Nidotherapy in the successful management of comorbid depressive and personality disorder

Abstract

Nidotherapy is a new form of psychological therapy that aims to improve mental health by a systematic and collaborative manipulation of the environment in all its forms without focusing on alleviation of symptoms. Following treatment with nidotherapy, we describe a dramatic, and continuing, improvement in a woman with comorbid severe depressive illness and borderline personality disorder. She had made repeated serious suicide attempts over the previous 25 years and had received many drug and psychological treatments without success. The nidotherapy solution enabled her to leave home and achieve greater autonomy. Prior to this, she had been demeaned and undermined in her role as a family carer, and no health professionals had appreciated previously the restrictions it had placed on her health and well-being. Nidotherapy effected a smooth and orderly transition with family approval; the reasons for this seem to lie in the emotional neutrality of nidotherapy as a purely environmental intervention. Without this approach, we judge that separation from the family would not have been possible. Copyright © 2017 John Wiley & Sons, Ltd.

On the clinical utility and empirical verification of nontraditional interventions: Nidotherapy as exemplar

“…In contrast to family therapy, nidotherapy focuses on changing the environment rather than exploring it . As Spears et al note, ‘the description of this case is a part response to the suggestion….that nidotherapy should be explored further by studies of the role of situational and interpersonal changes within the theoretical system.’ A key element of nidotherapy is that it is nonjudgmental—that in contrast to family therapy, which involves exploration of dysfunctional dynamics, nidotherapy seeks to alter a pathology‐inducing situation without assigning blame for problematic features of the system (see).…”

“…A second issue that should be addressed in this context concerns Spears et al's suggestion ‘that nidotherapy should be explored further by studies of the role of situational and interpersonal changes within the theoretical system’. This is an excellent point, and addressing it requires a focus on process—collecting evidence regarding how this intervention effects longstanding changes in patient functioning.…”

“…Although myriad interventions had been implemented over the years, including cognitive‐behavioural, psychodynamic and pharmacological treatments, Ethel's pathology did not remit; her psychological dysfunction could best be described as being chronic and treatment resistant. Spears et al report that where other interventions had failed, nidotherapy —in this case, relocation away from a pathology‐inducing environment—succeeded. Ethel's symptoms diminished substantially, and for the first time in her adult life, she became reasonably well‐adjusted, with improved social and occupational functioning.…”

“…This Commentary focuses on three aspects of Spears et al's case description: (1) how to determine whether nidotherapy is more effective than other environmental interventions; (2) how the effectiveness of nidotherapy may compare with that of family therapy; and (3) how dysfunction and improvement in the patient can best be assessed. In all three areas, I highlight unresolved issues and offer suggestions for drawing more definitive conclusions regarding nidotherapy's clinical utility.…”

Empirical and narrative approaches to case study designs: A commentary on ‘Nidotherapy in the successful management of comorbid depressive and personality disorder’

“…Nidotherapy is a promising approach to treating a range of psychological difficulties, and it is possible that it was the mechanism of change responsible for the improvements in the case of Ethel, as described by Spears, Tyrer, and Tyrer . If so, it would be an impressive demonstration, given Ethel's longstanding functional difficulties and her exposure to a variety of other treatment approaches over several decades that had failed to improve her situation.…”