“Good Enough” Psychiatric Residency Training in Borderline Personality Disorder: Challenges, Choice Points, and a Model Generalist Curriculum

Abstract

While the public health burden posed by borderline personality disorder (BPD) rivals that associated with other major mental illnesses, the prevailing disposition of psychiatrists toward the disorder remains characterized by misinformation, stigma, aversive attitudes, and insufficient familiarity with effective generalist treatments that can be delivered in nonspecialized health care settings. Residency training programs are well positioned to better equip the next generation of psychiatrists to address these issues, but no consensus or guidelines currently exist for what and how residents should be taught about managing BPD. Instead, disproportionately limited curricular time, teaching of non-evidence-based approaches, and modeling of conceptually confused combinations of techniques drawn from specialty BPD treatments are offered. In this article, we (1) explain why training in a generalist model is sensible and why alternative approaches are not appropriate for residents, (2) propose a plan for giving residents adequate training via a generalist model, highlighting minimal didactic and clinical-training objectives (dubbed "core competencies" and "milestones") and a model curriculum developed at the Massachusetts General Hospital/McLean Hospital residency program, and (3) describe obstacles to implementation of effective generalist training posed by infrastructural, faculty-centered, and resident-centered variables.

The availability of training opportunities in personality disorders in American Psychological Association- and Psychological Clinical Science Accreditation System-accredited clinical and counseling psychology doctoral programs.

“…Since this study, there has been little follow-up. Although there are a few reports on implementing training in personality disorders in psychology department clinics (Noll et al, 2020;Rizvi et al, 2017) and several more within residency programs (e.g., Bernstein et al, 2015;Unruh & Gunderson, 2016;Zerbo et al, 2013), we did not find empirical reports of the scope of training in personality disorders in clinical psychology programs beyond those in Magnavita et al (2010).…”

Birds of a Feather Flock Together: Concurrent Personality Disorders and Substance Use Disorders

“…22 These countertransference reactions have the potential to cause serious disruptions in the therapeutic process, if left unexamined and unacknowledged. 22 Managing countertransference is the foundation of therapy 66 and clinicians must be able to identify when they are experiencing it. Common signs include becoming overemotional in the dislike or positive feelings toward the patient, feeling physiologically aroused or uncomfortable during the session, being different with 1 patient compared to others, or being preoccupied with the patient's case outside sessions.…”

Transtorno de personalidade borderline

“…Para Balint (8) o ato da consulta, e o dar e receber de uma prescrição, parecia constituir a sua própria razão de ser, sendo a consulta, nesta medida, a Tais intensões não pairam sobre um terreno utópico, pois pesquisadores (57)(58)(59) tem se dedicado ao estudo e aplicação de oficinas em settings ambulatoriais, que mobilizem boas práticas no manejo à pacientes diagnosticados com TPB.…”

“…Segundo Unruh (59) esses avanços pavimentam coletivamente um caminho mais claro para equipar a próxima geração de psiquiatras. Para atender as necessidades de um tratamento generalista e amplamente eficaz no atendimento de pacientes com TPB.…”

“…Alguns autores (59,60) , consideram algumas críticas, centradas no programa de residência, na infraestrutura e nos próprios residentes. Sendo: viés ou desinformação da faculdade sobre a importância e prognóstico ou tratabilidade; falta de conhecimento do corpo docente/supervisores, sobre abordagens eficazes de tratamento generalista; ausência de diretrizes de treinamento e abordagens psicossociais; falta de interesse frente aos desafios do tratamento do TPB, entre outros.…”