Rep36 Understanding Personality Disorder

3.2.2b Psychodynamic psychotherapy 
Psychodynamic psychotherapy has been
evaluated using randomised controlled trial. Two
forms of psychodynamic therapy have been
compared, interpersonal group therapy and
individual dynamic psychotherapy (Munro-Blum
& Marziali, 1995). Of the men and women who
remained in the study (28 per cent of the sample
withdrew), both forms of therapy demonstrated
improvement on measures such as levels of social
functioning and depression at follow-up,
regardless of treatment condition. 
Psychodynamic psychotherapy associated with
partial hospitalisation has been found to be
more effective than standard psychiatric care in
the treatment of men and women with a
diagnosis of borderline personality disorder
(Bateman & Fonagy, 1999). Partial
hospitalisation was intensive, and like DBT,
included both group and individual therapy,
lasting for 18-months. The control group
received regular psychiatric review approximately
twice a month and, if appropriate, in-patient
treatment with out-patient follow-up at
discharge. At 18 months follow up, the results
still showed an advantage for those who had
psychodynamic psychotherapy and partial
hospitalisation (Bateman & Fonagy, 2001).
Although the results for partial hospitalisation
are promising, there are some methodological
problems with this study as 16 per cent of
patients were not treated in their original group
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and patients continued to receive treatment
during the follow-up period, although this was
not as intensive as the first 18 months. Also, it is
not possible to identify the essential ingredients
of treatment from this research. 
When considered together, studies using
randomised controlled group designs
demonstrate that structured and systematic
psychological treatments can be effective at
reducing self-harm and improving social and
interpersonal functioning in patients with BPD.
Importantly these gains are maintained, on the
whole for at least six months in a naturalistic
setting and for longer when patients continue to
receive therapy (Bateman & Fonagy, 2001).
However, most studies have been on small
samples of patients and larger more
generalisable studies, involving more than one
centre, are needed.