Group Counseling for Borderline Personality Disorder and Major Depression

Group counseling can be an important part of treatment for people living with borderline personality disorder (BPD), major depression, or both, but the phrase “group therapy” covers many different approaches. A skills group for BPD is not the same as an open-ended support group, and treatment for depression may focus on different goals than treatment for BPD. Current psychiatric guidance emphasizes something more important than choosing a group simply because a diagnosis is present: treatment should be structured, person-centered, evidence-based, and matched to the individual’s symptoms, risks, co-occurring conditions, goals, and preferences. The American Psychiatric Association’s updated guideline for BPD recommends a structured psychotherapy with support in the literature that targets the core features of the disorder. The National Institute of Mental Health similarly describes psychotherapy as the primary treatment for BPD and notes that therapy can occur individually or in group settings. For depression, psychotherapy—including cognitive behavioral therapy (CBT) and interpersonal therapy (IPT)—is also a standard treatment option and may be delivered individually or in groups. This guide explains how group counseling can fit into care for BPD and major depression, what different groups are designed to accomplish, how clinicians manage safety and co-occurring problems, and what patients can look for when evaluating a program. It is general educational information, not a diagnosis or treatment plan for a particular person.

The National Institute of Mental Health — Borderline Personality Disorder explains that BPD involves persistent difficulty regulating emotions, self-image, behavior, and relationships but can improve with treatment. The National Institute of Mental Health — Depression describes major depression as a condition involving persistent mood and functional symptoms, while National Institute of Mental Health — Psychotherapies outlines how evidence-based talking therapies can address symptoms, coping patterns, relationships, and behavior.

Understanding BPD and Major Depression Together

Borderline personality disorder is a mental health condition involving persistent difficulty with emotional regulation, relationships, self-image, and impulsivity. Symptoms vary substantially from one person to another. Common features may include: intense and rapidly changing emotions; strong sensitivity to rejection or abandonment; unstable or conflict-filled relationships; uncertainty about identity or self-image; impulsive behavior; chronic feelings of emptiness; intense anger; self-harm or suicidal behavior in some people; stress-related dissociation or suspiciousness in some cases. BPD should not be reduced to stereotypes such as “manipulative,” “attention-seeking,” or “impossible to treat.” Modern evidence shows that many people improve substantially with appropriate care, and symptoms can become less severe over time. Understanding Major Depression. Major depressive disorder involves more than temporary sadness. It can affect mood, motivation, concentration, sleep, appetite, energy, self-worth, and the ability to function at work, school, or home. Symptoms may include: persistent sadness, emptiness, or irritability; loss of interest or pleasure; fatigue; sleep changes; appetite or weight changes; difficulty concentrating or making decisions; feelings of worthlessness or excessive guilt; slowed or agitated behavior; thoughts of death or suicide. Depression treatment may include psychotherapy, medication, or both. For some people whose symptoms do not respond sufficiently, other treatments may be considered by specialists.

Can BPD and Depression Occur Together?. Yes. NIMH notes that people with BPD may also experience depression, anxiety disorders, post-traumatic stress disorder, substance use disorders, eating disorders, and other conditions. Co-occurring depression can complicate treatment because some symptoms overlap. Hopelessness, social withdrawal, self-criticism, impulsivity, emotional pain, and suicidal thoughts can have several possible causes. A clinician needs to understand which symptoms are part of BPD, which reflect a depressive episode, and which may be related to trauma, substance use, bipolar disorder, physical illness, medication effects, or other conditions. This is one reason a full psychiatric assessment is more useful than choosing treatment based on a label alone. The current American Psychiatric Association — Treatment of Patients With Borderline Personality Disorder guideline recommends a structured psychotherapy approach supported by the literature and targeted to the core features of BPD. The American Psychiatric Association — Updated BPD Practice Guideline also emphasizes comprehensive assessment, a person-centered treatment plan, collaborative discussion of diagnosis and treatment, and careful review of medications and co-occurring conditions.

What Current Guidance Recommends for BPD Treatment

The American Psychiatric Association published an updated BPD practice guideline in 2024, with current resources maintained through 2026. Among its central recommendations are: a comprehensive initial assessment; assessment of suicide, self-injury, and aggressive-behavior risk; a documented, comprehensive, person-centered treatment plan; collaborative discussion and psychoeducation about the diagnosis and treatment; a structured psychotherapy supported by the literature that targets the core features of BPD; careful review of co-occurring disorders and previous treatment before adding medication; using medication, when indicated, as an adjunct aimed at specific measurable symptoms rather than as the primary treatment for core BPD symptoms. APA also emphasizes that several structured psychotherapies have evidence of benefit and that no single psychotherapy emerged as the universal “gold standard” for every person.

Why Group Therapy Can Be Useful

Many of the difficulties addressed in BPD and depression occur in relationships and daily life. A well-run group creates a structured environment in which participants can learn skills, observe patterns, receive feedback, and practice interacting differently. Potential benefits include: reducing isolation; learning that others experience similar emotional struggles; practicing communication and boundary-setting; learning emotional-regulation skills; developing problem-solving strategies; receiving constructive feedback; practicing coping skills before using them in high-stress situations; building accountability for treatment goals. But group therapy is not automatically appropriate simply because someone has BPD or depression. The type of group, level of structure, current safety needs, cognitive capacity, substance use, and ability to participate without harming oneself or others all matter.

DBT Skills Groups for BPD

Dialectical behavior therapy (DBT) was developed specifically for people with BPD and chronic suicidal or self-harming behavior, although it is now used in other clinical contexts as well. A comprehensive DBT program commonly includes more than a weekly group. Depending on the program, it may involve individual therapy, skills training, between-session coaching, and a therapist consultation team. DBT skills are commonly organized into areas such as: Mindfulness. Learning to notice thoughts, emotions, sensations, and surroundings without immediately reacting to them.

Distress tolerance. Surviving intense crises without making the situation worse through impulsive or self-destructive actions. Emotion regulation. Understanding emotional vulnerability, recognizing patterns, and using strategies that reduce extreme swings and ineffective responses. Interpersonal effectiveness. Asking for needs, setting boundaries, maintaining self-respect, and navigating relationships more effectively. A DBT skills group is usually more structured than a traditional process group. Participants learn and practice specific skills rather than simply discussing whatever happened during the week.

CBT and Interpersonal Approaches for Depression

Cognitive behavioral therapy focuses on relationships among thoughts, behavior, emotions, and environment. In depression, people may withdraw from meaningful activities, interpret experiences through strongly negative assumptions, and lose sources of reinforcement that previously supported mood. Group CBT may address: behavioral activation; identifying unhelpful thinking patterns; testing beliefs against evidence; problem solving; sleep and routine; relapse prevention; communication and coping skills. Participants benefit not only from the therapist but from seeing how other people recognize and challenge similar patterns. Interpersonal Therapy for Depression. Interpersonal therapy focuses on the relationship between mood and interpersonal events. It can be especially relevant when depression is associated with grief, conflict, role transitions, or social isolation. In group formats, participants may work on communication, changing relationship patterns, building social support, and responding to life transitions. For someone who has both BPD and depression, the treatment plan must account for the broader pattern of emotional and relationship instability rather than assuming depression-focused group work alone will address BPD’s core features.

Skills Groups, Process Groups, and Program Design

Neither format is universally superior. The right choice depends on the treatment model and the person’s needs.

Group Therapy Should Sit Inside a Broader Treatment Plan

For BPD, a standalone unstructured group may not provide everything a person needs. Structured evidence-based treatment often includes individualized assessment, crisis planning, monitoring of self-harm or suicide risk, and coordination of co-occurring conditions. If a person is in a DBT program, for example, the skills group may be only one component of the model. Individual therapy may address life-threatening behavior, therapy-interfering behavior, and individualized treatment goals. People considering a group should ask what treatment model it uses and how the group connects with individual care.

Managing Suicide, Self-Harm, and Substance-Use Risk

BPD and major depression can both be associated with suicidal thoughts and behavior. Any group serving these populations needs a clear approach to safety assessment and crisis response. A group is not a substitute for emergency care. If a person has an immediate intention to harm themselves, cannot remain safe, or is experiencing a psychiatric emergency, urgent individualized assessment is necessary. A robust treatment program may include: routine risk assessment; an individualized safety or crisis plan; clear instructions for after-hours emergencies; coordination with prescribers and other clinicians; protocols for escalating care when risk rises.

In the United States, people in suicidal crisis can call or text 988 for the Suicide & Crisis Lifeline. In immediate danger, emergency services should be used. Substance Use Needs to Be Addressed Directly. BPD and depression can co-occur with alcohol or drug problems. Substance use may intensify impulsivity, worsen mood, interfere with medication, increase suicide risk, and make it harder to use therapy skills. A treatment plan should not assume the substance problem will simply disappear if mood improves. Some people need integrated treatment that addresses both mental health symptoms and substance use. Group programs differ in whether they require abstinence, allow participation while someone is working toward reduction, or coordinate with a separate substance-use program. Expectations should be clear before treatment begins.

Medication, Polypharmacy, and Co-Occurring Conditions

Medication has a different role in BPD and major depression. For major depression, antidepressant medication is an established treatment option, often used alongside psychotherapy, especially for moderate or severe episodes depending on clinical circumstances. For BPD, the APA guideline does not support medication as a treatment for the core disorder in the same way psychotherapy is. If psychotropic medication is used, APA suggests it should be targeted to a specific measurable symptom, time-limited where appropriate, and adjunctive to psychotherapy. Co-occurring conditions such as major depression may independently justify medication. This is why medication review matters when BPD and depression occur together: the clinician needs to know which condition or symptom each medication is intended to treat. Polypharmacy Deserves Careful Review. People with complex psychiatric histories can accumulate medications over time as different symptoms appear. APA recommends regular medication reconciliation for BPD, including reassessing effectiveness and whether some medications can be tapered or discontinued. Patients should not stop psychiatric medicines abruptly without medical guidance. The purpose of review is to ensure every medication still has a clear role and that risks, side effects, interactions, and benefits remain acceptable.

Family Support, Confidentiality, and Group Boundaries

BPD can place substantial stress on families and close relationships. NIMH notes that caregivers and relatives may benefit from education or therapy that helps them understand the disorder and respond more effectively. Helpful family goals can include: learning about BPD without stigmatizing the person; using validation without reinforcing harmful behavior; setting consistent boundaries; understanding crisis plans; improving communication; protecting caregiver well-being. Family involvement should be individualized. Not every family relationship is safe or appropriate to include in treatment.

What Makes a Group Therapeutic Rather Than Harmful

Groups serving people with significant emotional vulnerability need more than a circle of chairs and a facilitator. Important features include: a licensed or appropriately trained clinician; a defined treatment model; screening before admission; clear confidentiality expectations; rules about threats, harassment, intoxication, and disruptive behavior; a plan for crisis escalation; appropriate group size; consistent attendance expectations; coordination with individual treatment when needed. Peer support is valuable, but clinical group therapy and informal peer support are not interchangeable.

Confidentiality in Group Therapy. Licensed clinicians have professional and legal confidentiality duties, subject to exceptions such as imminent safety concerns and other reporting requirements. Other group members, however, are not necessarily bound in exactly the same way as a clinician. Programs normally establish rules requiring members to keep personal information private, but participants should understand the practical limits. A therapist should explain confidentiality and its exceptions before group participation begins. How Group Dynamics Can Help People With BPD. BPD often involves intense interpretations of interpersonal events. A delayed reply may feel like abandonment. Neutral feedback may feel rejecting. Conflict may quickly become overwhelming. A structured group can create opportunities to notice these patterns in real time and try different responses. With skilled facilitation, participants can practice:

checking assumptions; tolerating disagreement; asking for clarification; setting boundaries; repairing conflict; recognizing another person’s perspective; remaining in the relationship without escalating or abruptly withdrawing. This interpersonal learning can be one of the group format’s greatest strengths. How Group Therapy Can Help Depression. Depression often creates a self-reinforcing cycle: low mood reduces activity and social contact, which reduces rewarding experiences and support, which can deepen low mood. Groups can interrupt that cycle by creating regular structure and contact. Participants can set behavioral goals, observe how depression affects others, share problem-solving strategies, and practice re-engagement. However, a person who is severely depressed, psychotic, manic, medically unstable, intoxicated, or at acute suicide risk may need a different level of care before a routine outpatient group is appropriate. What treatment model does the group use?; Is it designed specifically for BPD, depression, or a broader population?; Who leads the group, and what training do they have?; Is there an intake assessment?; How are suicide and self-harm risks managed?; Is individual therapy required or recommended?; How does the program handle substance use?; How long does the program last?; Is the group open, with members joining at any time, or closed as a cohort?; What are the confidentiality expectations?; How is progress measured?. Warning Signs of a Poorly Designed Program. Be cautious if a program: claims one technique cures every person with BPD; discourages appropriate psychiatric or medical care; uses humiliating or confrontational methods; has no safety protocol; provides no information about clinician qualifications; makes medication changes without an appropriate prescriber; treats BPD as a moral defect; encourages dependency on the group or therapist; cannot explain how treatment goals are evaluated.

Measuring Progress and Choosing a Program

Improvement should not be judged only by whether a person “feels better” after a session. Depending on treatment goals, progress may involve: fewer self-harm episodes; reduced suicidal behavior; less severe depressive symptoms; better emotion regulation; improved attendance at work or school; less substance use; more stable relationships; better use of coping skills; fewer emergency or inpatient episodes; greater ability to pursue personal goals. APA encourages person-centered planning, which means the patient’s own goals should be part of how treatment success is defined. Recovery Is Possible. One of the most damaging myths about BPD is that it is untreatable. Contemporary guidance rejects that view. Many people experience substantial symptom reduction and improved functioning with structured psychotherapy and sustained treatment. Progress is rarely perfectly linear. Stress, relationship changes, trauma reminders, physical illness, or major life transitions can temporarily intensify symptoms. A setback does not mean therapy has failed. For depression, recurrence is also possible, which is why relapse-prevention skills, ongoing monitoring, and early response to returning symptoms are useful.

Conclusion

Group counseling can be a valuable component of treatment for borderline personality disorder and major depression when it is structured, clinically appropriate, and connected to a broader individualized treatment plan. For BPD, evidence-based psychotherapy is the core treatment, and group formats are often used to teach and practice skills or address interpersonal patterns. For depression, group CBT, interpersonal approaches, and other structured psychotherapies can reduce isolation and help people change patterns that maintain depressive symptoms. The most important decision is not simply whether to “join a group.” It is whether the group uses a credible model, addresses the person’s actual needs, has strong safety procedures, and coordinates appropriately with individual therapy, medication management, substance-use treatment, or higher levels of care. BPD and depression are serious conditions, but they are treatable. A well-designed group can provide skills, perspective, accountability, and connection—while a comprehensive treatment plan ensures that the individual remains more than a diagnosis in a room full of people with similar labels.