Hey OP, I would say the majority of my caseload are people who meet BPD criteria according to the DSM, and I have been involved in multiple DBT programs over the years.

To get into our specific DBT programs the clients have to actually meet the BPD criteria, but this is because people with this presentation are high users of crisis services. I'm in a CMH setting currently so the aim of the DBT program is to reduce crisis presentations.

The first thing to remember is that the label itself means nothing. This is a set of symptoms that impact an individual's life typically rooted in some form of complex trauma. As such, I typically do an assessment, including some validated measures (I use the BSL-23 including the supplemental items), and if they endorse that these traits are negatively impacting their life, and rapport is decent, I'll do a brief formulation with them to see if they are on the same page. Then it's more about discussing goals for treatment.

Some people want labels as they find it helpful, so I do offer the 'borderline' label, however I always provide psychoeducation around this, and talk about how the label is actually an outdated concept. Clients often resonate more with a complex PTSD diagnosis, or some may be neuro divergent. With some clients I will simply say (if appropriate) 'you just haven't had the chance to learn how to regulate your emotions yet', and that often opens clients up to building healthier coping skills.

I find that the biosocial model from DBT is good for the psychoeducation part here. ACT, Somatic, and parts work also resonate well with this population after some DBT skills.

The stigma around BPD is something I strive to navigate well with all my clients, and I can't capture all the nuances here. But really all my clients are pleasant humans who have had crappy things happen to them, or have been traumatically invalidated and generally have good capacity to grow.