The present panel represents a panorama of state of the art research on mechanisms of change in psychotherapies for personality disorder, with a particular focus on borderline personality disorder. Three papers will be presented. The first proposes an overview of mechanisms of change studied in the context of transference-focused psychotherapy, the second on ways to improve the effectiveness of psychotherapy for borderline personality disorder, and the third discusses results of a randomized controlled trial on emotional processing in good psychiatric management.
1st presentation: speaker: Kenneth N. Levy
Title: Transference-Focused Psychotherapy for working with patients with Borderline and Narcissistic Personality Features
Presenter: Kenneth N. Levy
Professor and Associate Director of Clinical Training
Department of Psychology
Pennsylvania State University, PA, USA
Abstract:
Transference‐Focused Psychotherapy (TFP) is a comprehensive and ambitious evidence‐based treatment for patients with severe personality disorders such as borderline and narcissistic personality disorders (BPD and NPD). TFP is a modified and manualized psychodynamic treatment based on Otto Kernberg and colleagues’ writings on object relations theory. Its efficacy has been demonstrated in multiple studies, both regarding symptom change and changes in personality structure and has been found to have comparable results to other evidence-based treatments. As such, TFP is recognized as one of the “big five” psychotherapies for treating borderline personality disorder in several treatment guidelines and reviews. The broad goals of TFP are better behavioral control, increased affect regulation, more intimate and gratifying relationships, and the ability to achieve satisfactory life goals consistent with one’s capacities and interests. Specific goals are a reduction of the symptoms, including suicidality, parasuicidality, impulsive hostility, and angry outbursts, resulting in fewer emergency room visits, hospitalizations, and relationship difficulties. In this presentation, I will focus on presenting advances in TFP as well as recent data, with a focus on mechanisms of change in TFP treatment.
2nd presentation: speaker: Brin Grenyer
Title: How can we improve psychotherapies for borderline personality disorder? An empirical study of process-outcome links
Brin F.S. Grenyer
University of Wollongong, Australia
Abstract
Background
While recovery from personality disorder by psychotherapy treatment for is common, not all individuals improve over time, despite recieving evidence based therapy. We studied features that contribute to non-response for individuals at different stages of recovery over a longitudinal follow-up, studying previous literature and new followup data from treated patients.
Method
We began with a systematic review on the problem of non-response to psychotherapy over 28 published studies representing 2,436 participants. Then, participants with a diagnosis of BPD were followed up after one year of receiving psychological treatment (N=184). Finally, a subset was defined as those either ‘functioning well’ (n = 23) or ‘functioning poorly’ (n = 25). Participant qualitative responses were analysed thematically and via Leximancer content analysis.
Results
Non-response in the published literature is common, across high quality RCTs, controlled trials and naturalistic studies, with an overall estimate of 48.8% non-responding to therapy. Prospective longitudinal analyses of patients confirmed 48.4% non-response. Despite beginning with the same level of severity of symptoms, qualitative analysis showed how participants who were ‘functioning well’ after 12 months of therapy described meaningful relationships with others, enjoyment in vocation, and described less frequent or manageable life crises. The ‘functioning poorly’ group described relationship conflicts, vocational challenges, feelings of aimlessness and purposelessness, instability in daily living and frequent crises.
Conclusion
We conclude that non-response is often due to poor life stability, ineffective relationships and incapacity to make vocational and employment gains. This shows the centrality of working in psychotherapy to achieve the capacity to ‘love and work’ in fostering a sense of personal recovery. Treatments may need specific focus on these factors, as they appeared to reinforce symptomatic trajectories of either improvement or poor non-response to therapy.
3rd presentation: speaker: Ueli Kramer
Effects and mechanisms of change of brief psychiatric treatment for borderline personality disorder: results of a randomized controlled trial
Ueli Kramer1,2,3, Loris Grandjean1, José Blanco1, Hélène Beuchat1, Philippe Conus2, Yves de Roten1, Jean-Nicolas Despland1, Stéphane Kolly21 Institute of Psychotherapy, Department of Psychiatry, Lausanne University Clinic and University of Lausanne, Switzerland 2 General Psychiatry Service, Department of Psychiatry, Lausanne University Clinic and University of Lausanne, Switzerland 3 Department of Psychology, University of Windsor, Canada
Abstract
Background: Treatment for patients with borderline personality disorder (BPD) involves structured psychotherapy, and may involve brief psychiatric treatment as first-line intervention. No controlled study has assessed the effectiveness of such brief intervention. We still lack an understanding of how and why these effects are produced from a patient perspective, change in emotional processing being a strong candidate for mechanism of change. The present study assesses the effectiveness of brief psychiatric intervention and the role of emotional processing to explain outcomes.
Methods: The present two-arm randomized controlled study tests the effects of a brief psychiatric treatment (Good Psychiatric Management over 4 months), compared with treatment as usual. Participants (N = 80 patients with BPD) undergo assessments at three timepoints (intake, 2 months, and discharge). In addition to symptom measures, individuals undergo assessment of emotional processing using an event-based experiential task focusing on self-critical content. We hypothesize that change in emotional processing explains the treatment effects. Results: The study is currently ongoing and first results will be presented at the conference.
Discussion: The present study used an easy-to-implement treatment of BPD, and assesses emotional processing in an event-based paradigm over the course of brief treatments. It will help increase the effectiveness of brief treatments for BPD, contribute to the understanding of how these effects are produced, and help diminish the societal burden of disease related with BPD, in early stages of treatment.
Keywords: Psychiatric Treatment; Randomized Controlled Trial; Mechanisms of Change; Borderline Personality Disorder; Emotional Processing