AAPEL
The borderline personality disorder and the therapy (therapies)
"what is a therapy ?"
... "magic ?", "voodoo ?"
... "which one to choose ?"
Meme page en Francais / Same page in french
Summary
Preamble:
It is important to read first the page "Medication to treat BPD disorder" before this one

Thank you "Mister De la Palisse" for this brilliant introduction "The therapy you should do is the one you need"
He could also suggest us "practice makes perfect" (insist, try again and again)
or "bad luck comes in threes"
All this for saying since there are already psychological links between drug which is "a simple" chemical substance and the individual (the placebo effect was proven), this is even more clear between a patient and his therapist.
Confidence is essential (but not enough)(it is also necessary to put oneseld into it), everyone does not get along with everybody.  What is good for your neighbor is not necessariliy good for you and vice versa.
"There's just not rapport with your therapist ?"
(if you think that this man / woman has nothing to offer you or worse if you think that he "degrades you")
Ask yoursellf to know if it is your "fault" or not
Discuss with him
...  And if after thought it through very carefully (and even spoken with your close relations) come to you to the conclusion that it is not a "good" (for you) therapist, then change!
"There are plenty of fish in the sea"
All these reflections are true but you must keep in mind that your therapy will be successful only if you, patient, you imply and play the truth's game while finishing (gradually) with escapes and lies

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Summary:
Need help, support, yes, but not reprimands
"Border what ?". Psychotherapits don't "want" borderlines peoples !
Therapy ? - Attention, borderline disorder is also biological
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What is a therapy ?
What is a psychotherapy ? Several kind ? Is it "working" ?
Is your diagnosis useless for a therapy ?
How to choose a (good) BPD therapist ? (generality)

What is psychodynamic therapy / psychoanalysis ?
Is psychoanalysis adapted to treat borderline peoples ?
Knowing ourself is a good thing, but be careful to suicide !

Cognitive therapy, what is it ?
Behavioral therapy, what is it ?
What are the differences between both, cognitive and behavioral therapies ?
Are they well adapted to BPD treatment ?

"Therapy for borderlines ?" DBT (Dialectical Behavior Therapy)
Another  "therapy for borderlines", TFT (Transference Focused Therapy), Masterson Therapy
"Transactional analysis" ?

What is the "philosophy" of behavioral therapies like DBT ?
What is the DBT therapy ? ("shrink" answer, in short that we don't understand)
What is the DBT therapy ? (second try)
Doing a dbt therapy is like going to school ?
Frequency and duration of each session
What is a "lesson" ?
In which way the dbt therapy is different from "classical" behavioral therapy ?

How long is a DBT therapy, is there some "end" ?
Clinical Trial Studies on therapies

Hope

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Need help, support, yes, but not reprimand
Borderline parents more than anything need support from family - anything from baby-sitting to emotional support.
I have not spoken to someone with BPD yet that has answered "yes" when asked if they like themselves. Borderlines have a very low self-esteem. ("Borderline Personality Disorder Therapy", mhsanctuary 2OO2)

AAPEL: At the risk to repeat oneself, the patients require to be helped, that one understands that their behaviors are the fruit of their distress and that they must have support and not reproaches, even if  they need to be responsible and to take in hand their own destiny.  That one ceases saying "this person destroy all that there is around her" but "her disease has dramatic consequences for himself/herself and its family circle"

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"Border what ?". Therapits don't "want" borderlines peoples !
* "Some therapists think these clients are very hard to work with. They are many times not easy to be around sometimes. Letís face it, we rage, experience mood swings, split, etc. In fact, I remember slamming my counselorís door a few times." ("Borderline Personality Disorder Therapy", mhsanctuary 2OO2)

* "Many mental health professionals find working with borderline patients arduous and exhausting, promising new studies often go unnoticed by clinicians who don't specialize in BPD. It becomes a vicious circle: clinicians don't read studies that could help them work with borderline patients because they believe that borderline patients are always going to be difficult to work with
Some are saying "There is no such thing as BPD"
More than three hundred research studies and three thousand clinical papers provide ample evidence that BPD is a valid, diagnosable psychiatric illness.
Clinicians may claim that BPD doesn't exist for several reasons.
They may not  have kept up-to-date with the research and are misinformed.
They may believe that BPD is not a separate disorder, but part of another illness such as Bipolar Disorder or Post-Traumatic Stress Disorder.
They may simply reject the idea of labeling anyone as "borderline" because they think it is too stigmatizing, or they may find nearly all psychiatric" ("Myths and Realities about BPD", bpdcentral)

AAPEL:  No doubt that there is a lack of training of some psychotherapists who believe to know (all) and look of an eye rather scorning an organization like ours who "dares" imply that a degree is not enough to be competent and that taking a new look at oneself must be the golden rule (huge progress was made in the BPD area).  Humility must be one of the first rules of very good psychotherapist.

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Therapy ? - Attention, the borderline disorder is also biological
* "First of all, it is extremely important to know that no form of therapy will assist a person with the borderline personality disorder unless the person is properly medicated, reducing many of the symptoms"
"Drug therapy first! Otherwise you are simply and completely wasting your time. You need to give insulin to a diabetic before they can receive any assistance from therapy. Remember that the BPD is biological." (Paul Markovitz M.D. Ph. D,"Borderline Therapy and Other Thoughts", bpdsanctuary)
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AAPEL: In short, before starting a reeducation of its broken legs, it is necessary to make sure that the bones are knitted. Drugs make it possible to accept the therapy.  It would seem that people who suffer from a BPD don't all need for drugs.
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What is a therapy ?
Therapy : treatment which helps someone feel better
copyright cambridge dictionary
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What is a psychotherapy ?
the treatment of mental illness by discussing the problems which caused it with the sufferer, instead of using drugs or operations
copyright cambridge dictionary
Psychotherapy is a method to treat psychological disorders using psychological ways
copyright 2OO1 Hachette Multimédia / Hachette Livre
AAPEL
There are several "families"
- psychodynamic therapy
- cognitive therapy
- behavioral therapy
- dialectical behavioral therapy (dbt)
- Transference Focused Therapy
and many more

Is it "working" ?

Yes, a psychotherapy produce "real" changes. You will find in the study section some evidences of it
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Your diagnosis is useless for a therapy ?
* "I remember two different therapists telling me, after advising them of my BPD diagnosis, "It doesn't matter what your diagnosis is. I don't group people into categories. I treat everyone the same." If you hear this from a counselor, don't just walk to the exit, run! They simply don't have a clue of how to treat borderlines." ("Borderline Personality Disorder Therapy", mhsanctuary 2OO2)

AAPEL
Some schools of thought are saying that we don't have to say to a patient the name of his disease, while at the same time the therapeutist would have determined.
It's up to you to judge if to reach for one of the objectives, i.e. made (again) confidence  with the person who suffers, it's necessary to use lies which consists to hide this.
It is certain that an diagnosis should not result in being unaware of others disturbing.
One will also retort, and rightly, that mental illness is not treated like we treat an influenza.
Right. But it's to you to see whether when you have an influenza or a cancer, you wish or not that your doctor gives you a diagnosis or hides it and when it is about your own mental health it is the same or not.
We have sometimes the same therapists who will cry "scandal" when we speak about the "childish" side of a borderline and in the same time will not consider the patient "adult" to know her diagnosis?!
We pronounce the name of "depression" in offices, I do not understand why we could not say "borderline personality disorder"
To meditate...  ...
What to say about this site which has the purpose to say everything ? (contact us)
If your psychotherapist is not a "enthusiast" of diagnosis to not "categorize" people, but if for you it is important, if that would doing some good to you to know the name of your disease, then you completely have the right to require it while saying "I want to know my diagnosis".
And if by bad luck, your philosophies are not "compatible", then change your therapist, it is you the patient, it is you who suffer, it is you the "customer", it is you who pay, not him.  Your psychotherapist is at YOUR disposal and not the opposite!
 (read page code of ethics)

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How to choose a (right) BPD psychotherapist for BPD ?(generality)

Choosing the right therapist is crucial. While many wonderful therapists are knowledgeable about BPD, many aren't.
"Therapists who work with BPD patients must be absolutely committed to the process of working with the patient and the family. This is not short term therapy, and anyone looking for short term solution focused therapy quick fixes is not going to accomplish it with this type of client" (Speaking of the therapist here.)
...
"One of my principal concerns is the absence of adequate training in the recognition and treatment of BPD, which results in bad outcomes for many. Most of my current clients ended up with me after multiple prior treatment failures, often because the therapist, while well meaning, did more harm than good...
Much of the damage occurs because the therapists have lousy boundaries, either because of their own issues or because they are inadequately trained.
"The 'harm' results when the therapist recognizes the boundary violations and suddenly changes the rules, even blaming the BPD patient. Since issues of trust, rejection and safety are so important to the BPD client, this therapist behavior can be very destructive.
...
When trying to find a therapist, ask many questions. Determine the person's attitude toward BPD and their knowledge of the subject::

We strongly advise you to interview them carefully before becoming a patient
("How to choose a BPD therapist ", bpdcentral)
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What is psychodynamic therapy / psychoanalysis ?
psychoanalysis
any of a number of the theories of the human personality, which attempt to examine a person's unconscious mind to discover the hidden causes of their mental problems
copyright cambridge dictionary
- the psychodynamic therapy (analytical psychotherapies) is here to help us no more about ourself - is it true ?
Psychodynamic therapy focuses on increasing both an intellectual and an emotional/experiential understanding of ourselves.  The intellectual insight by itself is not generally considered sufficient, though it is satisfying and a basis for continued growth.
Daniel C Claiborn Ph D
AAPEL: Please read personality disorders, psychoanalysis
Attention not to confuse psychoanalysis with short term analytical psychotherapies!  ("short in comparison with the psychoanalysis which does not have duration and can last for years")
In psychoanalysis, the therapist has to be "absent" with a minimum of targeted interventions, the visible portion of his action is quasi-non-existent.
In a short term psychoanalytical psychotherapy, generally face to face, the therapist is active, it establishes an empathic and confident relationship with the patient.  It helps for example the patient to be centered on a practical problem.  It helps the patient to clarify his problems.  It helps the patient to become aware of his inappropriate behaviors and owing to the fact that it does not any(more) "need" them.
One can thus affirm that a psychoanalysis and a psychoanalytical psychotherapy are totally different!  (see below TFP which is a psychoanalytical form of psychotherapy)
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Is psychoanalysis therapy adapted to treat borderline peoples ?
"By itself, psychodynamic therapy is not enough for BPD individuals, who need more specific techniques and guided practice to reduce anxiety and establish healthier behaviors and perceptions.
Simply knowing yourself better is not sufficient treatment for BPD and other personality disorders"
(Daniel C Claiborn Ph D)

"The contemporary attitude of American psychoanalysts is that psychoanalytic psychotherapy is of great value for particularly severe personality disorders that have contra-indications for psychoanalysis proper, or for mild conditions that may be helped by a psychoanalytically inspired psychotherapy without having to undergo a long psychoanalysis."
(Otto Kernberg - JOURNAL OF EUROPEAN PSYCHOANALYSIS - Spring-Fall 1997)

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Knowing ourself is a good thing, but be careful to suicide !
* "It will not help to try to "figure out what event in life" caused this disorder.
It will not help to blame the parents or the environment.
I do not believe this is where the BPD originates from anyway. This is wasted energy in my opinion in the treatment of borderlines.
We cannot handle stress as well as many people. We are not weak, we have brains that have malfunctioned and betrayed us. Many times our brains "fire out of control"  and we feel dysphoric (anxiety, depression, despair, rage) and life is painful, so painful it is hard to express in words.
When we begin to understand the medical component to this disorder, we can begin to forgive ourselves for our behavior, our mistakes and our past decision making
Anytime your therapy takes you to "the edge, feeling suicidal" it is time to STOP! The suicide rate for borderlines is 10% and this moves up to 25% if the person also has a diagnosis of panic disorder.
Yes, we need therapy, but we need to live through it. We just need the right kind of therapy and therapists desperately need to be educated regarding this" ("Borderline Personality Disorder Therapy", mhsanctuary 2OO2)
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Cognitive therapy, what is it ?
It is a form of treatment used to change someone's habitual patterns of thinking when these thoughts are damaging that person.
copyright cambridge dictionary
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Behavioral therapy, what is it ?
In psychology, behaviour therapy is the general name for a form of treatment which tries to change someone's particular unwanted behaviour rather than treating the causes.
copyright cambridge dictionary
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What are the differences between cognitive and behavioral therapies ?
- there is also cognitive therapy and behavorial therapies what are their differences
Cognitive therapies and behavior therapies both are based on principles of learning, conditioning, and habit formation and maintenance.  Cognitive therapies focus on retraining of thoughts and perceptions and labeling of experiences, whereas behavior therapies focus on mokification of voluntary and involuntary (such as blood pressure, skin temperature, heart rate) behaviors
Daniel C Claiborn Ph D
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Are they well adapted to BPD traitment ?
Cognitive and behavioral therapies are very helpful with BPD, though they, too, are not sufficient.  A combination of psychodynamic and cognitive/behavioral therapies , such as DBT, is best.
Daniel C Claiborn Ph D
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"Therapy for borderlines" DBT (Dialectical Behavior Therapy)
* "I encourage you if possible to obtain this form of therapy created by Marsha Linehan, from the University of Seattle in Washington. It is therapy especially designed for borderlines.
DBT has assisted many people who have the borderline personality disorder" ("Borderline Personality Disorder Therapy", mhsanctuary 2OO2)

Some evidence suggests that dialectical behavioral therapy (DBT) is beneficial for treatment of Borderline Personality Disorder. While other psychotherapies may be helpful for treatment of borderline personality disorder, they have not been evaluated scientifically in the same way as the treatment listed here.("Borderline Personality Disorder", American Psychological Association 2OO3)

The most successful and effective psychotherapeutic approach to date has been Marsha Linehan's Dialectical Behavior Therapy. Research conducted on this treatment have shown it to be more effective than most other psychotherapeutic and medical approaches to helping a person to better cope with this disorder. It seeks to teach the client how to learn to better take control of their lives, their emotions, and themselves through self-knowledge, emotion regulation, and cognitive restructuring. It is a comprehensive approach that is most often conducted within a group setting.
Borderline personality disorder is intrinsically difficult to treat. Personality disorders, by definition, are long-standing ways of coping with the world, social and personal relationships, handling stress and emotions, etc. that often do not work, especially when a person is under increased stress or performance demands in their lives. Treatment, therefore, is also likely to be somewhat lengthy in duration, typically lasting at least a year for most. ( John M. Grohol, "Borderline Personality Disorder TREATMENT", psychcentral.com)

Each treatment approach offers something relevant to BPD patients, and there needs to be matching between the symptom pattern of a particular patient and their degree of impairment with the type of treatment program offered.  DBT combines several strategies, so it fits a broader range of patients.

Daniel C Claiborn Ph D
Summary of the Dialectical Behavioral Therapy and its efficacy
Text on DBT wrote by marsha linehan
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"Another Therapy for borderlines" TFT (Transference Focused Therapy) and also the masterson therapy
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"Transactional analysis psychotherapy ?"
"In psychotherapy, transactional analysis utilizes the "Adult" in both the client and the clinician to sort out pathological behaviors and thoughts that result in incapacitation. Thoroughly trained and skilled transactional analysts intervene with the precision of surgeons as they work "with" clients to eliminate dysfunctional behaviors and establish and reinforce healthy functioning." (http://www.itaa-net.org/ International Transactional Analysis Association)

AAPEL: As we know, there is no studies about TA and Borderline disorder. That's not mean that it is not "working" but that's mean that it is not an usual way to treat bpd

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What is the "philosophy" of behavioral theapies like DBT ?
"if we act like this it is because we have learned to act like this"
"our thought determine our acts", but in the opposite way, "our acts determine our thoughts?"
"if i'm acting right, i'm thinking right"
"if we have been able to learn something "wrong", we are also able to learn something "right" ?"
While better thoughts can guide better actions and thus create better feelings, it is true that better actions can result in better feelings and thoughts.  Active coaching and encouragement is needed to help the BPD person initiate and sustain healthier ways of acting.
Daniel C Claiborn Ph D
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What is the DBT therapy ? ("shrink" answer, in short that we don't understand)
DBT is a combination of psychodynamic and cognitive/behavioral therapies.
I would explain that DBT is an assortment of exercises, methods, and scientific principles presented to us in a structured, progressive way to change the way we think and act so as to be less anxious and self-destructive.  It involves learning and practicing the thinking and acting strategies so as to become comfortable using them when our old habitual ways might get us into trouble
Daniel C Claiborn Ph D
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What is the DBT therapy ? (second try)
"Ok very interesting, but please answer my question now"
(I could think it was magic, now with this previous answer i think that it is some of ritual)
Yes it was a therapist answer, you're quite right.
I think it is difficult to describe therapy techniques in non-therapist, non-technical terms.
I use words like practicing, learning new behaviors, developing different attitudes, stopping negative thinking, becoming less defensive, understanding anger, and so on.
I sometimes tell BPD patients they have trouble growing up, calming down, trusting others, and avoiding the "detour to shitland."
Growing up              --           Responsibility for oneself, one's outward choices
Calming down          --          Peace, calmness
Trusting others         --          Intimacy, ability to merge and enjoy being a part of something bigger than oneself
Avoiding detour         --          Self-control, responsibility for one's inner choices
The "detour to shitland" means instinctively and repetitively following a destructive mental train of thought which results in feeling bad about oneself.  People really seem to understand what the detour to shitland means, and they can learn to avoid it, since they gradually appreciate that it does them no good, it does not protect them, it does not offer new information--and they learn that not going on the detour helps and does not hurt them.
Daniel C Claiborn Ph D
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Doing a dbt therapy is like going to school ?
- the teacher (therapist) teaches the theory (behavior)
- the student (patient) has then to understand the lesson, make exercises at school (office) and go back home, have homeworks to do ?
Yes, therapy is like going to school, and the therapist is like a teacher (mentor, friend, supporter, guide, coach, role model).  And, the patient does have homework to do.
Daniel C Claiborn Ph D
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Frequency and duration of each session
DBT usually consists of about two hours per week of DBT Skills training for clients in a group setting, and one hour of individual therapy with a client. It takes about one year to go through all of the skills that are taught in a DBT skills training group.
www.behavioraltech.com
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How long is a DBT therapy, is there some end ?
Yes there is a end.
"It takes about one year to go through all of the skills that are taught in a DBT skills training group" ("Dbt Therapy",www.behavioraltech.com, 2OO3)

"BPD can be effectively treated using psychotherapy, behavior modification, and medication as needed.  Often the treatment takes 3 to 5 or 7 years"

Daniel C Claiborn Ph D
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What is a DBT lesson ?
I know how school is, how teacher learn history, but i don't know how to teach "calm" and don't "rage" to a people who is prompt to overact (without using drugs)
In the therapy sessions, the patient gets aroused and the therapist coaches him or her (with breathing techniques, mental techniques, focusing of attention) to calm down.
Daniel C Claiborn Ph D
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In which way the dbt therapy is different from "classical" behavioral therapy ?
The lesson and exercise are specially adapted to the bpd disorder ?
Yes, the lessons, tasks, and exercises in DBT have been especially created and adapted to treat the BPD person.
Daniel C Claiborn Ph D
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Clinical trial, studies therapies

* Perry JC, Banon E, Ianni F. -Institute of Community and Family Psychiatry, McGill University, Canada.
1999 Am J Psychiatry - Effectiveness of psychotherapy for personality disorders.

Effectiveness of psychotherapy for personality disorders in psychotherapy outcome studies
Fifteen studies
RESULTS: All studies reported improvement in personality disorders with psychotherapy
They included psychodynamic/interpersonal, cognitive behavior, mixed, and supportive therapies
A heuristic model based on these findings estimated that 25.8% of personality disorder patients recovered per year of therapy, a rate sevenfold larger than that in a published model of the natural history of borderline personality disorder (3.7% recovered per year, with recovery of 50% of patients requiring 10.5 years of naturalistic follow-up).
CONCLUSIONS: Psychotherapy is an effective treatment for personality disorders
* Meares R, Stevenson J, Comerford A. - Department of Psychological Medicine, University of Sydney, Westmead Hospital, Australia
1999 Aust N Z J Psychiatry - Psychotherapy with borderline patients: Comparison between treated and untreated patients.
Compare the clinical outcome of patients with borderline personality disorder (BPD) who had received outpatient psychotherapy for 1 year with BPD patients who received no formal psychotherapy for the same period.
CONCLUSIONS: Patients who received psychotherapy were significantly improved. Thirty percent of treated patients no longer fulfilled DSM-III criteria for BPD. The untreated patients were unchanged.
* Paris J. - Institut de psychiatrie communautaire et familiale de l'Hopital General Juif-Sir Mortimer B. Davis.- Canada
1997 Sante Ment Que - Success and failure in the treatment of patients with borderline personality disorder
Psychodynamic psychotherapy has not been proven to be effective, but dialectical behavior therapy yields symptomatic improvement.
* Verheul R, Van Den Bosch LM, Koeter MW, De Ridder MA, ... - DeViersprong Center of Psychotherapy, U of Amsterdam, The Netherlands
2OO3 - Br J Psychiatry - Dialectical behaviour therapy (DBT) for women with borderline personality disorder: 12-month, randomised clinical trial
Fifty-eight women with BPD were randomly assigned to either 12 months of DBT or usual treatment in a randomised controlled study
CONCLUSIONS: Dialectical behaviour therapy is superior to usual treatment in reducing high-risk behaviours in patients with BPD
* Alper G, Peterson SJ - Anoka Metro Regional Treatment Center, Anoka, MN,  USA.
2OO1 J Psychosoc Nurs Ment Health Serv - Dialectical behavior therapy for patients with borderline personality disorder.
15 women hospitalized on a DBT unit was traced over a 4-week period.
The self-injurious behaviors decreased by almost 50%
Semi-structured interviews were conducted to determine the nurses perceptions of the effectiveness of DBT. Their responses were uniformly positive. The most commonly occurring phrase was "it works."
* Hampton MC. - University of California, San Francisco, USA.
1997 Arch Psychiatr Nurs - Dialectical behavior therapy in the treatment of persons with borderline personality disorder.
Highly suicidal, borderline patients are difficult to treat within the hospital and the community.
Psychotherapy has shown moderate success for some borderlines
A form of cognitive-behavioral therapy called dialectical behavior therapy has shown a high rate of effectiveness in reducing inpatient hospital days, suicide attempt frequency, and therapy attrition.
* Cedar R. Koons, Clive J. Robins, J. Lindsey Tweed,,... - Duke University Durham VA Medical Center
2OO1 Behavior therapy Journal 32 - Efficacy of Dialectical Behavior Therapy in Women Veterans With Borderline Personality Disorder
Twenty women veterans who met criteria for borderline personality disorder (BPD) were randomly assigned to Dialectical Behavior Therapy (DBT) or to treatment as usual (TAU) for 6 months. Compared with patients in TAU, those in DBT reported significantly greater decreases in suicidal ideation, hopelessness, depression, and anger expression. In addition, only patients in DBT demonstrated significant decreases in number of parasuicidal acts, anger experienced.
Patients in both conditions reported significant decreases in depressive symptoms and in number of BPD criterion behavior patterns, but no decrease in anxiety. Results of this pilot study suggest that DBT can be provided effectively independent of the treatment's developer, and that larger efficacy and effectiveness studies are warranted.
* Linehan MM, Schmidt ... - Department of Psychology, University of Washington, Seattle USA
1999 Am J Addict - Dialectical behavior therapy for patients with borderline personality disorder and drug-dependence.
Subjects were randomly assigned to either DBT or TAU (treatment as usual) for a year of treatment.
Conclusions: Subjects assigned to DBT had significantly greater reductions in drug abuse than did subjects assigned to TAU. DBT also maintained subjects in treatment better than did TAU, and subjects assigned to DBT had significantly greater gains in global and social adjustment at follow-up than did those assigned to TAU.
* Palmer RL, Birchall H, Damani S, Gatward,... Department of Psychiatry, Leicester Warwick Medical School, Leicester, United Kingdom
2OO3 Int J Eat Disord - Dialectical behavior therapy,program for people with eating disorder and borderline personality disorder
Full dialectical behavior therapy (DBT) program for people with comorbid eating disorder and borderline personality disorder. The program included a novel skills training module written especially for eating-disordered patients.
The program was run for 18 months. Days in hospital and major acts of self-harm were counted for the 18 months before and after DBT.
RESULTS: There were no dropouts from the program. The patients seemed to benefit. Most patients were neither eating disordered nor self-harming at follow-up.


* Linehan MM, Armstrong HE, Suarez A, Allmon D, Heard HL. - Department of Psychology, University of Washington, Seattle USA
1991 Arch Gen Psychiatry - Cognitive-behavioral treatment of chronically parasuicidal borderline patients

22 subjects who were assigned to DBT and 22 control subjects
DBT subjects: Maintenance in therapy with the same therapist over one (1) year: 83.3%, attrition / dropout rate 16.7%
Control subjects TAU (treatment as usual): Maintenance in therapy with the same therapist over one (1) year:50%, attrition / drop-out rate 50%
* Ralph M. Turner, University of the Sciences
2OOO Behavior therapy Journal 32 - Comparing the effectiveness of a dialectical behavior therapyĖoriented treatment (DBT) with a client-centered therapy control condition (CCT) for borderline personality disorder patients (BPD).
24 patients diagnosed with BPD were randomly assigned to either DBT or CCT.
Measures of suicide attempts, self-harm episodes, psychiatric hospitalization days.
Outcomes showed the DBT group improved more than the CCT group on most measures.
* Clarkin JF, Foelsch PA, Levy KN, Hull JW, Delaney JC, Kernberg OF. - Personality Disorders Institute, Weill Medical College of Cornell University, White Plains, NY, USA
2OO1 J Personal Disord - The development of a psychodynamic treatment for patients with borderline personality disorder: a preliminary study of behavioral change
This study examines the effectiveness of a modified psychodynamic treatment called Transference Focused Psychotherapy (TFP) designed specifically for patients, with borderline personality disorder (BPD).
Compared to the year prior to treatment, the number of patients who made suicide attempts significantly decreased, as did the medical risk and severity of medical condition following self-injurious behavior.
Compared to the year prior, study patients during the treatment year had significantly fewer hospitalizations as well as number and days of psychiatric hospitalization. The dropout rate was 19.1%.
Psychotherapy changing the brain

* Paquette V, Levesque J, Mensour B,... - Institut Universitaire de Geriatrie de Montreal, Quebec, Canada
2OO3 Neuroimage. - "Change the mind and you change the brain": effects of cognitive-behavioral therapy on the neural correlates of spider phobia.

Questions pertaining to the neurobiological effects of psychotherapy are now considered among the most topical in psychiatry. With respect to this issue, positron emission tomography (PET) findings indicate that cognitive and behavioral modifications, occurring in a psychotherapeutic context, can lead to regional brain metabolic changes in patients with major depression or obsessive-compulsive disorder. (functional magnetic resonance imaging).
These findings suggest that a psychotherapeutic approach, such as CBT, has the potential to modify the dysfunctional neural circuitry associated with anxiety disorders. They further indicate that the changes made at the mind level, within a psychotherapeutic context, are able to functionally "rewire" the brain.
* Brody AL, Saxena S, Stoessel P, Gillies LA, Fairbanks LA,... - Department of Psychiatry and Biobehavioral Sciences, University of California-Los Angeles
2OO1 Arch Gen Psychiatry. - Regional brain metabolic changes in patients with major depression treated with either paroxetine or interpersonal therapy
In functional brain imaging studies of major depressive disorder (MDD), regional abnormalities have been most commonly found in prefrontal cortex, anterior cingulate gyrus, and temporal lobe... We also performed a preliminary comparison of regional changes with 2 distinct forms of treatment (paroxetine and interpersonal psychotherapy)... Between scans, subjects with MDD were treated with either paroxetine or interpersonal psychotherapy (based on patient preference), while controls underwent no treatment. RESULTS: At baseline, subjects with MDD had higher normalized metabolism than controls in the prefrontal cortex (and caudate and thalamus), and lower metabolism in the temporal lobe. With treatment, subjects with MDD had metabolic changes in the direction of normalization in these regions. After treatment, paroxetine-treated subjects had a greater mean decrease in Hamilton Depression Rating Scale score (61.4%) than did subjects treated with interpersonal psychotherapy (38.0%), but both subgroups showed decreases in normalized prefrontal cortex (paroxetine-treated bilaterally and interpersonal psychotherapy-treated on the right) and left anterior cingulate gyrus metabolism, and increases in normalized left temporal lobe metabolism. CONCLUSIONS: Regional metabolic changes appeared similar with the 2 forms of treatment.
* Martin SD, Martin E, Rai SS, Richardson MA, Royall R. - Affinity Research Unit, Cherry Knowle Hospital, Ryhope, Sunderland, UK.
2OO1 Arch Gen Psychiatry. - Brain blood flow changes in depressed patients treated with interpersonal psychotherapy or venlafaxine hydrochloride: preliminary findings.
Functional brain imaging studies in major depression have suggested abnormalities of areas, including the frontal cortex, cingulate gyrus, basal ganglia, and temporal cortex.
METHODS: Twenty-eight men and women aged 30 to 53 years with a DSM-IV major depressive episode...Thirteen patients had 1-hour weekly sessions of IPT from the same supervised therapist. Fifteen patients took 37.5 mg twice-daily of venlafaxine hydrochloride.
RESULTS: Both treatment groups improved substantially... No patients had structural brain abnormalities...
CONCLUSIONS: This preliminary investigation has shown limbic blood flow increase with IPT yet not venlafaxine, while both treatments demonstrated increased basal ganglia blood flow.
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Hope
You are not alone, you are among many even though you do not see them, they suffer with you and like you. I know. I was there and I am not there now. This should tell you that there is hope. There is a light, though it may appear dim, out there at the end of this long tunnel you are in now. In my opinion, medication will shorten this tunnel tremendously.
There is always light out there for you. There is love out there and peace. There is healing.
I know the pain you feel
http://www.mhsanctuary.com/borderline/therap.htm
There is a cure !
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AAPEL - Back to BPD summary page
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Warning:
All the information in this site is aimed at helping people understand a "rather particular" and puzzling kind of disease
But more especially, to support everyone affected by it, sick or not.  In any case, it is ESSENTIAL to see a therapist who specialises in this field they can confirm or give an alternative diagnosis
The name of what youíve got doesnít matter so much, getting the right treatment for the right patient does
bordeline
last update  2008
Copyright AAPELTM federation - All rights reserved
Author, Alain Tortosa, psychotherapist, founder president of the Aapel
Non profit organization