Improving treatment outcomes for adolescents with borderline personality disorder through a socioecological approach

Abstract

Background There is a dearth of studies evaluating treatment efficacy for adolescents diagnosed with borderline personality disorder. The few available randomized controlled trials that have been conducted show modest results and treatments appear to have equivalent effects. The current paper draws on (a) the lessons learnt from the last 50 years of psychotherapy research in general and (b) recent advances in mentalization-based understanding of why treatment works, which together point to the importance of following a socioecological approach in the treatment of personality problems in adolescence – a developmental period that insists on a treatment approach that goes beyond the therapist-client dyad. Case presentation Here, we describe such an approach, and offer a clinical case example with a young 16-year old girl diagnosed with borderline personality disorder, to illustrate what a shift toward a more socioecological approach would entail. Conclusions The clinical impact of the socioecological approach and the potential benefits as illustrated in the current case illustration, offers a framework that justifies and allows for the expansion of service delivery for youth with borderline personality disorder beyond dyadic therapist-client work.

Adapting Short-Term Mentalization-Based Therapy to ICD-11 Personality Disorder in Adolescents

“…Subsequent explorative analyses of drop-out and outcomes from this trial found that lower reflective functioning, i.e., mentalizing, predicted drop-out in the MBT intervention [22] and that a more internalizing profile, as opposed to an externalizing one, predicted better outcomes at a two-year follow-up [23]. Overall, these results have led experts in MBT to suggest that more individual and family therapy should be offered to patients with higher personality disorder severity [19], should be of higher intensity and duration [5], and should include a greater focus on and involvement of the social environment (social-ecological approach) [24][25][26].…”

“…However, considering the immense importance of social environment and family for adolescent development and personality function [31], we believe that further focus on and inclusion of the most important people in the young person's life will be of the utmost importance. This may simply include offering family therapy, as reported in the Rossouw and Fonagy [18] trial, or it may include one or several network approaches, as described by Bo and colleagues [26] and in the Adolescent Mentalization-Based Integrative Therapy (AMBIT) intervention for the hardest-to-reach adolescents [32]. However, it should also be noted that in the Rossouw and Fonagy trial [18], which arguably has provided the most favorable results, one-third of the patients in the MBT group did not receive the family or network interventions.…”

Therapeutic and Preventive Interventions in Adolescents with Borderline Personality Disorder: Recent Findings, Current Challenges, and Future Directions

“…Empirical evidence supporting the efficiency of specific psychotherapies for adolescentonset BPD is limited. In contrast, clinical observations show the benefit of providing the patient and his family with a care network of intensive daily support for clinical and functional recovery [76]. This approach is in line with the concept of rehabilitation in adults, which is relatively more familiar to child and adolescent psychiatrists, as young patients are generally strongly embedded in multiple social networks, including families, schools, and other educational partners.…”

The role of interpersonal coordination dynamics in alliance rupture and repair processes in psychotherapy—A systematic review

“…The working alliance has relatively consistently been found to be a robust predictor for outcome across a wide range of different psychotherapies and mental health problems ( Del Re et al, 2012 ; Wampold, 2015 ; Flückiger et al, 2018 ; Bo et al, 2022 ). In a meta-analysis that included 295 studies, with data on more than 30,000 patients, a stronger alliance was found to be associated with better treatment outcome ( r = 0.28, corresponding to a medium effect size of Cohen’s d = 0.58) ( Flückiger et al, 2018 ).…”