Values are closely linked to emotions and patients with BPD experience significant fluctuations in their emotions. Psycho-education about the hierarchy, proximity, and temporality of values offers an opportunity to reduce impulsivity and increase hope.

Most effective forms of therapy address personal agency. For this, the clinician needs to create a non-blaming, non-judgemental, and compassionate milieu which can enable the patient to take responsibility for their actions. Values-based interventions can improve agency, increase motivation, and help the patient find meaning, which is negatively associated with depression, suicidality, and self-harm. Early empirical evidence supports the usefulness of working with the patient’s values in therapy using acceptance and commitment therapy (ACT), a modality that focusses on acting in accordance with one’s stated values. Empirical evidence from longitudinal observation suggests that an increase in agency in the patient’s life narrative is part of the recovery process.

Patients with BPD follow a different path in terms of recovery. Patients often find the word ‘recovery’ problematic and many feel that ‘discovery’ describes their journey more accurately. A significant proportion of people with BPD feel that they are not ill in the same way as people with other major mental illnesses but that they need help and support.

The person’s values determine the meaning structure of the world they live in and drive their actions. The depressed patient’s values tend to change dramatically over the weeks and usually return to normal. At the height of their illness, patients can constantly feel that they are transgressing important personal and group values.

Examining the values at play is similar to creating a map with three dimensions: (1) the level of organization/proximity to primary stakeholders; (2) the hierarchy; and (3) the temporality of values. The patient’s values can be misaligned with those of others temporarily owing to the illness, and value-mapping can facilitate realignment. Changes in value hierarchy are often necessary for recovery. These changes can be dramatic and can happen at a faster pace whilst the person is becoming ill and during recovery.

The patient can be temporarily cut off from the values they would normally hold. Besides records of their former wishes and collateral information, sources of knowledge about value changes include peer support workers, first-hand narratives, philosophical and social scientific studies, media reports, and art portrayal of depression. Changes in one’s life narrative are also essential for recovery and resilience. The patient’s social environment, including the professionals, can facilitate (or hinder) this.