A practical approach to the treatment of patients with borderline personality disorder
Journal/Book: Psychiat Clin N Amer. 2000; 23: Independence Square West Curtis Center, Ste 300, Philadelphia, PA 19106-3399, USA. W B Saunders Co. 211+.
Abstract: This article describes a comprehensive approach to treating borderline personality disorder based on current empiric knowledge about personality disorder and treatment outcome. The results of recent studies of the etiology and structure of personality disorder challenges the view of borderline pathology adopted by many traditional approaches to classification and treatment. The evidence suggests that borderline pathology is a biopsychological entity caused by a combination of biological and psychosocial factors and that some aspects of borderline personality are more amenable to change than others. These findings provide the basis for a rational approach to treatment. A therapeutic model is presented that has two components: (1) general strategies to manage core self and interpersonal pathology that characterizes all cases of personality disorder and (2) a specific or tailored component required to manage the problems and psychopathology of individual cases. The general strategies emphasize the therapeutic relationship, treatment alliance, validation, and a consistent therapeutic process. These strategies are derived from ideas about therapeutic change adopted by integrated approaches to therapy, and they are consistent with the ideas of self-psychology and more supportive approaches to treating borderline problems. An array of specific interventions, including medication and psychotherapeutic interventions drawn from different schools of thought, are built onto this framework as required to meet the needs of individual cases and the skills and orientation of therapists. The overall model is not an eclectic approach to treatment but an integrated framework based on the understanding of the psychopathology of borderline personality disorder that emerges from recent research.
Note: Article Livesley WJ, Univ British Columbia, Dept Psychiat, 2255 Wesbrook Mall, Vancouver, BC V6T 1W6, CANADA
Keyword(s): DIMENSIONS; CHILDHOOD