Specific Forms Of Psychotherapy Research Articles

Moving to know boundaries: applying dance movement therapy in body privacy training

ABSTRACT Dance movement therapy as a specific form of psychotherapy has its successful applicability in various psycho-social intervention programmes. However, the most common utilisation of this therapy has been observed in the clinical and rehabilitation fields. Its applicability in community mental health training, though not totally overlooked, but not empirically explored as well. The present work tried to bridge this research gap in relation to training and development in children. This study has focused on understanding dance movement therapy’s role in training children with the concept of body privacy, at the same time developing healthy body image, and facilitating communication skills in them. Qualitative techniques were employed for data collection and analysis purpose. The findings were intriguing in terms of evaluating dance movement therapy as a training process to teach children body privacy concept, which can further find its application in school counselling and various other child training and intervention programmes.

Expanding the reach of psychological science through implementation science: Introduction to the special issue.

Implementation science is the study of methods to promote the systematic uptake of effective practices into routine care settings with the broad goal of ensuring that scientific discoveries realize their potential and improve people's lives. As a field, implementation science includes three primary foci: (a) understanding the context in which individuals will implement practices that have a strong, established evidence base; (b) developing implementation approaches that target the factors that may accelerate or hinder implementation; and (c) conducting pragmatic trials to test these implementation approaches. Psychological science has contributed substantially to the knowledge and methods used in implementation science. In medicine and public health, these contributions have been leveraged to facilitate the uptake of screening and prevention programs, hand hygiene to reduce infection transmission, and many medical innovations. In behavioral health settings, implementation science has often focused on specific forms of psychotherapy, with emphasis on the evidence-based psychological practices that are highlighted in treatment guidelines. This article provides an overview of the field, with an emphasis on the bidirectional relationship between implementation science, and psychological science, illustrated through the articles in this special issue of the American Psychologist. It concludes with recommendations for future research at the intersection of implementation science and psychological science. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Short-term versus long-term psychotherapy for adult psychiatric disorders: a protocol for a systematic review with meta-analysis and trial sequential analysis

BackgroundPsychiatric disorders are highly prevalent and associated with great symptomatic, functional, and health economic burdens. Psychotherapy is among the recommended and used interventions for most psychiatric disorders and is becoming widely accessible in mental health systems. The effects of specific forms of psychotherapy (e.g., psychodynamic therapies, cognitive and behavioral therapies, humanistic therapies, and systemic therapies) have been assessed previously in systematic reviews, but the appropriate psychotherapy duration for psychiatric disorders has not been reviewed. The aim of this systematic review will be to synthesize the evidence of the effects of short-term compared with long-term psychotherapy for all adult psychiatric disorders.Methods/designA comprehensive search for relevant published literature will be undertaken in Cochrane Central Register of Controlled Trials (CENTRAL), Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica database (EMBASE), Latin American and Caribbean Health Sciences Literature (LILACS), PsycINFO, Science Citation Index Expanded (SCI-EXPANDED), Social Sciences Citation Index (SSCI), Conference Proceedings Citation Index—Science (CPCI-S), and Conference Proceedings Citation Index—Social Science & Humanities (CPCI-SSH) to identify relevant trials. We will search all databases from their inception to the present. We will include randomized clinical trials comparing a short-term and a long-term version of the same psychotherapy type for adult psychiatric disorders including attention deficit hyperactivity disorder, psychotic disorders, depressive disorders, bipolar disorders, anxiety disorders, obsessive-compulsive disorder, trauma- and stressor-related disorders, eating disorders, and personality disorders (as defined by standardized diagnostic criteria). We will rely on the trialists defining their compared interventions as short term and long term (or similar terminology). Primary outcomes will be quality of life, serious adverse events, and symptom severity. Secondary outcomes will be suicide or suicide attempts, self-harm, and level of functioning. Two review authors will independently extract data and perform risk of bias assessment using the Cochrane risk of bias tool. A meta-analysis will be performed as recommended by the Cochrane Handbook for Systematic Review of Interventions, bias will be assessed with domains, and Trial Sequential Analysis will be conducted to control random errors. Certainty of the evidence will be assessed by GRADE.DiscussionAs psychotherapy is among the treatments of choice for most adult psychiatric disorders, a systematic review evaluating the benefits and harms of short-term compared with long-term psychotherapy is urgently needed. It is the hope that this review will be able to inform best practice in treatment and clinical research of these highly prevalent and burdensome disorders.Systematic review registrationPROSPERO CRD42019128535

Cognitive Behavioral Therapy for Psychosis (CBTp): Multicenter Randomized Clinical Trial on Specific Efficacy

Background: Cognitive behavioral therapy for psychosis (CBTp) is a specific form of psychotherapy recommended in evidence-based treatment guidelines for patients with psychosis. However, it remains unclear whether CBTp is more efficacious than unspecific psychotherapies such as supportive therapy (ST). Methods: This multicenter, single blind, randomized clinical trial used a parallel group design to compare CBTp and ST. In total, 330 patients with persistent positive symptoms were included. Participants received 20 sessions of CBTp or ST over a 9-month period. Therapy was provided in six outpatient clinics at university psychiatry departments. The primary endpoint was the severity of positive symptoms (Positive and Negative Syndrome Scale-positive) until post-treatment at 9 months after inclusion. Analysis was carried out by intention to treat with multilevel linear modeling. Findings: There was a between group effect size of g=0·33 (0·11-0·55) in favor of CBTp for positive symptoms, with pre-post effect sizes of g=0·93 (0·70-1·15) for CBTp and g=0·62 (0·40-0·84) for ST. CBTp showed favorable effects for hallucinations and social functioning, but not for negative symptoms and readmission rates. Ratings of the therapeutic relationship, number of adverse events, and antipsychotic medication did not differ between the groups. Positive symptoms decreased in both groups until the 24 month follow-up, with a between group difference of g=0·09 (-0·23-0·39). Interpretation: CBTp is more efficacious than ST in patients with persistent positive symptoms. CBTp effects cannot be explained by therapeutic attention alone. This indicates CBTp has specific mechanisms of action, and further supports the unrestricted recommendation of CBTp for the treatment of psychosis. Trial Registration Number: ISRCTN29242879 Funding Statement: The study was funded by the German ministry of education and research (grant no. 01GV0618). Declaration of Interests: All authors declare that there is no conflict of interest. Ethics Approval Statement: The study protocol was reviewed without objections by the ethics committee of the coordinating study center and the local ethics committees of all participating centers. Patients were included in the study after written informed consent was obtained, which was assured by external monitoring.

Clinical implications of biological factors in personality disorders.

Personality disorder (PD) describes mental abnormalities that reflect long-term changes in cognition, emotion, and behaviour that affect mental functioning. PDs have been shown to be heritable, although research has not identified any consistent biomarkers associated with them. Biological research on PD is in a very early stage, and cannot be used as a basis for biological treatment. Current practices that favour aggressive drug therapy are not justified by the current state of research. Moreover, medications are often not effective for this patient population, while specific forms of psychotherapy have much better established efficacy.Keywords: personality disorder, heritability, neuroimaging, psychopharmacologyResumeLe terme « trouble de la personnalite » (TP) renvoie a des anomalies mentales attribuables a des changements a long terme dans la cognition, les emotions et les comportements qui nuisent au fonctionnement de l'esprit. Il a ete montre que les TP peuvent etre hereditaires, bien que les recherches n'aient pas cerne de biomarqueurs leur etant associes. Les recherches biologiques sur les TP en sont a leurs debuts et ne peuvent servir de base a un traitement biologique. L'etat actuel de la recherche ne justifie pas les pratiques favorisant la pharmacotherapie energique. De plus, la medication se revele souvent inefficace pour les patients souffrant de TP, alors que l'efficacite de certaines formes de psychotherapie a ete etablie.Mots-cles : trouble de la personnalite, heritabilite, neuroimagerie, psychopharmacologie.All mental disorders have neural correlates, and personality disorder (PD) is no exception. All mental disorders are also associated with heritable risk factors that play a role in their etiology (for a review, see Jang, 2005). Behaviour genetic methods compare concordance rates in monozygotic and dizygotic twins, allowing for quantitative estimates of heritability. They show that genes account for about half the variance in personality traits, as well as in PDs (Plomin, DeFries, Knopik, & Neiderhiser, 2012).The heritability of PDs has been demonstrated by large scale behaviour genetic studies (Reichborn-Kjennerud, 2010; Torgersen et al., 2002; Torgersen et al., 2012). Thus, borderline personality disorder, for example, which was long thought to be an environmental condition, has a single heritable factor that accounts for 55% of the variance in all nine of its DSM-5 criteria (Reichborn-Kjennerud et al., 2013). These studies also showed that the level of genetic influence is in much the same range as for personality traits. The precise nature of these heritable factors remains unknown.These findings confirm that PD is not a simple, direct consequence of bad parenting or child abuse, but is rooted in interactions between an abnormal temperament and an adverse environment. Even when a disorder is heritable, it does not necessarily develop unless environmental stressors are also present (e.g., Rutter, 2006). Thus, the effects of biology always have to be understood in the light of their interactions with a psychosocial context: Genes bend the twig, but do not determine the shape of the tree.Genetic influences can also be measured by temperament, defined as the heritable aspect of personality, present a birth, which is then shaped by experience into stable traits, and can be amplified to pathological levels by psychosocial adversity (see Rutter, 1987). A vulnerable temperament tends to make the development of a PD more likely, and determines the type of PD that can develop. This principle applies to all PDs: For example, highly introverted people will rarely develop narcissistic PD, and a highly extraverted person would not develop avoidant PD (Paris, 2003).Some of the most important effects of heritable factors in psychopathology lie in individual differences in susceptibility to environmental risks. People who are highly resilient can be surprisingly unaffected by serious life adversities (Rutter, 2012). …

The Search for Common Factors in Psychotherapy: Two Theoretical Models with Different Empirical Implications

The difficulties of demonstrating that any specific form of psychotherapy is more effective than any other has led to the formulation of the so-called Dodo Bird Verdict (that all forms of therapy are equally effective) and to the suggestion that what really matters for therapeutic efficiency are factors that are common to different forms of therapy. The term “common factors”, however, is seldom defined in an unambiguous way. In this paper, two different models of “common factors” are differentiated, and their implications are compared. The first model is referred to as the Relational-Procedural Persuasion (RPP) model and is primarily based on the writings of Frank and Wampold; according to this model effective psychotherapy requires a good therapeutic relationship, a specified therapeutic procedure, and a rhetorically skilful psychotherapist who persuades the client of a new explanation that provides new perspectives and meanings in life. The contents of these procedures and perspectives, however, are less important – according to this model, the treatment procedures are beneficial to the client because of the meaning attributed to these procedures rather than because of the specific nature of the procedures. The other model, the Methodological Principles and Skills (MPS) model, is based on the assumption that effective psychotherapy relies on common methodological principles that are instantiated in various ways in different forms of psychotherapy, and on the therapist’s capacity of applying these principles in a skillful way. According to this model, method matters, and it is possible to improve existing methods. Whereas the MPS model carries a hope for the improvement of psychotherapy, the RPP model implies a more pessimistic view of psychotherapy as forever bound by the limits of the Dodo Bird Verdict. It is concluded that psychotherapy research may benefit from using the MPS model as a working hypothesis, but that a comprehensive model of common factors in psychotherapy also needs to integrate important insights from the RPP model, as well as an understanding of the structural characteristics that psychotherapy shares with other kinds of social interaction.

Borderline Personality Disorder

Recent research findings have contributed to an improved understanding and treatment of borderline personality disorder. This disorder is characterised by severe functional impairments, a high risk of suicide, a negative effect on the course of depressive disorders, extensive use of treatment, and high costs to society. The course of this disorder is less stable than expected for personality disorders. The causes are not yet clear, but genetic factors and adverse life events seem to interact to lead to the disorder. Neurobiological research suggests that abnormalities in the frontolimbic networks are associated with many of the symptoms. Data for the effectiveness of pharmacotherapy vary and evidence is not yet robust. Specific forms of psychotherapy seem to be beneficial for at least some of the problems frequently reported in patients with borderline personality disorder. At present, there is no evidence to suggest that one specific form of psychotherapy is more effective than another. Further research is needed on the diagnosis, neurobiology, and treatment of borderline personality disorder. (Reprinted with permission from Lancet 2011;377:74–84)

CS05-04 - Cognitive behavioral analysis system of psychotherapy (CBASP)

Chronic depression accounts for roughly a third of all mood disorders. It is a particularly disabling disorder, which is associated with greater comorbidity and suicidality, more significant impairments in functioning, and increased health care utilization than acute major depressive episodes. In the past, chronic depression was often considered as treatment-resistant since traditional pharmacological and psychological treatment approaches show at most modest success. In addition, relatively few psychotherapy studies have focused on chronic (mostly dysthymia) forms of depression. However, in chronic Major Depression a specific form of psychotherapy, the Cognitive Behavioral Analysis System of Psychotherapy (CBASP), proved to be equally effective than medication; the combination of CBASP and medication revealed significant superiority over both monotherapies.CBASP-developed by James McCullough-is the only psychotherapeutic intervention specifically designed for chronic depression. The approach integrates behavioral, cognitive, psychodynamic, and interpersonal strategies. It focuses on problems resulting from an inhibition of maturation in early childhood often caused by early traumatization by using the therapeutic relationship in a disciplined personal way. In addition, other interpersonal strategies are applied to overcome preoperational thinking. By means of a specific behavioral technique, the Situation Analysis, patients learn to focus on the consequences of their behavior and to use efficient social problem-solving. The techniques of CBASP will be demonstrated.Results of two pilot studies will be presentedFirst, a randomized pilot outpatient study comparing CBASP with the interpersonal psychotherapy (IPT) in early onset chronically depressives was conducted showing significant superiority of CBASP against IPT. Second, a first open pilot study in the inpatient setting investigated a new modified multidisciplinary CBASP inpatient program. The data of the first patients suggest that the three-month CBASP inpatient program is a feasible and effective treatment for severely chronically depressed patients with severly to extreme traumatization.

What should be used for baselines against which to compare treatments’ effectiveness?

None of the kinds of control groups that are commonly relied on in randomized clinical trials can provide a clinically ethical and meaningful lower baseline against which to demonstrate that any specific form of psychotherapy is worth providing. The outcome of the natural course of a malady is what logically sets the lower bound baseline for how effective a treatment for the malady ought to be, but natural courses of psychological maladies are now generally neither ethically nor feasibly determinable. So it is the available ethically adequate treatments for a psychological malady that properly must define a lower baseline against which to compare new treatments for their effectiveness. Optimal mental health is the obvious upper bound baseline, and so treatments ought to always be also evaluated against it to show how ineffective they are.

Combined cognitive-behavioural therapy and pharmacotherapy for adolescent depression: Does it improve outcomes compared with monotherapy?

Adolescent depression can be effectively treated with selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine, or with specific forms of psychotherapy, such as cognitive-behavioural therapy (CBT) and interpersonal therapy. A single course of any of these treatments, however, leaves between one-third and one-half of patients insufficiently improved and still depressed. In an effort to increase effectiveness, medication and CBT have been combined (COMB). A few controlled clinical trials have recently compared COMB with monotherapy. TADS (Treatment for Adolescents with Depression Study) randomly assigned 439 adolescents with major depressive disorder to fluoxetine, CBT, COMB or clinical management with placebo. After 12 weeks of treatment, both fluoxetine and COMB reduced depression more than CBT or placebo did, but only COMB was effective in inducing remission, achieving functional recovery and reducing suicidal ideation. After 36 weeks of treatment, there was no difference in improvement among treatments, but more suicidal events occurred in the medication only group than in the CBT only group. However, in another trial, ADAPT (Adolescent Depression and Psychotherapy Trial), involving 208 youths, no advantages of COMB over usual care with an SSRI could be detected. In a third trial, TORDIA (Treatment of Resistant Depression in Adolescence), which randomized 334 patients with an major depression unresponsive to previous SSRI treatment, COMB produced a greater response rate than medication monotherapy. These and other, smaller trials of COMB in adolescent depression are reviewed in this article. It is concluded that, while there is no univocal support for the superiority of COMB, two controlled trials indicate that COMB has a more favourable benefit/risk balance than monotherapy in adolescent depression. It remains to be determined for which patient subgroups and in which clinical settings COMB may be most advantageous.

Können psychosetypische Strukturen quantitativ erfasst werden?

The paper describes the development of a psychoanalytically oriented self-report questionnaire which quantifies structural characteristics of psychotic patients, so that changes of these characteristics in the course of psychoanalytic psychotherapy can be measured. Its use is seen in evaluative studies where it can assess the specific efficiency of this specific form of psychotherapy. Five psychoanalytic notions constitutive of an understanding of psychotic illness, subjectobject differentiation, ego strength, ambivalence, destructiveness/aversity and regulation of self-esteem, led to the generation of a large item pool. Factor analysis of the data of a sample of 57 psychotic patients showed one global factor: psychotic insecurity. Item analysis produced a 28-item scale whose sum score provides a measure of psychotic insecurity. The reliability of the scale is high and for the present its validity can be judged as sufficient.

Competency in Combining Pharmacotherapy and Psychotherapy: Integrated and Split Treatment

Back to table of contents Previous article Next article Book ReviewFull AccessCompetency in Combining Pharmacotherapy and Psychotherapy: Integrated and Split TreatmentJeffrey L. Moore M.D.Jeffrey L. Moore M.D.Search for more papers by this authorPublished Online:1 Mar 2008https://doi.org/10.1176/ps.2008.59.3.332AboutSectionsView articleView PDFView EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail View articleThis book is the fifth and last in the core competencies series, edited by Glen Gabbard. The series has done a great deal to illuminate the requirement of the Psychiatry Residency Review Committee (RRC) of the American Council for Graduate Medical Education first introduced in 2001, to train residents in specific forms of psychotherapy. The authors of the latest text are well known and have published previously on related topics in the training of psychiatry residents. The intended audience for the book is clearly psychiatric residents and their teachers, although it will likely be of some interest to other educators and psychiatrists in practice.The book is divided into three parts. The first section, on integrated treatment, uses plain language to describe a practical approach to psychiatric treatment in which the resident provides both medication and psychotherapy. In the second section, the same themes are repeated but elaborate the complexities that are introduced when another professional provides the therapy and the resident sees the patient for medication alone. Suggested competencies are set off in boldface throughout this section; these competencies are collected together in the third part, which deals with evaluation, monitoring, and supervision of trainees.The entire book might be used as a course text or an introduction to outpatient psychiatry. There are excellent discussions of general issues in starting treatment, performing an initial evaluation, planning and sequencing treatment, and ending treatment. In the section on split treatment, there is appropriate emphasis on the importance of good communication between the therapist and resident and on the many pitfalls that can arise. Training directors will find the last section quite helpful in documenting competencies for the RRC.Throughout the book, integrated treatment is clearly preferred when possible, illustrated by use of the term "split" instead of "collaborative" treatment. The authors decry the fragmentation of the system of mental health care and the lack of organization and planning in its construction. At the same time, they offer practical, real-world advice on recognizing the drawbacks of split treatment and dealing with them in a way that optimizes the treatment of patients. For example, there is an especially good discussion of issues in split treatment of patients with borderline personality and guidance on how to manage them.The authors are not afraid to take a firm position on certain possibly contentious issues in split treatment. These include a recommendation that residents should develop the ability to potentially reformulate a case, a clear statement that "thirty minutes is not adequate for any initial evaluation," and recognition that the resident must determine when not to prescribe medication in a split-treatment arrangement.The structure of the book allows for the first and second sections to stand alone, although the resulting repetition of material can be irritating in a single read through. The section on integrated treatment might benefit from more discussion of mind-brain issues, addressing questions of when symptoms and responses should be understood as relevant to the therapy or the psychopharmacology.Competency in Combining Pharmacotherapy and Psychotherapy is a wonderful addition to residency training, with a comprehensive approach to the teaching and evaluation of competency in combined treatment. Dr. Moore is associate professor of psychiatry at the Northeastern Ohio Universities College of Medicine and chairman of the Psychiatry Department at Akron General Medical Center. FiguresReferencesCited byDetailsCited ByNone Volume 59Issue 3 March, 2008Pages 332-333PSYCHIATRIC SERVICES March 2008 Volume 59 Number 3 Metrics History Published online 1 March 2008 Published in print 1 March 2008

Competency in Combining Pharmacotherapy and Psychotherapy: Integrated and Split Treatment

Back to table of contents Previous article Next article Book ReviewFull AccessCompetency in Combining Pharmacotherapy and Psychotherapy: Integrated and Split TreatmentJeffrey L. Moore M.D.Jeffrey L. Moore M.D.Search for more papers by this authorPublished Online:1 Mar 2008https://doi.org/10.1176/ps.2008.59.3.332AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail This book is the fifth and last in the core competencies series, edited by Glen Gabbard. The series has done a great deal to illuminate the requirement of the Psychiatry Residency Review Committee (RRC) of the American Council for Graduate Medical Education first introduced in 2001, to train residents in specific forms of psychotherapy. The authors of the latest text are well known and have published previously on related topics in the training of psychiatry residents. The intended audience for the book is clearly psychiatric residents and their teachers, although it will likely be of some interest to other educators and psychiatrists in practice.The book is divided into three parts. The first section, on integrated treatment, uses plain language to describe a practical approach to psychiatric treatment in which the resident provides both medication and psychotherapy. In the second section, the same themes are repeated but elaborate the complexities that are introduced when another professional provides the therapy and the resident sees the patient for medication alone. Suggested competencies are set off in boldface throughout this section; these competencies are collected together in the third part, which deals with evaluation, monitoring, and supervision of trainees.The entire book might be used as a course text or an introduction to outpatient psychiatry. There are excellent discussions of general issues in starting treatment, performing an initial evaluation, planning and sequencing treatment, and ending treatment. In the section on split treatment, there is appropriate emphasis on the importance of good communication between the therapist and resident and on the many pitfalls that can arise. Training directors will find the last section quite helpful in documenting competencies for the RRC.Throughout the book, integrated treatment is clearly preferred when possible, illustrated by use of the term "split" instead of "collaborative" treatment. The authors decry the fragmentation of the system of mental health care and the lack of organization and planning in its construction. At the same time, they offer practical, real-world advice on recognizing the drawbacks of split treatment and dealing with them in a way that optimizes the treatment of patients. For example, there is an especially good discussion of issues in split treatment of patients with borderline personality and guidance on how to manage them.The authors are not afraid to take a firm position on certain possibly contentious issues in split treatment. These include a recommendation that residents should develop the ability to potentially reformulate a case, a clear statement that "thirty minutes is not adequate for any initial evaluation," and recognition that the resident must determine when not to prescribe medication in a split-treatment arrangement.The structure of the book allows for the first and second sections to stand alone, although the resulting repetition of material can be irritating in a single read through. The section on integrated treatment might benefit from more discussion of mind-brain issues, addressing questions of when symptoms and responses should be understood as relevant to the therapy or the psychopharmacology.Competency in Combining Pharmacotherapy and Psychotherapy is a wonderful addition to residency training, with a comprehensive approach to the teaching and evaluation of competency in combined treatment. Dr. Moore is associate professor of psychiatry at the Northeastern Ohio Universities College of Medicine and chairman of the Psychiatry Department at Akron General Medical Center. FiguresReferencesCited byDetailsCited ByNone Volume 59Issue 3 March, 2008Pages 332-333PSYCHIATRIC SERVICES March 2008 Volume 59 Number 3 Metrics PDF download History Published online 1 March 2008 Published in print 1 March 2008

An outcome study of psychotherapy for patients with borderline personality disorder.

This study evaluated the effectiveness of well-defined outpatient psychotherapy for patients with borderline personality disorder. Thirty patients with borderline personality disorder diagnosed according to the DSM-III criteria were given twice weekly outpatient psychotherapy for 12 months by trainee therapists who were closely supervised. The treatment approach was based on a psychology of self (this term being used in its broad sense), and strong efforts were made to ensure that all therapists adhered to the treatment model. Outcome measures included frequency of use of drugs (both prescribed and illegal), number of visits to medical professionals, number of episodes of violence and self-harm, time away from work, number of hospital admissions, time spent as an inpatient, score on a self-report index of symptoms, and number of DSM-III criteria (weighted for frequency, severity, and duration) fulfilled. The subjects showed statistically significant improvement from the initial assessment to the end of the year of follow-up on every measure. Moreover, 30% of the subjects no longer fulfilled the DSM-III criteria for borderline personality disorder. This improvement had persisted 1 year after the cessation of therapy. The results suggest that a specific form of psychotherapy is of benefit for patients with borderline personality disorder.

Comment

<h3>To the Editor.—</h3> At the Chief Editor's request, I am writing in response to the letter to the editor from Donald F. Klein, MD, regarding the article by Elkin and colleagues in the November 1989 issue of theArchives.¹ The aims of the NIMH Treatment of Depression Collaborative Research Program were "to test the feasibility and value of the collaborative clinical trial model... in the area of psychotherapy research and to study... the effectiveness of two specific forms of psychotherapy... for treating nonbipolar, nonpsychotic depressed outpatients." Regarding the first aim, I am sure that Dr Klein would join me in agreeing that the article clearly demonstrates the feasibility of high-quality clinical trials, including psychotherapy and pharmacotherapy. Regarding the second aim, the article describes in considerable detail the results of analyses that were carefully planned<i>prior</i>to examination of the data. They therefore are not biased by any knowledge of