This chapter reviews components of the major models of borderline personality disorder (BPD) with respect to empirical support and an emphasis on the dialectical behavior therapy (DBT) model. It discusses how theoretical mechanisms of BPD may interfere with empirically supported treatments and outcomes, and provides clinical recommendations for how to adapt treatment in response to these factors. Efficacious treatments for BPD exist in the form of DBT, as well as mentalization therapy and other psychodynamic approaches, skills-based training, and cognitive models. These treatments themselves are often adaptations of models that were developed for psychopathology more generally but that needed modification to treat the high severity and risks associated with BPD. Emotion dysregulation and skills deficits are likely major mechanisms of BPD pathology. These problems regularly cause strife for the suffering individual in their daily lives and, thus, it can be expected that they will also cause problems in the context of treatment as well.