BPDFamily.com

While I'm not around here as much anyone, since I've been split with my BPD exw for almost 4 years, I still do keep abreast of developments in the field, if only because of my daughter. There was this recent study (see www.jamanetwork.com/journals/jamapsychiatry/article-abstract/2605200 (http://www.jamanetwork.com/journals/jamapsychiatry/article-abstract/2605200)) where they looked at all of the studies of therapy with BPD.  

The secret sauce with this therapy appears to be manualization of the therapy.  
In plain English, it means that the best treatment for BPD was the enforcement of clear rules and regulations.  I know it works in my experience with my BPD exw, and it's backed up with data.  

You HAVE to put your foot down.

Is it painful?  YES.  

Does she not really comprehend what she's doing?  Probably not, at least until she seeks professional help.  

However, you have to take care of yourself.  Nothing more or less.  She doesn't have the right to your feelings.

I don't think the authors were making that point. Manualized treatments are treatments that have exact steps, so that each person has relatively the same treatment. This differs from customized treatment where each patient and each therapist is participating in a one-off customized treatment sessions.


This is not a very promising conclusion, at least for now and where the state of the art is currently. "Psychotherapies specifically designed for borderline personality disorder have significant yet modest benefits over other general treatments.These therapies are making small but significant improvements , but the benefits are inflated by risk of bias and publication bias."

Correct but it still is very much a bounded program that first and foremost prevents the pwBPD from using any kind of manipulation against the therapist. I've seen first hand how well a high functioning pwBPD can manipulate a therapist.


One thing I have noticed popping up in relationship to DBT is that its very hard to get patients to move beyond the first phase. My therapist mentioned a piece published just this month on that very problem. They get past the first phase and its "I'm cured" but they have only gotten to the point that they are not ruled by their emotions and are finally capable of some introspection. Its stages 2, 3, & 4 where that capability for introspection is used and the actually personality disorder is addressed.

Quick question did this include schema therapy? I've found that schema therapy provides at least in my case the best explanation of what is actually happening in the BPD psyche. I found with my pwBPDex that she would bounce between personalities, the only difference between her and someone with DID was that her personalities knew and remembered what the others did ... .most of the time at least.

And results from schema therapy that I have read were quite promising.

I'm sure it did, but it would not be respresented in the same numbers as DBT - they make that points.

Have you taken our Schema test?
https://bpdfamily.com/message_board/index.php?topic=202548.0

Mode   Tendency   Avg
Vulnerable child    Mod    3.8
Angry Child    Mod    3.2
Enraged Child    --    1.0
Impulsive Child    --    1.6
Undisciplined Child    Mod    3.0
Happy Child    --    2.1
Compliant Surrender     High    4.0
Detached Protector    High    3.6
Detached Self-Soother    Mod    4.0
Self-aggrandizer    Mod    3.1
Bully and Attack mode     --    2.7
Punishing Parent     --    2.3
Demanding Parent     High    3.8
Healthy Adult    Mod    3.4

Interesting that they specifically call out publication bias. There is concern about the "file drawer effect," where negative study results aren't submitted for publication or aren't accepted if submitted. (Research effects are sexy! Not finding effects ... .less sexy.) This can inflate how representative positive results appear to be.

Very true but I have been heartened by studies that do show an increase in brain activity in the inpusle and stress control centers of the brain after 6 months of DBT. That is much more believable than subjective tests.

That's why gunderson is worth every penny because they are stuck there for 60-120 days and they are held accountable for the therapy and showing up while regular therapist can't hold them accountable round the clock

My wife's ex-husband tried to get her into there after her DUI with the kids. She would never ever go there.

I think if we walk away from this article thinking the message is that "enforcement" is the best treatment, we are doing ourselves a disservice.

McLean Hospital ("gunderson" says this:

Independent motivation to change is an essential requirement and while family members or clinicians may see the Gunderson Residence as a good fit, the individual must be ready to actively participate in her recovery—regardless of outside factors such as pending legal charges. In addition, adequate levels of physical health and sobriety are reviewed to determine whether this level of care is appropriate for the individual.
www.mcleanhospital.org/programs/gunderson-residence/admission-cost

Additionally, studies organized by McLean has show that a trusted and loving support person (family member) is the single most predictable marker of success. This person has to be both benevolent and strong.

Additionally, it is mentioned in several texts that "structure" is very important. Expectations and rules are certainly part of that, but just a part. Nutrition, sleep, exercise, no drugs, employment, obligations, etc. are also part of that.

Good discussion.

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