ACT and IPT Treatment Planning for Borderline Personality Disorder
This paper presents a clinical case study of Jen, a 19-year-old presenting with behaviors consistent with a tentative diagnosis of Borderline Personality Disorder (BPD) and possible Post-Traumatic Stress Disorder stemming from childhood abuse. The paper covers diagnostic reasoning using DSM-5 criteria, an analysis of client characteristics and intervening variables, and the formulation of short- and long-term therapeutic goals. Two theoretical orientations—Acceptance and Commitment Therapy (ACT) and Interpersonal Therapy (IPT)—are applied to develop structured treatment plans addressing Jen's trauma history, risky behaviors, interpersonal deficits, and difficulties with emotional regulation and self-direction.
- Diagnosis: Tentative BPD and PTSD diagnosis with DSM-5 criteria
- Client Characteristics and Intervening Variables: Background gaps, risks, and social context
- Therapeutic Goals: Short- and long-term treatment targets for Jen
- Theoretical Orientations: Rationale for combining ACT, IPT, and DBT
- Treatment Plan: IPT: Phased twelve-week interpersonal therapy plan
- Treatment Plan: ACT: Mindfulness and values-based ACT intervention plan
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What makes this paper effective
- It moves logically from diagnosis through goal-setting to treatment, mirroring the real clinical workflow and giving the argument a clear, professional structure.
- Diagnostic claims are tied directly to DSM-5 criteria and supported by secondary sources (Koerner, Lazarus et al.), demonstrating evidence-based reasoning rather than unsupported assertion.
- The paper maintains a consistently non-judgmental clinical tone, modeling the therapeutic stance it recommends for the client.
Key academic technique demonstrated
The paper demonstrates integrative clinical reasoning: it does not simply describe two therapies in isolation but explains why ACT and IPT complement each other for this specific client profile, and how both can interface with DBT. This technique—selecting and justifying a combination of evidence-based modalities for a complex presentation—is a core graduate-level clinical skill.
Structure breakdown
The paper opens with a brief case vignette before moving through six named sections. The Diagnosis section establishes the tentative BPD framework. Client Characteristics identifies gaps in clinical knowledge. Therapeutic Goals separates short-term stabilization targets from long-term developmental aims. Theoretical Orientations justifies the dual ACT/IPT approach. The final two sections translate those orientations into concrete, phased treatment plans, each organized around the same short-term/long-term goal structure introduced earlier.
Diagnosis
Jen is a 19-year-old female of mixed ethnic background. When asked about her therapeutic goals, she states that she wants to "get over" the physical abuse she experienced from her mother's ex-husband, her stepfather. In her third therapy session, she abruptly claims that she may not continue with therapy because she is just "therapist shopping."
Also in this session, Jen mentions for the first time that she works as an exotic dancer. She asks with a belligerent tone, "You don't have a problem with that, do you?" Without waiting for a response, Jen quickly defends herself: "I love my work. I make so much money. There is nothing else I can do to make this much money. All my friends work harder than I do but they make less than me! I not only pull in what I make from dancing and tips, but I also sell drugs out of my house — it's like the perfect job. And I am practically getting paid to get high or drunk or whatever. And there's no one telling me what to do or how late I can stay out. It's really a dream job for me."
When asked whether she is in any relationships, Jen laughs and says, "Um, yeah, I go home with at least half the guys I meet at the club. No relationship needed, no strings attached, no ball and chain for me."
Because of her unwillingness to commit to a therapist — evidenced by her avowed "therapist shopping" — her persistent self-destructive behavior such as high-risk sex, and her general recklessness, the most appropriate DSM-5 diagnosis for Jen at this time is Borderline Personality Disorder (BPD). This remains a tentative diagnosis until more can be learned about her. She may also be experiencing Post-Traumatic Stress Disorder, as she admits to having experienced systematic abuse from her stepfather.
Jen currently meets several of the criteria for Borderline Personality Disorder (APA, 2016). The first is self-direction issues: her goals, aspirations, and career plans center on exotic dancing and selling drugs, which is not a sustainable plan and reveals a troubled sense of identity and self-concept. Second, Jen exhibits impairments in interpersonal functioning with respect to intimacy. Her relationships can be described as "intense, unstable, and conflicted," likely rooted in her abusive childhood (APA, 2016). Furthermore, Koerner (2012) points out that childhood sexual abuse is a "prototypical invalidating environment related to borderline personality disorder," with invalidation as its cornerstone, leading to emotion dysregulation (p. 7).
Jen's negative affect has yet to be fully determined but should emerge if she chooses to continue therapy. She does appear to exhibit separation insecurity, fearing the loss of her autonomy — which is why she clings to her job as a source of freedom. As she puts it, "no one can tell me what to do." Although the therapist has not yet witnessed hostile behavior, this should be explored in future sessions. Jen has not yet admitted to having suicidal thoughts or having attempted suicide.
Jen's disinhibition, however, is evident. She has demonstrated relative impulsivity — taking strangers home from the club and shopping around for therapists. She also takes considerable risks in her work, engaging in unsafe sex and allowing men into her home while intoxicated, leaving herself extremely vulnerable. She also sells drugs from that home, which means these men could take further advantage of her by robbing her. Future sessions should reveal how long these patterns have persisted and whether they constitute chronic issues.
References
American Psychiatric Association (APA, 2016). Diagnostic and statistical manual of mental disorders. Retrieved from http://www.psi.uba.ar/academica/carrerasdegrado/psicologia/sitios_catedras/practicas_profesionales/820_clinica_tr_personalidad_psicosis/material/dsm.pdf
Baer, R. A. (2006). Mindfulness-based treatment approaches. London: Elsevier.
Hayes, S. C., & Lillis, J. (2012). Acceptance and commitment therapy. Washington, DC: APA.
Koerner, K. (2012). Doing dialectical behavior therapy. New York: Guilford Press.
Lazarus, S. A., Cheavens, J. S., Festa, F., & Rosenthal, M. Z. (2014). Interpersonal functioning in borderline personality disorder: A systematic review of behavioral and laboratory-based assessments. Clinical Psychology Review, 34(3), 193–205.
Morton, J., Snowdon, S., Gopold, M., & Guymer, E. (2012). Acceptance and commitment therapy group treatment for symptoms of borderline personality disorder: A public sector pilot study. Cognitive and Behavioral Practice, 19(4), 527–544.
Welch, S. S., Rizvi, S., & Dimidjian, S. (2006). Mindfulness in dialectical behavior therapy (DBT) for borderline personality disorder. In R. A. Baer (Ed.), Mindfulness-based treatment approaches. London: Elsevier.
Weissman, M. M., Markowitz, J. C., & Klerman, G. L. (2007). Clinician's quick guide to interpersonal psychotherapy. New York: Oxford University Press.
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