Five-year outcome of outpatient psychotherapy with borderline patients

Abstract

Background. Borderline personality disorder (BPD) is a serious mental illness. Due to scepticism about the effectiveness of its treatment, the care of these patients is neglected. In this study we evaluated the effect of treatment 5 years after its ending, of patients with BPD.Method. Thirty subjects were treated twice weekly for 1 year by psychotherapy based on the 'Conversational Model ' of Hobson. Outcome measures included time in hospital, number of episodes of violence and self-harm, number of medical appointments, drug use and work history. A 'morbidity budget ' made up of these items was collated for the year before treatment, the year following treatment, and for the year preceding the 5-year follow-up. Additional measures included DSM-III criteria and a self-report of symptoms. These outcomes were compared to a hypothetical natural history of BPD constructed from the DSM scores of 150 borderline patients aged between 18 and 52 years.Results. Except for one measure, the improvements evident 1 year following treatment were maintained 4 years later. This improvement was not predicted by the hypothetical natural history. Conclusion.A particular form of treatment of BPD has relatively long-lasting, beneficial effects.

Psychodynamic treatments of self‐injury

“…These results demonstrated that psychotherapy based on psychodynamic principles is generally beneficial to patients with BPD in a naturalistic setting, having strong ecological validity. A follow-up of all patients in this cohort 5 years after the treatment found maintained improvements (Stevenson, Meares, & D'Angelo, 2005). A recently completed second quasiexperimental study (Korner, Gerull, Meares, & Stevenson, 2006) replicated these findings.…”

Advances in psychotherapy of personality disorders: A research update

“…Stevenson et al [34] reported follow-up data on 30 of 48 subjects from their uncontrolled trial of 1-year, twiceweekly conversational model therapy (manualized as psychodynamic-interpersonal). At 4 years postdischarge, gains on self-harm behaviors, violent episodes, use of drugs, medical visits, and length of hospital admissions were maintained.…”

Efectividad de un programa terapéutico integrado para trastornos graves de la personalidad. Seguimiento pragmático de 36 meses

“…Durante muchos años, la dudosa efectividad de los tratamientos disponibles para los TP provocó que algunos clínicos se cuestionaran, incluso, la viabilidad de la atención de estos pacientes en los servicios públicos de salud 4,5 . En los últimos 25 años varios estudios prospectivos han mostrado la utilidad de diferentes intervenciones psicoterapéuticas en los TP 6,7 , tanto en tratamientos ambulatorios 4,8---20 como en programas de hospital de día (HD) 1,21---26 o de internamiento 27,28 .…”

“…Finalmente, dado que muchos TP presentan un curso crónico, cabe preguntar si los beneficios obtenidos en las diversas terapias persisten con el paso de los años. La información al respecto es escasa, pues son pocos los estudios que realizan un seguimiento de más de 2 años, ya sea en tratamientos ambulatorios 4,14,20,32 , como en programas de internamiento 33 o de HD 21,34 .…”