Manualized supportive-expressive psychotherapy was as effective as nonmanualized community-delivered psychodynamic therapy conducted by experienced dynamic clinicians.

In this prospective study of psychiatric outpatients with personality disorders, the authors examined patient factors that predicted dropout from supportive-expressive (SE) psychotherapy. Eighty patients were randomized to 40 sessions of time-limited SE psychotherapy. The dropout rate was 35%; 50% of dropouts terminated psychotherapy before Session 7, and 10% were nonengagers. A model including age, type of Axis II cluster, total amount of interpersonal distress, and degree of focus on 1 particular type of interpersonal problem predicted 71% of the completers and 50% of the dropouts. The prediction model was more accurate for men than women. The findings regarding age and type of Axis II cluster are consistent with those of prior studies. The findings for total amount of interpersonal distress and degree of focus on 1 particular type of interpersonal problem are in accordance with key concepts in interpersonal theory and research. Thus, patients' manner of relating to others is associated with dropout. Researchers are encouraged to examine the association between interpersonal factors and dropout in greater depth.

The study is aimed at investigating the impact of a personality disorder (PD) diagnosis, in terms of functional impairment and subjective distress, in order to better understand the burden of this diagnosis and its implications. Among the 462 consecutive psychiatric patients diagnosed with the DSM structured interview for Axis I, II and V diagnoses, almost 60% had PD. Patients with PD displayed considerable vulnerability and suffering in many domains, including finances and interpersonal relationships. Despite the educational and occupational similarities of PD patients and non-PD patients, the PD patients had more problems maintaining permanent job positions. They also had more symptomatic suffering and concerns about health than non-PD patients. Generally, the results were in line with findings in the literature but more thoroughly captured the challenges that PD patients face in various areas of life. Awareness of the frequent comorbidity of PD with Axis I disorders seems crucial in developing future treatment plans with an emphasis on psychosocial rehabilitation, vocational training and social support.

The aim of the present study was to assess the effect of initial level of psychiatric severity on treatment outcome in psychodynamic therapy and dialectical behavior therapy (DBT) for borderline personality disorder (BPD). It was hypothesized that DBT would lead to better outcome for patients with high psychiatric severity, whereas dynamic treatment would lead to better outcome for patients with lower psychiatric severity. Data from the 5th-year follow-up of the Stockholm City Council's and the Karolinska Institute's Psychotherapy Project were used in the present study. A total of 106 female patients diagnosed with BPD with at least 2 past suicide attempts were randomized into object-relational psychotherapy (ORP; based on transference-focused psychotherapy), DBT, and treatment as usual. Patients' baseline global severity index was used as a moderator. Global Assessment of Functioning (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition [American Psychiatric Association, 1994]) was used to examine outcome. There was a significant 3-way interaction of Time × Treatment × Severity. Post hoc analyses suggested that patients with lower levels of severity had significantly better outcomes in object-relational psychotherapy. For patients with higher severity, the 3 treatments resulted in similar outcomes in terms of level of functioning. Outcome of treatment for BPD might differ significantly for patients depending on their initial levels of overall psychiatric severity. If our findings are replicated for patients with low severity and supported for a high-severity sample, psychiatric severity can be used as a low-cost and effective tool to match patients with BPD to optimal treatments. (PsycINFO Database Record

Studies involving patients with personality disorders (PD) have not focused on improvement of core aspects of the PD. This paper examines changes in quality of object relations, interpersonal problems, psychological mindedness, and personality traits in a sample of 156 patients with DSM-IV PD diagnoses being randomized to either manualized or non manualized dynamic psychotherapy. Effect sizes adjusted for symptomatic change and reliable change indices were calculated. We found that both treatments were equally effective at reducing personality pathology. Only in neuroticism did the non manualized group do better during the follow-up period. The largest improvement was found in quality of object relations. For the remaining variables only small and clinically insignificant magnitudes of change were found.The prevalence of personality disorders (PD) among psychiatric patients ranges between 31 -45 % (Samuels et al., 2002). Psychotherapeutic treatment in general and dynamic therapy in particular has increasingly shifted from a long term to briefer time formats. As a result, the focus of brief dynamic psychotherapies has shifted from restructuring personality Publisher's Disclaimer:The following manuscript is the final accepted manuscript. It has not been subjected to the final copyediting, fact-checking, and proofreading required for formal publication. It is not the definitive, publisher-authenticated version. The American Psychological Association and its Council of Editors disclaim any responsibility or liabilities for errors or omissions of this manuscript version, any version derived from this manuscript by NIH, or other third parties. The published version is available at www.apa.org/journals/pst. NIH Public AccessAuthor Manuscript Psychotherapy (Chic). Author manuscript; available in PMC 2010 September 1. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript pathology to a focus on symptom reduction. For these briefer treatments, however, there is so far no substantial evidence for their capacity to reduce character pathology.A comprehensive meta-analysis of 25 clinical trials with patients with PD (Leichsenring & Leibing, 2003) indicated that most studies had focused on symptomatic measures such as the Symptom Check List-90 (SCL-90, Derogatis, 1997), Beck Depression Inventory (BDI, Beck & Steer, 1988), and Global Adjustment Scale (GAS, First, Spitzer, & Gibbon, 1997). Few of these studies included measures assessing core PD pathology. For example, interpersonal problems, often considered a major aspect of PD pathology, were assessed in only two psychodynamic studies (Bateman & Fonagy, 2001Muran, Safran, Samstag, & Winston, 2005). Furthermore, measures theoretically relevant to the goals of psychodynamic psychotherapy (e.g., reflective functioning and levels or forms of attachment) have surprisingly rarely been used (for an exception see Levy et al., 2006).Improving maladaptive personality functioning is of considerable importance for patients with PD. Crits-Christoph and Barbe...