20b - Short- and Long-Term Personality Disorder Treatment Studies Should Inform One Another: Commentary on Brief Therapeutic Approaches for Personality Disorders

Summary

This commentary extends on Dixon-Gordon, Conkey, and Woods’ (this volume) review of studies on brief personality disorder treatments by exploring two ways in which this evidence base advances the state of personality disorder treatment, and, relatedly, ways in which findings from short-term and long-term treatment studies might be productively integrated toward the development and testing of better treatments. First, these studies improve the accessibility of personality disorder treatment by testing specific interventions of limited intensity and duration that may be implemented with greater ease by generalist clinicians with less specialized training, time, and program resources. Good Psychiatric Management for borderline personality disorder is offered as an example of a “stepped-care model” in which the delivery of specific short-term interventions could be stratified according to an evidence-based algorithm yielding maximal benefit for the largest number of patients within the shortest amount of time. Second, brief personality disorder treatment studies suggest ways to conceptualize change processes at the level of structural features of treatments and at the level of what is happening in patients’ minds. Change models derived from studies on longer-term personality disorder treatments, such as the generation of “epistemic trust” as posited by the developers of Mentalization-Based Treatment, might be productively applied and empirically evaluated in the setting of short-term treatments.