I’m a client and have some experience with this. I will say that a good therapist will never try to become a pwBPD’s “favorite person” as that would likely fall outside of the therapeutic boundaries and cause harm to the client, not to mention it wouldn’t be pleasant for the therapist either.
With that said, I believe any therapist who is going to treat someone with BPD, or even someone with some BPD adaptations, needs to really understand the whole concept of “favorite person,” both how that works in general and how that is playing out for the client in front of him.
I would also recommend that all therapists educate themselves on that concept so they know what to look for in case they do have a client with those adaptations who does not know it or hasn’t been diagnosed. I got my own education on the concept right here on Quora, so I guess that would be a place to start, and there are probably academic papers about it too that psychotherapists can read and talk to each other about. As for learning about it from their clients, I would recommend pay special attention to what the client says about her one on one relationships and keep an ear out for any sort of repeating cycles. Of course, the “favorite person” phenomenon plays out differently for each affected client, but the general story goes something like this: client encounters a person and has very positive interaction, client and same person have another positive interaction and client begins to view that person as special, client then latches onto that person, trying to create intense moments they can share (and the context can be quite varied), “favorite person” starts feeling uneasy about the interactions, like maybe something is being taken from him, “favorite person” begins to distance from the client, client responds by some version of clinging tighter or causing some kind of drama, or turning on and discarding “favorite person.” I think that cycle will vary from client to client, but for a particular client it likely repeats itself. If what the therapist is seeing seems to match what he knows about the “favorite person” phenomenon, then he can be prepared to address various aspects of it as seems right in the course of treatment.
Here is the tricky part, though. Much of this is taking place outside of the conscious awareness of the client, so the therapist can have lots of fun figuring out how to gently bring that to consciousness, support the client in being made aware of it in herself.
The other tricky part is that any client awareness of what is going on there is likely to be very closely intertwined with intense shame and fear of abandonment. And by intense, I really mean epic, my entire world is about to fall apart intense! It will feel horrendously humiliating to the client to be outed or busted in any way, and even if the client outs herself, it’s still a humiliating experience. The therapist needs to be very sensitive to that and really affirm the client’s courage and integrity and whatever good qualities the client sees in herself and is most proud of. It is a monumental step to bring any of this to the light and demonstrates an intense commitment to healing on the part of the client.
It’s important for the therapist to know what it is the client is trying to accomplish through this whole “favorite person” business. The summary is that the client is trying to recreate and fulfill the early parent-child bond that she didn’t receive, or received in some kind of incomplete way. This could also be a very good conversation to have with the client on what it is she’s looking for. If all that can be broken down into specific components, the therapist and client will find that some of those things can be provided in the normal course of therapy. They include things like unconditional positive regard, deep listening, empathy and compassion, to name but a few. Therapists can absolutely offer all that and be quite generous with what they offer in session. A number of other things will have to do with transference and all therapists should have a working knowledge of how to handle that and absolutely not make any of it about them, but about exploring the client’s feelings.
So, in a way, the therapist can provide most, if not all, of what the client is trying to more underhandedly extract from a “favorite person.” The difference is that the therapist will be providing it as a therapist and as such doing it in a very transparent manner and with appropriate therapeutic boundaries, which have to be iron clad firm but not conspicuous. Another key difference is that through the work, the therapist and client are intentionally moving towards a time when the client does not need to get it from the therapist or a particular person. The client will be learning how to apply boundaries of her own, make and keep friends, have healthy relationships at home and at work, give and receive support in all the appropriate ways. That modeling of healthy relationships starts in therapy and then gets expanded out as the client makes progress. So I think there is probably a trend where the therapist is providing a lot of those supports early on in the relationship but gradually provides less and less as the client is able to meet those needs more in the course of normal life. But I’m not really sure how that works as I’m not a therapist.
On a related note, I’ve noticed hanging out here on Quora that it seems a lot of therapists are really spooked by BPD, even to the point where they don’t want to touch a client who has that diagnosis. I find that unfortunate because it stigmatizes and pathologizes what these afflicted people are doing rather than attending to the intentions and unmet needs behind the troubling behaviors. I can understand the hesitation if the pwBPD is especially low functioning and causes chaos and drama and destruction wherever she goes. That may take some more specialized treatment than what most psychotherapists can provide. However, it is my belief that for every person who actually has a clinical diagnosis of BPD, there are hundreds who have been suffering quietly with it, possibly for years. Some of those people eventually wind up in therapy and it may not be “discovered” until therapy has been underway for a while. In that case, the therapist is kind of stuck with it like it or not. The client already has a relationship with that therapist and I will say right here that it will cause the client harm if the therapist drops her claiming to not have what it takes to treat BPD. By virtue of the relationship, he has what it takes to treat that particular client and has already been treating her. I would say the BPD coming to light is likely a direct result of the success of therapy so far, which means that therapy should by all means continue.
So I would advocate for all therapists educating themselves about BPD and especially the favorite person concept so they can be of help to affected clients. Don’t hide behind, “I don’t treat BPD.” Odds are good that if you have enough clients to consider yourself to be working full time, you probably already are treating someone or even several people with BPD adaptations and you just don’t know it. I hope that what I have written here can provide some valuable insight into how you’re going to approach your own continuing education for the sake of your present and future clients.