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Two New Psychotherapies for Borderline Personality Disorder

Each reduced symptom severity and psychopathology.

The treatment of borderline personality disorder remains problematic. Researchers in Germany conducted a 3-year, randomized comparison of two structured, highly supervised and quality-controlled psychotherapies — schema-focused therapy (SFT, an "integrative cognitive therapy") and transference-focused therapy (TFT, a dynamic psychotherapy) — in 86 patients with borderline personality disorder.

Only six SFT recipients (14%) and two TFT recipients (5%) successfully terminated psychotherapy (i.e., patient and therapist concurred). However, both therapies significantly reduced symptom severity and psychopathology and improved quality of life, starting after year 1. The SFT group showed significantly more improvement than did the TFT group and had a significantly lower dropout rate. Recovery rates were also significantly different (46% vs. 24%). Patients taking psychotropic medications had worse outcomes with both therapies than did patients not on psychotropics.

Comment: The investigators omitted a control group because structured psychotherapies have been shown to be superior to a wait-list or a treatment-as-usual condition. But this decision is debatable: Previous controlled studies had shorter durations and might not have controlled adequately for nonspecific elements of the psychotherapies.

Still, these two therapies have differing treatment effects. Based on this extensive study, SFT, which focuses on pervasive systems of thinking, behaving, and feeling according to dysfunctional concepts of oneself and others, seems to produce better results — or at least be easier to administer — than TFT, which uses here-and-now transference to integrate good and bad self and object representations. Medicated patients might have worse outcomes because harder-to-treat patients tend to be given medications, not because medications interfere with therapy. As more psychotherapies are subjected to empirical testing, matching psychotherapy to patient preferences and traits might provide more-consistent benefits.

— Steven Dubovsky, MD

Published in Journal Watch Psychiatry July 31, 2006

Citation(s):

Giesen-Bloo J et al. Outpatient psychotherapy for borderline personality disorder: Randomized trial of schema-focused therapy vs transference-focused psychotherapy. Arch Gen Psychiatry 2006 Jun; 63:649-58.

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