Abstract
The objective was to review established literature on approaches to the psychotherapy of borderline personality disorder with specfic reference to suicide in order to determine if there were common factors across these efforts that would guide future teaching, practice and research.The publications from the proponents of five therapies for the treatment of suicidal behavior in individuals with borderline personality disorder (BPD), were reviewed and discussed by the members of the Group for the Advanced of Psychiatry, Psychotherapy Committee (GAPPC). Twenty nine published research and summary reports were reviewed of the specific treatments noted above along with two other reviews of common factors for this group of treatments. We used expert consensus as to the salient articles for review and the appropriate level of abstraction for the common factor definition. We formulated a definition of effectiveness and identified six common factors: 1) negotiation of a specific frame for treatment, 2) recognition and insistence on the patient’s responsibilities within the therapy, 3) provision to the therapist of a conceptual framework for understanding and intervening, 4) use of the therapeutic relationship to engage and address suicide, 5) prioritization of suicide as a topic to be actively addressed whenever it emerges, and 6) provision of support for the therapist in the form of supervision, consultation or peer support. We discuss common factors, their formulation, and implications for development and teaching of psychotherapeutic approaches specific to suicide in patients with borderline personality disorder and note that there should be greater attention in practice and education to these issues.
Highlights
Treating suicidal patients with borderline personality disorder (BPD) is a significant clinical challenge for mental health clinicians
There is a clear agnostic sense that theory is relatively unimportant compared to pragmatic engagement of the issues, and that perspective, in a sense, becomes an over arching theory. To determine whether these five psychotherapies met our effectiveness criteria and to derive their common factors, we reviewed and compared the five approaches and considered the literature addressing their outcomes as well as their critical features
The psychodynamic therapies focus on the transference meaning of suicide, that is, on feelings that can emerge in the patient during treatment that the therapist is indifferent, neglectful, or harmful to the patient
Summary
Treating suicidal patients with borderline personality disorder (BPD) is a significant clinical challenge for mental health clinicians. A 23-year-old woman with BPD, in psychotherapy for the past 6 months with symptoms that include Clinicians react to such situations with anxiety, concern, anger, guilt, and worry about their patient as well their own legal liability, and often question whether they want to work with such risky and challenging patients. Two additional treatments reviewed by the committee used with Borderline Personality Disorder are included in an Appendix. They are Cognitive and Behavioral Therapy (CBT) [9] and Alliance Based Intervention for Suicide (ABIS) [10]. While the evidence is in conflict about effectiveness for suicide in one (CBT) [11] and not thoroughly studied in the other (ABIS), both are used robustly in a variety of settings and demonstrate promise
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