NCT07342907

Internal Family Systems Therapy for Borderline Personality Disorder

Effectiveness of Internal Family Systems Therapy in Improving Mental Health in Individuals With Borderline Personality Disorder

• Status: Recruiting
• Phase: N/A
• Study type: Interventional
• Enrollment: 15 (estimated)
• Sponsor: Waypoint Centre for Mental Health Care · Academic / Other
• Sex: All
• Age: 18 Years
• Healthy volunteers: Not accepted

Summary

Borderline Personality Disorder (BPD) involves intense emotional ups and downs, unstable relationships, impulsivity, and a poor sense of self. These challenges often lead to addiction, self-harm, and frequent use of healthcare services. While certain treatments already in practice - such as dialectical behavior therapy - can help, they don't work for everyone or address all aspects of the disorder. This study plans to explore internal family systems (IFS) therapy, a method that views the mind as made up of different "parts" - each with its own thoughts and feelings. IFS helps people build understanding and compassion toward these parts and connect with a calmer, more centered "Self." This may be especially useful for those with BPD, who often feel fragmented and extremely critical of themselves and others. This will be the first study to examine internal family systems therapy for BPD. The participants (15 in total) will receive up to 50 individual sessions over 15 months. Changes in symptoms and overall mental health will be measured at four points during the study. People with lived experience of BPD will help shape the research to ensure it is relevant, respectful, and useful for others facing similar challenges.

Detailed description

Brief background and rationale: Borderline personality disorder (BPD) is a chronic and disabling psychiatric condition marked by pervasive affective instability, identity disturbance, interpersonal dysfunction, and impulsivity. It affects approximately 1-2% of the general population and up to 20% of psychiatric populations, contributing substantially to healthcare utilization, suicide risk, and long-term disability. Existing evidence-based psychotherapies for this condition, such as dialectical behavior therapy, mentalization-based therapy, or schema therapy show significant benefits but these are modest and these interventions are quite resource-intensive. There remains a need for additional, theoretically grounded treatments that target core pathomechanisms of BPD-particularly emotion dysregulation, shame, and self-fragmentation. Objectives: The primary objective of this pilot study is to assess preliminary effectiveness of internal family systems (IFS) therapy in reducing BPD symptom severity from baseline to post-treatment. Secondary objectives are to evaluate changes in emotion dysregulation, shame, self-compassion, interpersonal functioning, depression, anxiety, addictive behaviors and overall well-being; as well as to assess feasibility (recruitment, retention, adherence), acceptability, and safety. It is hypothesized that participants will demonstrate at least small-to-moderate improvements in BPD symptom severity, with congruent changes across secondary outcomes. Although clinical interest in IFS has grown exponentially in the past decades, empirical evaluation remains limited, and no studies to date have specifically examined its use in any personality disorder. Given the strong theoretical fit between IFS principles and BPD phenomenology, a structured pilot investigation is warranted to establish feasibility, safety, and preliminary effectiveness prior to larger controlled trials. Study design: The study will use a single-group, repeated-measures design with assessments at baseline, 4 months, 8 months, and post-intervention (12-15 months). A target sample of fifteen adults will be recruited. Inclusion criteria are age 18 or older, sufficient English proficiency for participation, and a formal BPD diagnosis confirmed by a referring clinician. Exclusion criteria include active psychosis or mania, cognitive impairment, inadequate English comprehension, or participation in another form of psychotherapy during the study period. Intervention: Internal family systems therapy, developed by Richard Schwartz, is an integrative psychotherapy that conceptualizes the mind as a system of subpersonalities ('parts') organized around a compassionate, stable core Self. The approach promotes internal harmony through increasing awareness, acceptance, and cooperation among these parts and the Self. Participants will receive weekly, one-hour IFS therapy sessions in the private mental health care setting over approximately 12 to 15 months. Treatment will be delivered by two licensed mental health professionals trained in the IFS model. Participants will pay a significantly subsidized session fee to reduce financial burden of participation in the intervention. Outcomes: The primary outcome is BPD symptom severity measured by the Borderline Symptom List-23 and its supplement. Secondary outcomes include validated measures of emotion dysregulation (DERS-18), shame and guilt (GSQ-8), self-compassion (SCS-SF), interpersonal functioning (EXIS.pers), depression (PHQ-9), anxiety (GAD-7), addictive behaviors (SSBA-G), and well-being (WHO-5). Feasibility and acceptability will be evaluated through attendance, retention, and brief structured questionnaires. Data collection and analysis: Data will be collected electronically via REDCap, using unique participant IDs and secure storage protocols. Analyses will include paired t-tests for pre-post differences and linear mixed-effects models for repeated measures across all four time points. Effect sizes will be prioritized over probability values when interpreting the results considering relatively low anticipated statistical power. Timeline: The study begins in early 2026 following ethics approval, with recruitment and intervention delivery extending through the end of 2027. Data analysis, manuscript preparation, and dissemination are planned for 2028.

Conditions

• Borderline Personality Disorder (BPD)

Interventions

Type	Name	Description
BEHAVIORAL	Internal family systems therapy	The internal family systems model was developed by Richard C. Schwartz in the 1980s. This psychotherapy is based on the assumption that the human mind is naturally multiple and consists of interacting sub-personalities ("parts"), including protective and vulnerable parts, shaped by development and adversity. All parts are assumed to have positive intentions, even when their effects are maladaptive; therapy therefore aims to transform rather than eliminate them. Internal family systems therapy further posits the existence of a core Self in every person, characterized by qualities such as compassion, clarity, and calm, which is inherently intact in each individual and capable of leading the internal system. Therapeutic change involves increasing the leadership skills of the core Self, building trusting relationships among parts and the core Self, and unburdening vulnerable parts so they can assume more adaptive roles, supporting improved emotion regulation and well-being.

Timeline

• Start date: 2026-02-01
• Primary completion: 2027-12-01
• Completion: 2028-12-01
• First posted: 2026-01-15
• Last updated: 2026-01-16

Locations

1 site across 1 country: Canada