A controlled trial of psychodynamic psychotherapy for co-occurring borderline personality disorder and alcohol use disorder.

Abstract

A randomized controlled trial was conducted to determine whether a manual-based psychodynamic treatment, labeled dynamic deconstructive psychotherapy (DDP), would be feasible and effective for individuals with co-occurring borderline personality disorder (BPD) and alcohol use disorder. Thirty participants were assessed every 3 months during a year of treatment with either DDP or treatment as usual (TAU) in the community. DDP participants showed statistically significant improvement in parasuicide behavior, alcohol misuse, institutional care, depression, dissociation, and core symptoms of BPD, and treatment retention was 67% to 73%. Although TAU participants received higher average treatment intensity, they showed only limited change during the same period. The results support the feasibility, tolerability, and efficacy of DDP for the co-occurring subgroup and highlight the need for further research. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

Is Longer-Term Psychodynamic Psychotherapy More Effective than Shorter-Term Therapies? Review and Critique of the Evidence

“…As shown in table 4 , only 2 of the 8 studies identified methods of randomization [4,7] . Two studies clearly did not randomize patients to conditions.…”

“…Piper et al [3] successfully concealed the allocation sequences by delaying decisions about assignments until after initial assessments. However, the remaining 7 studies either failed to conceal allocation sequence [9] or did not provide sufficient information to assess allocation concealment [4][5][6][7][8]10] . For example, Gregory et al [4] reported that patients were randomly assigned to outpatient treatment conditions, but did not provide information about measures taken to prevent investigators knowing ahead of time what the assignments would be.…”

“…For example, Bachar et al [5] reported that pre-and post-assessment procedures were conducted by the same evaluator, who was not the therapist, but did not specify if the evaluator was blinded to group assignment. In the remaining 3 studies, blindness of outcome evaluators was either not ensured [7,9] or not adequately tested [4] . Guessing group assignment [4] is an unsatisfactory test of blindness [33] .…”

“…Yet, a recent meta-analysis by Leichsenring and Rabung [2] concluded that longer-term psychodynamic psychotherapy (LTPP), defined as lasting at least 1 year or 50 sessions, was 'significantly superior to shorter-term methods of psychotherapy with regard to overall outcome, target problems, and personality functioning' (p. 1563). This claim was based on 8 small studies [3][4][5][6][7][8][9][10] 1 that compared LTPP to various control conditions across a diverse range of outcomes.…”

The changing shape of clinical practice: Driven by science or by pragmatics?

“…So the bards returned to their crypts and wrote a new ballad which is not yet published, and therefore I am only at liberty to share the refrain. They identified 10 controlled studies of long term psychoanalytic psychotherapy versus other types of treatment (Bachar, Latzer, Kreitler, & Berry, 1999;Bateman & Fonagy, 1999;Bateman & Fonagy, in press;Clarkin, Levy, Lenzenweger, & Kernberg, 2007;Dare, Eisler, Russell, Treasure, & Dodge, 2001;Gregory et al, 2008;Huber, Denscherz, Gastner, Henrich, & Klug, submitted;Korner, Gerull, Meares, & Stevenson, 2006;Svartberg, Stiles, & Seltzer, 2004) where these treatments were used in the treatment of complex disorders, chiefly personality disorder (7), eating disorders (2) Why are these findings of enormous importance? This is the first set of strong signals which suggests that long term psychodynamic psychotherapy is superior to less intensive treatments when directed towards complex mental disorders.…”