The borderline personality disorder and the therapy (therapies)
"what is a therapy ?"
... "magic ?", "voodoo ?"
... "which one to choose ?"

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

..
Summary:
Need help, support, yes, but not reprimands
"Border what ?". Psychotherapits don't "want" borderlines peoples !
Therapy ? - Attention, borderline disorder is also biological
.
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

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"

* "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.

Is it "working" ?

Yes, a psychotherapy produce "real" changes. You will find in the study section some evidences of it

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)

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::

• What percentage of their patient load is people with BPD?
• What treatment approach do they use?
• What is their philosophy about calls between visits?
• Read up on BPD and visit the therapist.

"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)

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.

Text on DBT wrote by marsha linehan

• TFP was developed at the Personality Disorders Institute (PDI) by Otto F. Kernberg

TFP is a modified psychodynamic psychotherapy, based in object relations theory, to treat personality disorders
TFT faq by the Personality Disorders Institute
 
• Masterson therapy is a modified psychodynamic psychotherapy, also based in object relations theory, to treat personality disorders

From the author "Masterson, in illustrating the use of such techniques as confrontation, interpretation and communicative matching in the various phases of therapy, shares not only his triumphs and sudden insights, but also his early counter transferential blind spots and the of errors clinical judgment he makes while learning what the patients need from him."
... and "In both shorter term and intensive analytic therapy, the therapist establishes a therapeutic alliance and facilitates the emergence of the patient’s real self through the use of confrontation"
(James F. Masterson MD, "Psychoanalytic Psychotherapy of the Personality Disorders", www.mastersoninstitute.org)

AAPEL: Actually we have no information about results of the TFT orMasterson therapy, no indication if it is "really" working and no comparison with DBT therapy) - If you have "serious" information, don't hesitate to contact us

Masterson and TFT therapy are not "classic" psychodynamic therapy. For example Masterson is talking about "confrontation" while in "classic" psychodynamic therapy the psychotherapist is "absent" as possible. It is then impossible to say "A psychoanalysis is 'working' because the TFP or Masterson approach are working". It is not the same !

"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

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

* 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

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.

Psychodynamic psychotherapy has not been proven to be effective, but dialectical behavior therapy yields symptomatic improvement.

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

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."

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.

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.

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.

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%

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.

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%.

* 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.

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.

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.