment is built to be accessible to both providers and patients, it is often accessible regardless of an individual’s financial circumstances.

The GPM therapist responds to what the patient hopes to receive from treatment. They work together to incorporate the patient’s needs into treatment goals. As therapy progresses, the therapist observes if the patient is using the treatment to get better.

Although GPM sessions typically occur once per week, the therapist and patient decide how often they will meet. They discuss if contact between sessions can occur, and if so, what such communication can entail.

The GPM therapist acknowledges any limitations of therapy. They emphasize an openness to the patient’s point of view.

People with BPD often engage in all-or-nothing thinking. For example, they may see a relationship or event as all good or all bad.

The GPM therapist models a different way of viewing stressful situations by taking a “not-knowing,” curious, thoughtful stance. They encourage the patient to reflect about events rather than react impulsively.

If therapy goes well, the patient will have a corrective experience with the therapist. For perhaps the first time in their lives, they may experience a healthy, validating relationship that they can use as a model for relationships outside of treatment.

What Is BPD?

Dr. Lois Choi-Kain helps us understand borderline personality disorder

Other Core Components of GPM

Case Management

The therapist works with the patient on aspects of the patient’s life outside of treatment.

For example, the therapist checks with the patient on practical matters, such as making sure the patient has paid their rent and health insurance on time. More complex exploration of the patient’s life can only take place once the patient masters more basic tasks.

Education

The therapist discusses the BPD diagnosis with the patient in the same way a doctor provides information about any newly diagnosed medical condition. This includes the role of genetics and environment in causing and maintaining BPD, the typical course of improvement over time, and available evidence-based treatments.

Psychoeducation empowers the patient through learning what causes, maintains, and improves symptoms. They learn their condition is not their fault. They become interested in their diagnosis and hopeful about the potential to feel better.

Goals

Patients are expected to engage in meaningful activities, such as schoolwork, volunteer activities, and hobbies. Because people with BPD tend to have intense interpersonal relationships, GPM prioritizes such goals over romantic pursuits according to the principle “work before love.”

Meaningful activities, and the structuring of the patient’s time around them, are stabilizing. Once a patient is managing stable employment, getting along with colleagues, maintaining a schedule, and keeping consistent friendships, they can open themselves up to the more complicated and intense realm of romantic relationships.

Accountability

Patients are expected to be active participants in treatment. They assume responsibility for their safety and quality of life, though they are encouraged to reach out to the GPM therapist when they need it.

Flexibility

GPM pulls in aspects of other treatments that may work for the individual patient. For example, if the therapist believes the patient would benefit from elements of a 12-step program, cognitive behavior therapy (CBT), or DBT, they can bring these into the treatment plan.

Common combinations include GPM individual sessions plus a DBT skills group, a mentalization group, and peer support groups where those may be available.

Family Involvement

GPM distinguishes different types of family involvement from family therapy. Family involvement is helpful for most patients’ situations. In family involvement, the therapist provides education and coaching for the parents’ relationships with each other.

In family therapy, patients and family members work on emotional stability. Family therapy is helpful once patients gain greater independence from their family members.

McLean Is Here To Help

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McLean is a leader in the treatment of borderline personality disorder. Call us today at 877.372.3068 to find the care you or a loved one needs.

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Who Benefits From GPM?

Many people with a diagnosis of borderline personality disorder can benefit from treatment through general psychiatric management. GPM allows for BPD patients to find stability in many parts of their lives, including work, interpersonal interaction, and in their sense of self.

In recent years, GPM has shown promise in treating patients with other mental health concerns.

According to a 2018 article in Psychodynamic Psychiatry, clinical experience has shown that GPM can benefit patients with narcissistic personality disorder.

In addition, a 2021 article in Personality and Impulse Control Disorders outlines how general mental health clinicians can use GPM to treat obsessive compulsive personality disorder.

As more clinicians learn GPM, more patients with BPD and other disorders can receive the treatment they need.

Find a GPM Therapist

More mental health professionals are learning GPM. If you are seeking therapy for BPD, ask prospective therapists if they received training in GPM or another BPD treatment.