Evaluating Three Treatments for Borderline Personality Disorder: A Multiwave Study
ABSTRACT The authors examined three yearlong outpatient treatments for borderline personality disorder: dialectical behavior therapy, transference-focused psychotherapy, and a dynamic supportive treatment.
Ninety patients who were diagnosed with borderline personality disorder were randomly assigned to transference-focused psychotherapy, dialectical behavior therapy, or supportive treatment and received medication when indicated. Prior to treatment and at 4-month intervals during a 1-year period, blind raters assessed the domains of suicidal behavior, aggression, impulsivity, anxiety, depression, and social adjustment in a multiwave study design.
Individual growth curve analysis revealed that patients in all three treatment groups showed significant positive change in depression, anxiety, global functioning, and social adjustment across 1 year of treatment. Both transference-focused psychotherapy and dialectical behavior therapy were significantly associated with improvement in suicidality. Only transference-focused psychotherapy and supportive treatment were associated with improvement in anger. Transference-focused psychotherapy and supportive treatment were each associated with improvement in facets of impulsivity. Only transference-focused psychotherapy was significantly predictive of change in irritability and verbal and direct assault.
Patients with borderline personality disorder respond to structured treatments in an outpatient setting with change in multiple domains of outcome. A structured dynamic treatment, transference-focused psychotherapy was associated with change in multiple constructs across six domains; dialectical behavior therapy and supportive treatment were associated with fewer changes. Future research is needed to examine the specific mechanisms of change in these treatments beyond common structures.
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Article: Evaluating Three Treatments for Borderline Personality Disorder: A Multiwave Study
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- "One of the key contributions of this author is the theoretical development and the clinical proposals related to the so-called " borderline personality organizations " (Kernberg et al., 2008). As a therapeutic approach to this complex clinical problem, Kernberg proposes his so-called transference-focused psychotherapy (TFP), a psychoanalytic psychotherapy, empirically validated by Doering et al. (2010) and Clarkin, Levy, Lenzenweger, and Kernberg (2007). "
ABSTRACT: Today, there are two ways of conceiving psychoanalysis, a classical one focused on the search for truth within the internal world of the patient, and a contemporary one perceiving the patient–therapist relationship as the axis of exploration. Rorty’s criterion, which divides disciplines into either truth-based or solidarity-based, may be applied to this dichotomy. These conflicting positions come from two different historical periods: the Enlightenment and the contemporary world. They inhabit a sterile environment without theoretical discussion or comparison. The Renaissance relocated man at the centre of creation and urged him to seek encounters with others as well as with the truth concealed in nature. Possibly, these elements of truth and solidarity, initially designed as complementary, integrative, and nonconflicting, can be found in the work of some psychoanalysts, specifically in Otto Kernberg’s proposals. Kernberg makes a creative integration of object relations theory, especially in its Kleinian approach, and ego psychology. In addition, Kernberg’s consideration of affects as key elements of the human’s internal world reflects a third psychoanalytical “way,” exposing the centrality of relational experiences from the earliest stages of life, alongside constitutional drive forces that link us to our biological make-up and determine much of our inner world and behaviouInternational Forum of Psychoanalysis 09/2014; DOI:10.1080/0803706X.2014.953579
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- "In an RCT (Clarkin et al., 2007; Levy et al., 2006), 90 clinically referred patients were randomized to one of the three treatments: TFP, DBT, and a psychodynamic supportive psychotherapy (SPT; Appelbaum, 2005). "
ABSTRACT: Abstract The growing number of individuals seeking treatment for mental disorders calls for intelligent and responsible decisions in health care politics. However, the current relative decrease in reimbursement of effective psychotherapy approaches occurring in the context of an increase in prescription of psychotropic medication lacks a scientific base. Using psychodynamic psychotherapy as an example, we review the literature on meta-analyses and recent outcome studies of effective treatment approaches. Psychodynamic psychotherapy is an effective treatment for a wide variety of mental disorders. Adding to the known effectiveness of other shorter treatments, the results indicate lasting change in many cases, especially for complex and difficult to treat patients, ultimately reducing health-care utilization. Research-informed health care decisions that take into account the solid evidence for the effectiveness of psychotherapy, including psychodynamic psychotherapy, have the potential to promote choice, increase mental health, and reduce society's burden of disease in the long run.09/2014; 42(3):377-421. DOI:10.1521/pdps.2014.42.3.377
- "In agreement with Bateman and Fonagy (1999), who reported significant group differences in the improvements in depression in BPD outpatients in mentalizationbased therapy, we found a significant decrease in depressive symptoms in the DST group. This contrasts with the majority of RCTs of specific BPD outpatient treatments , where no group differences in depression were reported (Clarkin et al., 2007; Doering et al., 2010; Linehan, Armstrong, Suarez, Allmon, & Heard, 1991; Linehan et al., 2006; Verheul et al., 2003). Our findings cannot be attributed to a high severity of depressive illness as Doering et al. (2010) do for the Bateman and Fonagy study, in which patients started with a BDI score of 36.0. "