Common Features Across Empirically-Supported Treatments
Despite theoretical and technical differences, the structured treatments for BPD that we have reviewed here (i.e., Dialectical Behaviour Therapy, Mentalization-Based Therapy, Transference-Focused Psychotherapy, and Schema-Focused Therapy, Dynamic Therapies, and Cognitive-Behavioral Therapies) share several common overlapping features. It is therefore quite possible that these common elements may account for a greater proportion of therapeutic change than specific interventions. Further dismantling and process studies are needed to test this idea.
Weinberg and colleagues have systematically examined the treatment manuals of therapies for BPD according to 12 categories of intervention. Below we present an adaptation of their findings. We have restricted our presentation to the major treatments reviewed here at the BPD Clinician Resource Centre – those which have been the subject of two or more Randomized Clinical Trial (RCT) studies. Weinberg et al also examined General Psychiatric Management (a form of psychodynamic psychotherapy; See section on Other Dynamic Therapies for BPD) and STEPPS (an adjunct psychoeducational approach; See section on Other Cognitive-Behavioural Treatments for BPD). These treatments, especially General Psychiatric Management, also share many of the interventions listed below. As the table indicates, effective treatments involve a clear treatment framework, an active therapist who focuses on the therapeutic relationship, attention to affect regulation, and an emphasis on exploration and change. The most notable difference pertains to the interpretation of unconscious processes. While Transference-Focused Psychotherapy (TFP) prioritizes interpretation, attention to unconscious processes is not considered relevant in Dialectical Behaviour Therapy (DBT). Mentalization-Based Therapy (MBT) regards interpretation as essentially unusable by patients with BPD, at least during early stages of treatment when patients’ capacity for mentalizing has not yet been developed.
|Type of Intervention||Distinct or Important||Moderate Presence||Absent||Contra-Indicated|
|Multimodal Treatment||DBT, MBT||SFT, TFP|
|Clear Treatment Framework||DBT, MBT, SFT, TFP|
|Explicit treatment target||DBT, MBT, TFP||MBT|
|Attention to affect||DBT, MBT, SFT, TFP|
|Focus on TX relationship||DBT, MBT, SFT, TFP|
|Active Therapist||DBT, MBT, SFT, TFP|
|Exploratory Interventions||DBT, MBT, SFT, TFP|
|Supportive Interventions||DBT,MBT, SFT||TFP|
|Change-Oriented Interventions||DBT, MBT, SFT, TFP|
|Support for Therapist||DBT, MBT||SFT, TFP|
|Attention to Everyday Functioning||DBT, TFP||MBT||SFT|
DBT = Dialectical Behaviour Therapy; MBT = Mentalization Based Treatment;
SFT = Schema Focused Therapy; TFP = Transference Focused Psychotherapy.
Adapted from: Weinberg, I., Ronningstam, E., Goldblatt, M. J., Schecter, M., & Maltsberger, J. T. (2011). Common factors in empirically supported treatments of borderline personality disorder. Current Psychiatry Reports, 13, 60-68.