The focus on this invited symposia is on organizing and delivering personality disorder services from an future-oriented and globalized perspective. Whilst research has demonstrated the effectiveness of various forms of psychotherapy for especially borderline personality disorder, much less is known empirically but of relevance to the organization and service delivery. Yet, service organization are a vital part of delivering good treatment for persons diagnosed with personality disorder. In the present symposia the talks will address many of the issues confronting service delivery from a global perspective. The talks will amongst other things address many of the wicked problems currently confronting the field, as well as issues pertaining to treatment length, and the matching of persons diagnosed with personality disorders to the optimal level of treatment.
Mickey Kongerslev: Oh, the many wicked problems confronting the field in terms of personality disorder service delivery
This talk will briefly introduce the symposia and provide an overview of the many issues confronting the organizing and delivering of personality disorder services. This is followed by three presentations:
Sebastian Simonsen: Experiences with short-term mentalization-based therapy (MBT) for borderline personality disorder: Therapist and patient perspectives
Organizing adequate evidence-based psychotherapy for patients with personality disorder poses a big challenge within the restricted resources allocated to treatment in many outpatient services. In this presentation we will present results from two different qualitative studies that were conducted within the context of a randomized controlled trial comparing a short and a long form of MBT. Analyses of qualitative interviews of twelve patients and seven therapists are presented in order to give voice to perspectives which may otherwise be overlooked if focus is only on quantitative evidence.
Results from analyses of the therapist’s experiences are presented as overall themes such as: The longer the better, change processes as intellectual or experiential and termination is more challenging in short-term MBT. Results from analyses of the patient’s experiences are presented based on overall themes such as: Too short or appropriately short, the group as a safe space and my life has changed for the better.
In short, this presentation will provide nuanced and sometimes surprising perspectives on patient’s and therapist’s perspectives on short-term treatment.
Shelley McMain: Matching Individuals with Personality Disorders to the Optimal Level of Treatment
Individuals with personality disorders, particularly those with borderline disorder, have heavy health care utilization including high rates of emergency department visits and inpatient hospitalizations. In addition to theoretical differences, evidence-based therapies for personality disorders differ in terms of duration, format and intensity. Although access to effective psychotherapy has improved in the past three decades, the demand for treatment exceeds available resources. Within the current climate of rising health costs and limited resources, there is a need to improve the organization of treatment services for individuals with personality disorders. Staged care and stepped care are recommended models are designed to achieve optimal treatment while making the best use of available resources. Decisions about how to match patients to optimal care requires an understanding of the factors linked to prognosis and treatment response. An emerging body of research is focused on identifying potential moderators of treatment response. This presentation will review the evidence related to moderators of response to psychosocial treatments including the selection of specific models and duration of treatment. As well, this presentation will discuss the implications of this research and how it may guide treatment selection and inform the organization of treatment services for individuals with personality disorders.
Louise McCutcheon: Implementing personality disorder services for young people is everyone’s business
Personality disorder has its peak incidence between puberty and young adulthood (young people aged 12-25 years). By any measure, it is among the most severe mental health problems occurring in young people, uniquely predicting severe current problems and acting as a ‘gateway’ to diverse and serious future problems. Yet, personality disorder still struggles for legitimacy, being either ignored or addressed in isolation from other mental health problems or the broader needs of young people as they transition to adulthood. Despite major advances in early detection and treatment for personality disorder the youth mental health field has been slow to embrace this knowledge and to implement it practice, and the personality disorder field has been slow to embrace the concept of youth mental health. The challenges of early identification, discrimination, parity of access to treatment, research translation, innovation, and functional recovery are best addressed through reforms to mainstream youth mental health systems globally to deliver parity of access to comprehensive, timely and effective treatment.
After the presentations professor Anthony Bateman will act as discussant.