Borderline personality disorder (BPD) presents a number of symptoms and adjustment issues for individuals, but it is also associated with a myriad of risks for the larger family system. A systemic perspective is crucial to comprehending the development of BPD. Promoting healthy relationships with one or more supportive adult enables the child to develop an identity apart from the dysfunctional system and successfully persevere in the future. Further, increasing mentalization capacities, also referred to as reflective functioning (RF), within the caregiver in relation to the child is a crucial aspect of a systemic approach. This article reviews the need for a systems perspective, including combining RF within a narrative therapy framework, when considering the development, maintenance, and prevention of BPD.