Skip to main content
Log in

Common Factors in Empirically Supported Treatments of Borderline Personality Disorder

  • Published:
Current Psychiatry Reports Aims and scope Submit manuscript

Abstract

In this article, we examine the manuals of empirically supported psychotherapies for borderline personality disorder (BPD) by comparing their common and specific treatment strategies. We compare these treatments using a previously constructed scale of treatment interventions. Individual psychotherapies for BPD have several common strategies: clear treatment framework, attention to affect, focus on treatment relationship, an active therapist, and exploratory and change-oriented interventions. Use of interpretations, supportive interventions, designating treatment targets, attention to patient functioning, multimodal treatment, and support for therapies varied across the psychotherapies. We discuss these findings in the context of clusters of BPD symptoms, reports regarding overlap in treatment interventions used by various psychotherapies, and the effectiveness of specific treatment strategies.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Zanarini MC: Psychotherapy of borderline personality disorder. Acta Psychiatr Scand 2009, 120:373–377.

    Article  CAS  PubMed  Google Scholar 

  2. •• Weinberg I, Ronningstam E, Goldblatt MJ, et al.: Strategies in treatment of suicidality: identification of common and treatment-specific interventions in empirically supported treatment manuals. J Clin Psychiatry 2010, 71:699–706. Our group blindly compared five treatment manuals for suicide attempters and identified treatment specific and unique intervention strategies.

    Article  PubMed  Google Scholar 

  3. Binks CA, Fenton M, McCarthy L, et al.: Psychological Therapies for People With Borderline Personality Disorder. The Cochran Collaboration, Wiley and Sons; 2007.

  4. Linehan MM: Cognitive Behavior Treatment for Borderline Personality Disorder. New York: Guilford Press; 1993.

    Google Scholar 

  5. Bateman A, Fonagy P: Psychotherapy for Borderline Personality Disorder. Mentalization-based Treatment. Oxford: Oxford University Press; 2004.

    Google Scholar 

  6. Clarkin JF, Yeomans FE, Kernberg OF: Psychotherapy of Borderline Personality. Focusing on Object Relations. Washington, DC: American Psychiatric Publishing; 2006.

    Google Scholar 

  7. Young JE, Klosko JS, Weishaar ME: Schema Therapy. A Practitioner’s Guide. New York: Guilford Press; 2003.

    Google Scholar 

  8. Blum N, Bartels N, St. John D, Pfohl B: STEEPS Group Treatment Program for BPD. Coralville, IA: Blums’ Books; 2002.

    Google Scholar 

  9. Clarkin JF, Levy KN, Lenzenweger MF, Kernberg OF: Evaluating three treatments for borderline personality disorder: a multiwave study. Am J Psychiatry 2007, 164:922–928.

    Article  PubMed  Google Scholar 

  10. Linehan MM, Comtois KA, Murray AM, et al.: The two-year randomized controlled trial and follow-up of dialectical behavior therapy vs. therapy by experts for suicidal behaviors and borderline personality disorder. Arch Gen Psychiatry 2006, 63:757–766.

    Article  PubMed  Google Scholar 

  11. Linehan MM, Armstrong HA, Suarez A, et al.: Cognitive-behavioral treatment for chronically parasuicidal borderline patients. Arch Gen Psychiatry 1993, 48:1062–1065.

    Google Scholar 

  12. Linehan MM, Tuteck DA, Heard H, Armstrong HE: Interpersonal outcome of cognitive behavioral therapy for chronically suicidal borderline patients. Am J Psychiatry 1994, 151:1771–1776.

    CAS  PubMed  Google Scholar 

  13. Bateman A, Fonagy P: Effectiveness of partial hospitalization in treatment of borderline personality disorder: a randomized controlled trial. Am J Psychiatry 1999, 156:1563–1569.

    CAS  PubMed  Google Scholar 

  14. Bateman A, Fonagy P: Treatment of borderline personality disorder with psychoanalytically oriented partial hospitalization: an 18-month follow-up. Am J Psychiatry 2001, 158:36–42.

    Article  CAS  PubMed  Google Scholar 

  15. Bateman A, Fonagy P: Health service utilization costs for borderline personality disorder patients treated with psychoanalytically oriented partial hospitalization versus general psychiatric care. Am J Psychiatry 2003, 160:169–171.

    Article  PubMed  Google Scholar 

  16. • Bateman A, Fonagy P: Randomized controlled trial of outpatient mentalization-based treatment versus structured clinical management for borderline personality disorder. Am J Psychiatry 2009, 166:1355–1364. In this randomized controlled study, outpatient MBT was compared with structured clinical management. Although patients in both conditions improved, MBT was associated with a faster pace of improvement.

    Article  PubMed  Google Scholar 

  17. • Doering S, Horz, S, Rentrop M, et al.: Transference-focused psychotherapy v. treatment by community psychotherapists for borderline personality disorder: randomised controlled trial. Br J Psychiatry 2010, 196:389–395. In this randomized controlled study, TFP was compared with treatment by community “experts.” In addition to symptomatic and functional improvement, TFP was also more effective in improving personality organization.

    Article  PubMed  Google Scholar 

  18. Giesen-Bloo J, van Dyck R, Spinhoven P, et al.: Outpatient psychotherapy for borderline personality disorder. Arch Gen Psychiatry 2006, 63:649–658.

    Article  PubMed  Google Scholar 

  19. Gunderson J: Borderline Personality Disorder. Clinical Guide, edn 1. Washington, DC: American Psychiatric Publishing; 2001.

    Google Scholar 

  20. Gunderson J, Links P: Borderline Personality Disorder. Clinical Guide, edn 2. Washington, DC: American Psychiatric Publishing; 2008.

    Google Scholar 

  21. • McMain SF, Links PS, Gnam WH, et al.: A randomized trial of dialectical behavior therapy versus general psychiatric management for borderline personality disorder. Am J Psychiatry 2009, 166:1365–1374. In this randomized controlled study, GPM was compared with DBT and was found to have similar effectiveness across multiple outcomes.

    Article  PubMed  Google Scholar 

  22. • Blum N, St. John D, Pfohl B, et al.: Systems training for emotional predictability and problem solving (STEPPS) for outpatients with borderline personality disorder: a randomized controlled trial and 1-year follow-up. Am J Psychiatry 2008, 165:468–478. In this randomized controlled study, STEPPS was compared with treatment in the community. STEPPS was associated with a significantly greater improvement in several areas.

    Article  PubMed  Google Scholar 

  23. Bos EH, van Wel EB, Appelo MT, Verbraak JPM: A randomized controlled trial of a Dutch version of systems training for emotional predictability and problem solving for borderline personality disorder. J Nerv Ment Dis 2010, 198:299–304.

    Article  PubMed  Google Scholar 

  24. Waldinger RJ: Intensive psychodynamic therapy with borderline patients: an overview. Am J Psychiatry 1987, 144:267–274.

    CAS  PubMed  Google Scholar 

  25. Beck AT, Rush AJ, Shaw BS, Emert G: Cognitive Therapy of Depression. New York: Guilford Press; 1978.

    Google Scholar 

  26. Bibring E: Psychoanalysis and the dynamic psychotherapies. J Am Psychoanal Assoc 1954, 2:745–770.

    Article  CAS  PubMed  Google Scholar 

  27. Ablon JS, Jones EE: Psychotherapy process in the National Institute of Mental Health Treatment of Depression Collaborative Research Program. J Consult Clin Psychol 1999, 67:64–75.

    Article  CAS  PubMed  Google Scholar 

  28. Ablon JS, Jones EE: Validity of controlled clinical trials of psychotherapy: findings from the NIMH Treatment of Depression Collaborative Research Program. Am J Psychiatry 2002, 159:775–783.

    Article  PubMed  Google Scholar 

  29. Gibbons MBC, Crits-Christoph P, Barber JP, et al.: Unique and common mechanisms of change across cognitive and dynamic psychotherapies. J Consult Clin Psychol 2009, 77:801–813.

    Article  PubMed  Google Scholar 

  30. Sanislow CA, Grilo CM, Morey LC, et al.: Confirmatory factor analysis of DSM-IV criteria for borderline personality disorder: findings from the Collaborative Longitudinal Personality Disorder Study. Am J Psychiatry 2002, 159:284–290.

    Article  PubMed  Google Scholar 

  31. Littrell J: Is the reexperiencing of painful emotion therapeutic? Clin Psychol Rev 1998, 18:71–102.

    Article  CAS  PubMed  Google Scholar 

  32. Zanarini MC, Frankenburg FR, DeLuca CJ, et al.: The pain of being borderline: dysphoric states specific to borderline personality disorder. Harv Rev Psychiatry 1998, 6:201–207.

    Article  CAS  PubMed  Google Scholar 

  33. Koenigsberg HW, Harvey PD, Mitropoulou V, et al.: Characterizing affective instability in borderline personality disorder. Am J Psychiatry 2002, 159:784–788.

    Article  PubMed  Google Scholar 

  34. Yen S, Zlotnick C, Costello E: Affect regulation in women with borderline personality disorder traits. J Nerv Ment Dis 2002, 190:693–696.

    Article  PubMed  Google Scholar 

  35. Agrawal HR, Gunderson J, Holmes BM, Lyons-Ruth K: Attachment studies with borderline patients: a review. Harv Rev Psychiatry 2004, 12:94–104.

    Article  PubMed  Google Scholar 

  36. Adler G: The myth of alliance with borderline patients. Am J Psychiatry 1979, 136:642–645.

    CAS  PubMed  Google Scholar 

  37. Links PS, Helsgrave R, van Reekum R: Impulsivity core aspect of borderline personality disorder. J Pers Disord 1999, 13:1–9.

    CAS  PubMed  Google Scholar 

  38. Dougherty DM, Bjork JM, Huckabee HC, et al.: Laboratory measures of aggression and impulsivity in women with borderline personality disorder. Psychiatry Res 1999, 85:315–326.

    Article  CAS  PubMed  Google Scholar 

  39. Kelly T, Soloff PH, Cornelius J, et al.: Can we study (treat) borderline patients? Attrition from research and open treatment. J Pers Disord 1992, 6:417–433.

    Google Scholar 

  40. Gunderson JG, Frank AF, Ronningstam EF, et al.: Early discontinuance of borderline patients from psychotherapy. J Nerv Ment Dis 1989, 177:38–42.

    Article  CAS  PubMed  Google Scholar 

  41. Skodol AE, Buckley P, Charles E: Is there a characteristic pattern to the treatment history of clinic outpatients with borderline personality? J Nerv Ment Dis 1983, 171:405–410.

    Article  CAS  PubMed  Google Scholar 

  42. Yeomans FE, Gutfreund J, Selzer MA, et al.: Factors related to drop-outs by borderline patients. Treatment contract and therapeutic alliance. J Psychother Pract Res 1994, 3:16–24.

    Google Scholar 

  43. • Caligor E, Diamond D, Yeomans FE, Kernberg OF: The interpretive process in the psychoanalytic psychotherapy of borderline personality pathology. J Am Psychoanal Assoc 2008, 57–271–301. This is a step-by-step outline of practical principles guiding the building of interpretation in treatments of BPD patients.

    Article  Google Scholar 

  44. Skodol AE, Gunderson JG, McGlashan TH, et al.: Functional impairment in patients with schizotypal, borderline, avoidant, or obsessive compulsive disorder. Am J Psychiatry 2002, 159:276–283.

    Article  PubMed  Google Scholar 

  45. Zanarini MC, Frankenburg FR, Reich B, Fitzmaurice G: The 10-year course of psychosocial functioning among patients with borderline personality and Axis II comparisons. Acta Psychiatr Scand 2010, 122:103–109.

    Article  CAS  PubMed  Google Scholar 

Download references

Disclosure

No potential conflicts of interest relevant to this article were reported.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Igor Weinberg.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Weinberg, I., Ronningstam, E., Goldblatt, M.J. et al. Common Factors in Empirically Supported Treatments of Borderline Personality Disorder. Curr Psychiatry Rep 13, 60–68 (2011). https://doi.org/10.1007/s11920-010-0167-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11920-010-0167-x

Keywords

Navigation