1. Borderline Personality Disorder
Recent Psychodynamic therapy Trials

2. BATEMAN AND FONAGY PARTIAL HOSPITILISATION STUDIES 1999, 2001, 2003, 2008
(1)
38 BPD patients
Random Allocation
18/12 partial Hospitalisation General Psychiatric Care
Individual and group Psychotherapy (Rx as Usual)
PH Stat sign suicide attempts
- self harming
- number and duration I/P stays
- self reports – depression, anxiety general symptom distress, interpersonal functioning and social adjustment
Began after 6/12 Continued to end.
TAU group limited change or deterioration

3. BATEMAN AND FONAGY – PH STUDIES
(2)
Follow up of original group. 3/12ly for 18/12 of 44 patients
Maintained gains and continued to improve (stat. sign.) on most measures for PH group.
Limited change in TAU group
Rehabilitative change

4. BATEMAN AND FONAGY – PH STUDIES
COSTS – Psychiatric, Pharmacological, A&E
Pre Rx and during Rx – No differences in service utilisation
cost of day care in PH group balanced by less I/P care and less A&E
Trend for costs in PH group during F/U no trend for costs in TAU group

5. 8 yr follow up-5yrs after Rx 2008
Rxed group-13% vs 87% TAU group still meet criteria for BPD
Stat sig decrease in suicidality, service and medication use in Rx Gp
Stat sig increase in global and vocational functioning in Rx Gp
But still appreciable social and functional impairment- quality of life.
Bateman and Fonagy Am J Psych

6. Transference Focused Therapy (TFP)
Clarkin et al 2007-Am J Psych 164: RCT
Levy et al 2006-J Cons and Clin Psychol 74(6) RCT
Structured Outpatient treatment-twice weekly, modified psychodynamic Rx based on Kernberg’s theoretical model

7. TFP /DBT/SPT Clarkin et al-1yr figs
All broadly equivalent overall but individual domains differ-?different routes to symptom change
TFP and DBT reduce suicidality
TFT and SPT reduce anger and impulsivity
All reduce depression, anxiety
All improve global functioning
All improve social adjustment
Only TFT sign predictive of changes in irritability, verbal and physical assault

8. TFP /DBT/SPT Clarkin et al-1yr figs
All broadly equivalent overall but individual domains differ-?different routes to symptom change
TFP and DBT reduce suicidality
TFT and SPT reduce anger and impulsivity
All reduce depression, anxiety
All improve global functioning
All improve social adjustment
Only TFT sign predictive of changes in irritability, verbal and physical assault

9. Attachment changes in Levy 2006
Same trial as Clarkin
Sign inc in attachment security on AAI in TFP not others
Sign inc in reflective functioning, and attachment coherence in TFT not others

10. Borderline Personality Disorders
Are Common
Frequently exist as co-morbid disorders
Arouse powerful feelings in staff and teams
Can test professional boundaries
Can be understood
Can be treated-often need combined psychotherapy and pharmacotherapy
MBT,DBT TFP all effective
Treatment teams need to communicate