Psychologically....BPD clients are adults stuck in children' minds and feelings. Most have been severely abused, and their thoughts, actions, and feelings reflect a tremendous amount of fear of being hurt and abandoned.

The BPD client uses defense mechanisms that "jab" at the therapist, such as projection and projective identification which constantly attribute horrible and angery thoughts and feelings at the therapist. The transferance/countertransferance reactions can be very difficult and hard. Sometimes it seems as if the BPD client is acting like the abuser is there in the room.

BPD are usually suicidal and self-harming. Therapists have to be willing to work with that. 10% of all BPD patients kill themselves and 30% if they self-harm. They are walking the lines of life and death frequently.

BPD dissociate and can get lost. Therapists have to be comfortable trying to get them back, with the risk of frightening them to death.

BPD lack understanding of boundaries. Some call constantly, show up at the office unexpectantly, do everything to get personal with the therapist. Strong boundaries are a MUST when treating a BPD.
(Many times have I refused to leave the office)

It is hard. BPD do NOT mean to behave like they do....but it is what they know. It is difficult on the therapist and requires a therapist with good training and a strong sense of self. Some T's can't deal with them.....