The authors researched individual psychotherapy of borderline personality disorder (BPD) in Japan using a questionnaire given to expert therapists. To select the expert therapists, a database search for the keywords "borderline personality disorder" and "border-line case" was carried out in the Japanese literature on psychiatry and clinical psychology. Thus, 280 expert therapists, who were authors of articles related to the psychotherapy of BPD, were selected. Qestionnaires on individual psychotherapy of BPD were sent to them, and 128 responses were obtained. About 60% of these therapists were performing structured individual psychotherapy. This was about half of the psychiatrists and almost all of the clinical psychologists. Most of the structured psychotherapy was performed once a week, with 50 minute sessions. But there also were biweekly, 30-39 minute, 40-49 minute, and 20-29 minute sessions. The basic therapeutic methodology was psychoanalytic psychotherapy, supportive psychotherapy, and eclectic therapy, with each of them constituting about one third of the total, in this order of percentage. In the case of structured individual psychotherapy, what the majority of the therapists performed is as follows. They talked about therapeutic goals. When talking about therapeutic goals, the focus was on realistic issues such as improving social adaptation, controlling impulsive behavior or reducing the symptoms. In the face of self-harm behavior, they talked about the meaning and the utility of self-harm behavior, listened to the progression of the episodes, or said it was definitely not a good thing to do. If the self-harm behaviors were repeated, they told the patients that it was necessary for them to be confined to the closed-ward, or told them that the continuation of psychotherapy might become difficult. When there was intense anger toward the therapists, they validated the rightful parts of it. Concerning the anger and depression of the therapists, they restrained their feelings and considered them later, talked about it with their colleagues and experts, or communicated to the patients their honest feelings. In the case of frequent telephone calls, they told their patients to reduce their calls as much as possible, but when the calls came, talked with them briefly. Or they allotted the times the patients could make a call. Disclosure of the private information of the therapists was not done at all, or was done sometimes according to the situation. They actively talked about the limitations of the therapists and the patient-therapist relationship. They appreciated and praised the achievements of the patients. They talked about the termination of the psychotherapy. When they happened to meet the patients outside of the therapy, they responded to the patients only when they were addressed, or they addressed the patients by themselves but just briefly. The clinical situation of the BPD individual psychotherapy in Japan was not made clear so far. Our research clarified the situation, though there was the methodological limitation of the questionnaire research.
Seishin shinkeigaku zasshi = Psychiatria et neurologia Japonica 02/2006; 108(8):801-12.