Transference-focused psychotherapy <i>v.</i> treatment by community psychotherapists for borderline personality disorder: randomised controlled trial

TLDR

The study aimed to compare the efficacy of transference‑focused psychotherapy with that of experienced community psychotherapists for borderline personality disorder. A 12‑month randomized controlled trial enrolled 104 female out‑patients who received either manualised transference‑focused psychotherapy or treatment from an experienced community psychotherapist. Transference‑focused psychotherapy led to significantly lower dropout and suicide‑attempt rates, superior improvements in borderline symptomatology, psychosocial functioning, personality organization, and psychiatric admissions, and preliminary evidence of reduced suicidality and inpatient need compared with community treatment, while both groups improved similarly on depression, anxiety, and general psychopathology.

Abstract

Transference-focused psychotherapy is a manualised treatment for borderline personality disorder.To compare transference-focused psychotherapy with treatment by experienced community psychotherapists.In a randomised controlled trial (NCT00714311) 104 female out-patients were treated for 1 year with either transference-focused psychotherapy or by an experienced community psychotherapist.Significantly fewer participants dropped out of the transference-focused psychotherapy group (38.5% v. 67.3%) and also significantly fewer attempted suicide (d = 0.8, P = 0.009). Transference-focused psychotherapy was significantly superior in the domains of borderline symptomatology (d = 1.6, P = 0.001), psychosocial functioning (d = 1.0, P = 0.002), personality organisation (d = 1.0, P = 0.001) and psychiatric in-patient admissions (d = 0.5, P = 0.001). Both groups improved significantly in the domains of depression and anxiety and the transference-focused psychotherapy group in general psychopathology, all without significant group differences (d = 0.3-0.5). Self-harming behaviour did not change in either group.Transference-focused psychotherapy is more efficacious than treatment by experienced community psychotherapists in the domains of borderline symptomatology, psychosocial functioning, and personality organisation. Moreover, there is preliminary evidence for a superiority in the reduction of suicidality and need for psychiatric in-patient treatment.