Recent clinical trials support the conclusion that patients with borderline personality disorder are best treated with structured and specifically designed forms of psychotherapy. The strongest evidence from clinical trials favors dialectical behavior therapy and mentalization-based treatment. These methods, which have several similarities, could be shortened to make them more accessible. Successful psychotherapy in individuals with borderline personality disorder should not resemble treatment as usual but should offer a predictable structure and methods to promote emotion regulation and problem solving in current life.