What is the role of psychotherapy in the treatment of borderline personality disorder (BPD)?

Updated: Nov 05, 2018
  • Author: Roy H Lubit, MD, PhD; Chief Editor: Caroly Pataki, MD  more...
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Answer

Psychotherapy, such as Dialectical Behavior therapy (DBT) is often a first line approach for BPD and has been shown to be useful and effective despite the challenges of patent regression, overwhelming affect, and impulsive behavior.

Kernberg, historically, prior to the development of DBT believed that psychoanalytic therapy was the most effective approach, however currently this type of treatment is not considered the first line of intervention. [11] The goal of this type of therapy is to resolve pathologic internalized representations of interpersonal relationships. The therapist requires adequate support systems, including access to prolonged hospitalization, which might be necessary.

A second view regarding psychotherapy for BPD is that the regressive transference resulting from analytically oriented treatment is often detrimental to the patient. According to proponents of this view, a supportive, reality-oriented approach in which the goal of therapy is a gradual social adjustment in the framework of a realistic therapeutic relationship is more beneficial.

A third view is that experiences are more likely to benefit the patient than explanations are. Thus, the therapist remains calm, without anxiety or anger, while remaining emotionally available. In this setting, the patient can learn to tolerate the hateful and destructive feelings that arise because of transference and, eventually, to replace them with more constructive and positive reactions. The patient also internalizes a calm, soothing supportive object.


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