What is it about?
Some evidence suggests that patients with personality disorders have poorer psychotherapy outcomes than those who only have symptom disorders. However, this research is almost exclusively based on short-term-, manualized-, and symptom-focused interventions. In contrast, the present study provided individually tailored, open-ended psychotherapy to a large sample of patients, half of which had at least one personality disorder at the start of treatment. The results revealed that patients with personality disorders demonstrated equal symptomatic improvement and greater interpersonal improvement than patients without, and that the patients with the more severe personality pathology demonstrated the greatest improvements. Accordingly, diagnostic changes were equivalent across the two groups. As was expected, the personality disorder group needed significantly higher therapy doses to attain these levels of change. Both groups demonstrated enduring improvements when assessed two and half years after the end of treatment.
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Why is it important?
A long standing misconception in psychiatry has been that patients with personality disorders either do not profit much from psychotherapy or need highly specialized treatment models to do so. The present study succinctly demonstrates that this is not so. To the contrary, given that psychotherapy is delivered by properly trained psychotherapists using their preferred model of treatment and is individually tailored in terms of focus and treatment length, the greatest improvements are attained by the patients with the most severe personality problems. This provides a hopeful message to a large population of patients who are often written off as difficult or even impossible to help in psychiatric care.
Perspectives
It has been a very important part of our clinical- and research efforts to try to keep our hearts and minds open and warm to those patients in mental health care who suffer the most. Commonly, both health providers, treatment systems and psychiatric- and psychotherapy research have prioritized the patients most easily helped, the ones with simpler and more straightforward problems, the ones who profit quickly and reliably from short-term and time-limited interventions. Important as this is, it leaves vast numbers of patients out of the picture, patients who objectively suffer more and struggle more with their everyday lives and relationships. This publication, along with others, contributes to a long needed change of course in the research on and delivery of mental health services. It delivers a strong message of hope and optimism for a group of patients that have not been sufficiently prioritized in mental health care in its current form.
Professor em. Jon Trygve Monsen
University of Oslo
Read the Original
This page is a summary of: Comparing the magnitude of improvement for patients with and without personality disorders in open-ended psychotherapy., Personality Disorders Theory Research and Treatment, November 2021, American Psychological Association (APA),
DOI: 10.1037/per0000474.
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