Good Psychiatric Management Research Articles

Therapeutic alliance rupture and resolution in a brief psychiatric treatment for borderline personality disorder

AbstractBackgroundThe focus of this case study was to explore the development of the therapeutic alliance in relation to alliance rupture and resolution and the effect of motive‐focussed psychotherapeutic techniques on this process in the treatment of borderline personality disorder (BPD).MethodsTherapeutic alliance rupture and resolution processes were analysed in relation to outcomes over the course of a 10 week, short‐term generalist psychiatric treatment for BPD in two patients, hereby referred to as Clara and Rebecca. Clara received treatment in the form of good psychiatric management (GPM) with the addition of motive‐oriented therapeutic relationship (MOTR) techniques. Rebecca received treatment in the form of GPM.ResultsBoth patients experienced a clinically significant reduction in symptoms. Ruptures and resolution processes occurred at low frequencies in Clara's treatment, while ruptures and resolution processes were numerous in Rebecca's treatment. The focus in Clara's treatment was on rupture prevention because of the added presence of MOTR techniques, while the focus in Rebecca's treatment was on rupture identification and resolution.DiscussionResults support the hypothesis that symptom reduction was achieved through two distinct pathways of change as a function of the treatment condition, which suggests the potential presence of multiple effective psychotherapeutic techniques for alliance development. Limitations of this study and clinical implications for the treatment of BPD in psychotherapy, with a special focus on the therapeutic alliance, are discussed.

Good Psychiatric Management of Borderline Personality Disorder: Foundations and Future Challenges.

Borderline personality disorder is a common condition characterized by numerous comorbid conditions, frequent use of clinical services, and an elevated lifetime risk for suicide. Good psychiatric management (GPM) was developed for patients with borderline personality disorder with the purpose of supporting wider community adoption and dissemination compared with existing therapies. The authors aimed to review the foundations and development of GPM, in particular the initial Canadian study assessing the therapy. They then reviewed the progress in research arising from the initial study and explored the research and educational opportunities needed to further the development of GPM for patients with borderline personality disorder. Research has indicated that patients with borderline personality disorder with complex comorbid conditions and impulsivity may benefit from GPM. Future research needs include noninferiority and equivalence studies comparing GPM with another evidence-based treatment; studies demonstrating that evidence-based therapies for borderline personality disorder improve functioning; and research on more accessible therapies, mechanisms of action for evidence-based therapies, extending therapies to patients with borderline personality disorder and significant comorbid conditions, and modifying therapies for men with borderline personality disorder. Attention should be directed toward testing stepped care models and integrating therapies such as GPM into psychiatric training programs. GPM is in development but shows promise as a therapy that is effective and accessible and that can be widely disseminated.

Le « Good Psychiatric Management-Adolescents » (GPM-A) : un modèle généraliste et accessible de traitement du trouble de la personnalité borderline chez l’adolescent

The Good Psychiatric Management for Adolescents (GPM-A) is a generalist model of structured care for adolescents with borderline personality disorder. It is based on principles derived from several psychotherapies validated in the treatment of borderline personality disorder and on current good practice data. Borderline personality disorder is conceptualised as the result of a particular sensitivity to relationships (defined with the term interpersonal hypersensitivity). The GPM-A offers clinicians a pragmatic approach based on good practice in the care of adolescents with borderline personality disorder. Developed in the United States, it is currently being disseminated in the French-speaking world. This article provides a summary of the main components of the model and a discussion of the benefits expected from its implementation among French-speaking clinicians.

Good-Enough Therapy: A Review of the Empirical Basis of Good Psychiatric Management

Good-Enough Therapy: A Review of the Empirical Basis of Good Psychiatric Management

The Impact of a One-Day Workshop on Good Psychiatric Management for Adolescent (GPM-A) Borderline PersonalityDisorder.

Despite evidence validating the diagnosis of borderline personality disorder (BPD) in youth, specifically showing persistence of BPD symptoms and morbidity similar to adults, there is reluctance to diagnose this in teens. Further, there is a belief among many trainees and academic child and adolescent psychiatrists (CAPs) that only specialty programs are effective, leading to treatment delays. This study charts the impact of a full-day workshop offered to an entire academic CAP department. A Good Psychiatric Management for Adolescent (GPM-A) Borderline Personality Disorder in-person workshop was offered to department members. Participants were asked to complete a pre-survey, an immediate post-training survey, and a survey at 6months post-training. Utilizing a Qualtrics questionnaire, both linear mixed-effect models and paired t-tests were used to estimate the immediate and sustained effects of the training. Thirty-two participants completed the workshop, with 31 answering the pre-survey, 27 the post-training survey, and 23 the 6-month follow-up survey. Immediately after the training and 6months later, participants demonstrated statistically significant (p < .05) improvements in willingness to disclose the diagnosis of BPD, a reduced negative attitude around BPD, and an enhanced sense of confidence in addressing the needs of adolescents with BPD. GPM-A training can make a positive impact on groups of clinicians who work with youth who meet criteria for BPD, specifically reducing stigma, encouraging trainees and faculty members to make the diagnosis more readily, and helping them feelmore competent inaddressing the treatment needs of adolescents with BPD.

The Interpersonal Hypersensitivity Formulation of Good Psychiatric Management as a Psychoeducational Intervention for Borderline Personality Disorder.

Interpersonal hypersensitivity (IHS) is a core organizing concept of Good Psychiatric Management, a generalist treatment for borderline personality disorder (BPD) that relies on basic tools most clinicians already employ yet is informed by an organized and evidence-based framework, developed for dissemination in various mental health care settings. We work in an inpatient psychiatric unit that specializes in the management of suicidal crises at the University Hospitals of Geneva, Switzerland. Because we see numerous patients with previously undiagnosed BPD during their first hospitalization, we have developed techniques and instruments to promote efficient and easy-to-implement psychoeducation. In this article, we propose a practical and user-friendly measure of IHS that is well-suited for use by multidisciplinary inpatient staff or outpatient nursing-based staff, the IHS Ruler, which is based on a visual analog scale. It is a pragmatic tool for preliminary psychoeducation for patients with BPD and their caregivers. Its ease of use and structured way of presenting the inner experience of these patients in relation to their current interpersonal environment allows caregivers to establish a framework for internal reflection and sharing, discuss the causes of current transactions, and illuminate larger patterns in the causes of the patient's crises. Ultimately, this process can help patients and the clinical staff supporting them anticipate future problems.

Good psychiatric management for borderline personality disorder: A qualitative study of its implementation in a supported employment team.

People with borderline personality disorder have difficulties with work. The Individual Placement and Support model has shown its worldwide effectiveness in terms of vocational rehabilitation for individuals with psychiatric disorders. However, only a few recent studies have explored its results for people with personality disorders, and the findings were mitigated. Additionally, Individual Placement and Support job coaches reported difficulties in supporting this population. An evidence-based psychotherapeutic method, also applicable in a case management context, called Good Psychiatric Management for borderline personality disorder, could potentially overcome these obstacles. This study aimed to evaluate the initial integration of Good Psychiatric Management in Individual Placement and Support practice. Individual Placement and Support practitioners of Lausanne University Hospital, Switzerland, were trained in Good Psychiatric Management in January 2022. Five of them participated in a focus group to collect their impressions about the training, and six were interviewed 9 months later to assess the initial adoption of Good Psychiatric Management into their practice. Thematic analyses were conducted. Job coaches were positive about this new tool. All of them found it useful and beneficial both for them and their patients. They were able to follow the main Good Psychiatric Management principles in their practice However, the findings also suggested some additional improvements in the implementation process. Integrating Good Psychiatric Management in Individual Placement and Support seems feasible, and the team who appreciated it adopted it. The method offers new perspectives in community support for people living with borderline personality disorder.

Corrective Experiences to Enhance Trust: Clinical Wisdom From Good (Enough) Psychiatric Management.

Unstable trust within social interchange underlies the symptom constellation of borderline personality disorder (BPD), resulting in preoccupation with intense dyadic relationships, limited capacity for social collaboration, and constricted social networks. Good Psychiatric Management (GPM) provides a distilled formulation of how interpersonal hypersensitivities drive the engine of BPD's symptomatic oscillations in both affect and attachment. The authors summarize clinically relevant conclusions from the empirical literature on trust in BPD, synthesize it with selected ideas from other empirically supported interventions, and distill a formulation of how the GPM approach can address problems of trust in BPD with strategies most clinicians can use to improve their work with patients. GPM's clinical management approach utilizes common factors in psychotherapy to structure collaboration with patients to be accountable partners in treatment, rely on themselves more to diminish unrealistic demands on others, and function more effectively in arenas that expand and stabilize their social network.

Pour une cohabitation pragmatique des modèles théoriques et cliniques : l’exemple du « Good Psychiatric Management » dans le traitement du trouble de personnalité borderline

Borderline personality disorder (BPD) is a common disorder in general and clinical populations and is related to potentially severe medical and socio-professional consequences. Treatment of BPD is based on evidence-based psychotherapies (such as Dialectical Behavioral Therapy, Mentalization-Based Therapy, Schema-Focused Therapy or Transference Focused Psychotherapy), which have been shown effective but are poorly available in France. Pharmacological treatments, which are more easily available, are not effective in treating symptoms of the disorder but can be useful in management of comorbidities. In this context, recently called “generalist” models have been developed, which every well-trained psychiatrist can implement in their daily practice, combining practical elements from evidence-based psychotherapies and elements of pharmacological management of symptoms and comorbidities. The purpose of this article is to present one of these models, the Good Psychiatric Management (GPM) and its basic principles and its applications, and to provide one of the first French-speaking resources about this model. In addition, beyond the practical elements proposed by the GPM, we discuss the deeper question that it raises, namely the question of a pragmatic integration of different theoretical and clinical models. Indeed, the treatment of BPD patients is at the junction of different conceptualizations of mental pathology (psychopathological, neurobiological) and different modalities of practice (psychotherapy, biological psychiatry). In a French context, that sometimes separates these two models, and in our opinion GPM constitutes an example of clinical collaboration which shows the interest of the combined role of psychiatrist-psychotherapist.

Co-Occurring Autism Spectrum and Borderline Personality Disorder: An Emerging Clinical Challenge Seeking Informed Interventions.

Co-Occurring Autism Spectrum and Borderline Personality Disorder: An Emerging Clinical Challenge Seeking Informed Interventions.

Good Psychiatric Management and Dialectical Behavior Therapy: A Clinician’s Guide to Integration and Stepped Care

PARIS: Emeritus Professor of Psychiatry, McGill University, Montreal, Québec, Canada. Marcia L. Verduin, MD, Book Editor Overall rating: 5 stars The author declares no conflicts of interest.

C-L Case Conference: Applying Good Psychiatric Management for Borderline Personality Disorder in Hospitalized Patients With Co-occurring Substance Use Disorders.

We present a case illustrating common challenges in the hospital management and treatment of comorbid borderline personality disorder and substance use disorders. Experts in the field of personality disorders and substance use disorders discuss various topics and strategies for patient-centered management. Key learning points include evaluation and diagnosis of borderline personality disorder, good psychiatric management, withdrawal and pharmacologic management, harm reduction, team dynamics, and behavior planning all in the hospital setting. This paper provides actionable considerations with elements common to many clinical encounters that present challenges to the consultation-liaison psychiatrist in the general hospital setting.

Brief psychiatric treatment for borderline personality disorder as a first step of care: Adapting general psychiatric management to a 10-session intervention.

The considerable demand versus supply gap of evidence-based treatments for borderline personality disorder (BPD) indicates the need for modular steps of care to tailor fit between individual patients' needs along the trajectory of their clinical course and effective interventions. These trajectories may or may not include lengthy specialized psychotherapies. Good psychiatric management (GPM) for BPD is being practiced by an increasing number of mental health professionals as a basic starting block of mental health services in the community. It remains an open question what duration of GPM is optimal, what the content of a shortened version of GPM may be, and how such brief treatment may be integrated into larger long-term treatment plans for patients with BPD. The present practice review elaborated on a brief version of GPM, addressed its conceptual background and the notion of stepped care in the treatment of BPD, and discussed the clinical tasks and contents of brief psychiatric management in 10 sessions (or lasting 4 months). It also summarized the moderate evidence base of brief forms of GPM: 2 randomized controlled trials of 10-session GPM, and 1 randomized controlled trial of a 6-session GPM psychoeducational group, have found medium-to-large effects in reducing BPD symptoms. Finally, this review offered 2 clinical vignettes of patients either stepping up or down the intensity of their treatment to illustrate how to implement brief GPM and suggested open avenues for future development and clinical practice. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Good Psychiatric Management for Borderline Personality Disorder - A Specialized Treatment Applicable in General Care

This article presents basic notions of "Good Psychiatric Management" (GPM) for Borderline Personality Disorder (BPD). There have been several evidence-based psychotherapeutic treatments for BPD for several decades. Nevertheless, high requirements and motivation required sometimes have a discouraging effect for trainees. GPM aims at offering «good enough» and less difficult to implement care. This article presents the notion of Interpersonnal Hypersensitivity and its different attachment states (attached, threatened, abandoned, and desperate) describing internal coherence of BPD and founding therapeutic interventions. GPM is principle based, thus is highly adaptable, as can be seen in integration with other intervention models or implementation of stepped care.

Good Psychiatric Management for Obsessive–Compulsive Personality Disorder

Good Psychiatric Management for Obsessive–Compulsive Personality Disorder

Integration Good Psychiatric Management to Psychodynamic Psychotherapy for Fresh Psychotherapists with Treatment of Borderline Personality Disorder

Integration Good Psychiatric Management to Psychodynamic Psychotherapy for Fresh Psychotherapists with Treatment of Borderline Personality Disorder

Good Psychiatric Management and Transference-Focused Psychotherapy for Borderline Personality Disorder: A Spectrum of Psychodynamically Informed Treatments.

Good psychiatric management for borderline personality disorder (GPM) and transference-focused psychotherapy (TFP) are evidence-supported treatments that may be used in a complementary, flexible manner to provide a spectrum of psychodynamically informed care. In this article, we provide overviews of TFP and GPM, describing GPM's eclectic approach that includes psychodynamically informed supportive psychotherapy, case management, and medication management, informed by a model of hypersensitivity to rejection, comparing it with TFP's focus on identity integration and modification of standard psychodynamic techniques for use in treating patients with borderline personality disorder. We outline convergences and divergences between TFP and GPM in assessment, establishment of treatment goals and a treatment agreement, family involvement, and moment-to-moment psychotherapeutic interventions. The options for integration of TFP and GPM theoretical principles, as well as for models of treatment sequencing, are explored. Clinical vignettes are provided that illustrate sequential uses of GPM and TFP as part of psychodynamically informed long-term clinical management.

The difficult differential diagnosis of BPD look-alikes

The traits of Borderline Personality Disorder (BPD) and various other personality or mental disorders may overlap, causing diagnostic difficulties and pitfalls for psychiatrists early in their career. An online survey conducted among psychiatric trainees and young specialists in 2019 showed that only 63% of them think they are well prepared to diagnose BPD. Predispositions such as impulsivity or emotional instability, which commonly are present in BPD, may also be prevalent in such disorders as Antisocial Personality Disorder, Bipolar Disorder, in people misusing psychoactive substances, or in neurodevelopmental disorders such as ADHD. These symptoms can lead to considerable difficulties in global functioning and performing adequate social roles unless appropriate treatment is provided. Therefore, a proper differential diagnosis is crucial in good psychiatric management of people with BPD features. Dr. Gondek will present what BPD symptom domains may be shared with other mental and personality disorders and how to navigate the diagnostic process to set the correct diagnosis in often unobvious clinical presentations of BPD and its look-alikes.DisclosureNo significant relationships.

Good Psychiatric Management and Dialectical Behavior Therapy: A Clinician’s Guide to Integration and Stepped Care

Good Psychiatric Management and Dialectical Behavior Therapy: A Clinician’s Guide to Integration and Stepped Care

Management of Suicidality with Borderline and Narcissistic Features

General suicide risk assessment and management should include consideration of core borderline and narcissistic vulnerabilities of interpersonal hypersensitivity and self-esteem dysregulation. Understanding the oscillating phenomenology of these vulnerabilities using the basic personality disorder treatment approach of Good Psychiatric Management provides a coherent, practical method for assessing and managing suicide risk not only in patients with these personality disorders but more broadly in those with some traits of personality disorder but not meeting full diagnostic criteria. [ Psychiatr Ann . 2020;50(4):139–145.]