18b - Consideration of Commonalities in Distinct Models of Treatment for Individuals with Borderline Personality Disorder: Commentary on Psychoanalytic/Psychodynamic Approaches to Personality Disorders

Summary

The chapter on psychoanalytic/psychodynamic approaches to personality disorders (this volume) particularly highlights Mentalization-Based Treatment (MBT), which has a number of striking commonalities with Dialectical Behavior Therapy (DBT). This commentary highlights commonalities of the two approaches in areas including structural properties, skills training, the approach to insight, and the emphasis on practitioner flexibility. While DBT and MBT have significant distinctions and are not equivalent treatments, the commonalities among the treatments may be indicative of best practices when treating individuals with BPD. Some candidates for what may be best practices include approaching treatment with a balanced combination of validation and change-based strategies which directly target severe behaviors such as suicidal behaviors and non-suicidal self-injury; providing a compassionate model of the pathology; actively building a strong, genuine, and validating therapeutic relationship; a central focus on emotions and how they are related to actions; use of a team based approach that promotes adherence to the treatment model; teaching skills that address the model of pathology; and promoting flexibility within the treatment approach to address the complexities of the clients’ problems.