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THE PSYCHOLOGY OF PERSONALITY DISORDERS
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Author Topic: BPD: Treatments, Cures, and Recovery  (Read 56296 times)
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« Reply #10 on: February 11, 2010, 12:10:44 PM »

Point well taken, Randi.

Here is a paper arguing the merits of Mentalization therapy...

The British Journal of Psychiatry (2006) 188: 1-3. doi: 10.1192/bjp.bp.105.012088

A promising evidence base is also available for psychodynamically oriented interventions. A randomised controlled trial of treatment of borderline personality disorder in a psychotherapeutically orientated day hospital offering modified individual and group psychoanalytical psychotherapy (Bateman & Fonagy, 1999, 2001) has shown significant and enduring changes in mood states and interpersonal functioning associated with an 18 month programme (effect size= -2.36, 95% CI -3.18 to -1.54). The benefits, relative to usual treatment, were considerable and observed to increase during the follow-up period of 18 months, rather than staying level as with dialectical behaviour therapy.

The Cornell Medical College Group recently reported the only head-to-head comparison of psychodynamic and dialectical-behavioural therapy (Clarkin et al, 2004). They found significant improvements in impulsivity-related symptoms, as well as mood and interpersonal functioning measures. The trial contrasted transference-focused psychotherapy, dialectical behaviour therapy and supportive psychotherapy. There was significant and equal benefit from all the interventions, although early drop-out rates were higher for dialectical behaviour therapy than for the other treatments.


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« Reply #11 on: February 15, 2010, 11:26:02 PM »

I would like to see studies on DBT being effective with high functioning "invisible" BPDs as well. Seems that DBT is focused more on the extremely abhorrent BPD behaviors like suicide and self mutilation.

Keep in mind that Marsha Linehan was working with what she called "The worst suicidal patients" when she was formulating DBT. She even admits she hadn't even heard of BPD until one of her colleagues mentioned that it seemed she was treating almost all borderlines. She then began to read up on borderline personality disorder and came to the conclusion that she was in fact treating borderline personality disorder.

Nevertheless, I think DBT has been extremely effective in determining what exactly it is that makes borderlines so difficult to treat and why they need to be treated completely different from other patients. Linehan puts it best when she posed the question of how do you treat a person that needs to change that is "terribly sensitive to being told that they need to change."

I think that any sort of therapy that understands this, and is more subtle with the "you are the patient, I am the therapist" type therapeutic relationships, can be very effective. Borderlines need to somehow learn to grow emotionally, this takes a nonthreatening environment which is hard to establish but it can be done. The problem with high functioning borderlines, is that they don't feel they need to change. The rest of their life is just "peachy" except their relationship partners. So its a lot easier to change partners than face the void of emptiness. Low functioning borderlines, who are much more prone to self-mutilation and suicide, have highly dysfunctional lives, far beyond just shattered relationships. So its easier for them to "radically accept" that they need to change. This gives the therapist a lot more leverage than with a high functioning borderline.

Anyone have a success story of a high functioning borderline being treated with DBT?
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po·ten·tial  adj.
1. Capable of being but not yet in existence; latent: a potential greatness.
2. Having possibility, capability, or power.
3. The inherent ability or capacity for growth, development, or coming into being.
4. Something possessing the capacity for growth or development.
Curt Kearney, MA, LPCP
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« Reply #12 on: April 20, 2010, 03:37:16 PM »

I am a therapist who works quite a bit with DBT, Schema therapy, and mentalization, often with folks who could be described as borderline.  These are some of my impressions off the top of my head.  Sorry to not have more detail, www.pubmed.gov is a good source for current research (coupled with a friendly librarian!).

Schema therapy is an integrated therapy, that is, it integrates from other, previously existing therapies, mostly CBT, Gestalt, psychoanalytic (particularly object relations), and attachment theory.  I haven't seen research looking at six months of treatment for BPD.  I would love to see it if someone can find a reference.  Most research I've seen has looked more at 2-3 years of usually twice a week outpatient Schema therapy.  Outcomes have been among the best for BPD research.  One notable thing to my mind, drop out has been particularly low.

DBT seems to me to focus very well on skills to manage behaviors, emotions, and relationships.  I usually integrate a lot of DBT into the Schema work I do with people.  A lot of Schema therapists seem to take this approach.  I think it may be a next step in the evolution of Schema therapy.  DBT has good outcomes in research, but may not be particularly strong in helping with some of the mood problems with BPD and drop out is higher than Schema.

Mentalization Based Therapy also has very good outcomes and lower drop out than DBT.  It seems to focus a lot on building psychological mindedness in patients with BPD -- reflecting on one's own mind, emotions, motivations, etc. and those of others.  Mentalization has been used as a stand alone treatment and has been viewed as an active ingredient of other therapies.  I use it as the later.  I think Schema therapy is an excellent mentalization therapy -- it has depth and a very accessible, understandable terminology that I think helps increase patients' (and therapists'!) mentalization very well.  Peter Fonagy and his gorup are the leaders here.  (DBT, particularly with its focus on mindfulness, can also be seen as increasing mentalization.)

The Schema Therapy Institute in NYC is probably the best place for referrals for Schema therapists.  (By the way, this post is not a personal plug, I am not certified by them so they won't be giving my name.  This is just a topic close to my heart, and, it seems to others here so I wanted to share.) www.schematherapy.com

The Netherlands seems to have embraced Schema therapy as the national insurance's therapy of choice for BPD (or that's what I can gather from my limited perspective here in the US).  There is a lot of excellent Schema research and clinical growth happening there. 
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« Reply #13 on: November 11, 2010, 02:49:37 PM »

 DBT truly worked a miracle for my husband. He went for 3 years..often, a year isnt long enough...and he now is considered recovered from BPD. No rages, so suicide stuff, no inappropriate behaviors..for over 2 years now.  Doing the right thing

   Steph
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« Reply #14 on: November 11, 2010, 03:06:37 PM »

My BPDbf went for 2 years and it helped him loads. I think the recommended time to be going to DBT is between 2 and 5 years! He still has issues but it helped him a lot and he's not half as bad as he used to be.

All the best  smiley
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« Reply #15 on: November 11, 2010, 05:03:54 PM »

my partner has been in dbt for abt 2.5 years.. i think it does help.. but its probably in the last year or so that theres the biggest difference
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« Reply #16 on: November 11, 2010, 07:47:29 PM »

My H attended DBT for 18 mos. and although he knew he needed to continue, stopped. It helped him tremendously. He still has BPD and issues that go along with it, but he is nowhere near what he used to be.

He is in T and MC, currently as he knows he needs help, but will/can not make time for DBT.

Lem
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« Reply #17 on: November 11, 2010, 09:08:47 PM »

My partner has done 9 years of psychotherapy, a year of 5-day a week DBT course, a year of PTSD group, and is currently doing psychotherapy and an anger management group. She's also been on a variety of meds.

The DBT was amazing for her. She really took it seriously, and her behavior has changed so much it's very impressive. She's still not perfect, but she's functioning so much better in every area of her life.
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« Reply #18 on: November 12, 2010, 08:09:48 AM »

My wife has gone through DBT for 6 months before she was kicked out of the program for missing too many therapy appointments.  While she hasn't gone through the full course of at least a year, I've found that DBT has proven itself useful.  She's much more under control than she was.
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He causes his sun to rise on the evil and the good, and sends rain on the righteous and the unrighteous.~ Matthew 5:45
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« Reply #19 on: November 13, 2010, 06:19:08 PM »

You will find lots of disagreements from proponents of each type of therapy. It's a bit like politics--wait, it IS politics.WHile studies can make generalities, each person is different, and what is right for one person may not be right for each other. In addition, even with standard BPD therapy, not all therapists are the same. Also, believe it or not, some people say they do DBT when they really don't have a whole program in place and technically they're not providing real DBT.Randi KregerThe Essential Family Guide to Borderline Personality Disorder
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