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.For example,Bateman and Fonagy [2], when discussing day treatment services in theirreview of the effectiveness of psychotherapeutic treatment of personalitydisorder, state: There are no data to suggest that the mere inclusion ofpsychotherapy within a day hospital is sufficient to ensure good outcome.All studies use an integrated and organised treatment programme within asingular, coherent (and to the patients understandable) system.Only suchintegrated programmes, with clinicians with various tasks and functionsworking to the same strategic goals, permit patients with severe problemsin understanding human motives to feel sufficiently safe to engageeffectively with the treatment .In 2003, the UK National Health Service (through the new NationalInstitute for Mental Health in England) gave its first ever formal policyimplementation guidelines for personality disorders [1].These guidelinesinvolved careful consultation with patients who had personality disorderand experience of UK mental health services.The guidelines include a longlist of factors experienced as helpful and unhelpful aspects of services.Theguidelines stress the need for therapy to be relatively long term and toinvolve a clear treatment alliance between therapist and patient.It will beinteresting to see if other national bodies and professional mental health BORDERLINE/HISTRIONIC PERSONALITY DISORDERS: COMMENTARIES ____ 265organizations provide personality disorder treatment guidelines and giveexpectations of service provision.This could be another route by which thetreatment culture changes, as surely such guidelines will lead to patientexpectations and patient groups challenging health services perhaps eventhrough the courts when such services fail to be provided to recommendedstandards.Although there are different approaches to the treatment of borderlineand histrionic personality disorders, the advances in recent decades inpsychoanalytic understandings of the more primitive mental mechan-isms used by such patients should not be underestimated.The realization ofthe extent to which splitting, projection and projective identificationmechanisms are central mental phenomena in these disorders has veryconsiderable therapeutic implications.The understanding has the potentialto be of considerable assistance when attending to the various feelings ofother family members, and of health and mental health staff.Althoughgreat care has to be taken in disentangling the psychology of the recipientfrom that of the person with the personality disordered person, borderlineand histrionic personality disorder patients are capable of arousing extremesof feelings in others and between others.Utilization of these feelings assources of information (countertransference) has led to considerablechanges in technique and practice of psychoanalytically informed clinicianscompared with those of the classical analysts, who often worked within a one mind psychology and were discomfited by powerful feelings stirredup by patients.REFERENCES1.National Institute for Mental Health in England (2003) Personality disorder: no longera diagnosis of exclusion.www.doh.gov.uk/mentalhealth/personalitydisorder.pdf2.Bateman A., Fonagy P.(2000) Effectiveness of psychotherapeutic treatment ofpersonality disorder.Br.J.Psychiatry, 177: 138 143. 266 __________________________________________________________________ PERSONALITY DISORDERS3.13Psychotherapy for Borderline Personality Disorder:Some Tentative Interpretations of the Available Empirical FindingsRoel Verheul1In this commentary on Michael Stone s excellent review, I will primarilydiscuss some issues surrounding the available empirical evidence for theeffectiveness of psychotherapeutic treatments for borderline personalitydisorder (BPD).In my opinion, it is possible to conclude more from theavailable studies than Stone actually does.First of all, Stone does not compare the outcome results of the treatmentmodels of Linehan (i.e [ Pobierz całość w formacie PDF ]
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.For example,Bateman and Fonagy [2], when discussing day treatment services in theirreview of the effectiveness of psychotherapeutic treatment of personalitydisorder, state: There are no data to suggest that the mere inclusion ofpsychotherapy within a day hospital is sufficient to ensure good outcome.All studies use an integrated and organised treatment programme within asingular, coherent (and to the patients understandable) system.Only suchintegrated programmes, with clinicians with various tasks and functionsworking to the same strategic goals, permit patients with severe problemsin understanding human motives to feel sufficiently safe to engageeffectively with the treatment .In 2003, the UK National Health Service (through the new NationalInstitute for Mental Health in England) gave its first ever formal policyimplementation guidelines for personality disorders [1].These guidelinesinvolved careful consultation with patients who had personality disorderand experience of UK mental health services.The guidelines include a longlist of factors experienced as helpful and unhelpful aspects of services.Theguidelines stress the need for therapy to be relatively long term and toinvolve a clear treatment alliance between therapist and patient.It will beinteresting to see if other national bodies and professional mental health BORDERLINE/HISTRIONIC PERSONALITY DISORDERS: COMMENTARIES ____ 265organizations provide personality disorder treatment guidelines and giveexpectations of service provision.This could be another route by which thetreatment culture changes, as surely such guidelines will lead to patientexpectations and patient groups challenging health services perhaps eventhrough the courts when such services fail to be provided to recommendedstandards.Although there are different approaches to the treatment of borderlineand histrionic personality disorders, the advances in recent decades inpsychoanalytic understandings of the more primitive mental mechan-isms used by such patients should not be underestimated.The realization ofthe extent to which splitting, projection and projective identificationmechanisms are central mental phenomena in these disorders has veryconsiderable therapeutic implications.The understanding has the potentialto be of considerable assistance when attending to the various feelings ofother family members, and of health and mental health staff.Althoughgreat care has to be taken in disentangling the psychology of the recipientfrom that of the person with the personality disordered person, borderlineand histrionic personality disorder patients are capable of arousing extremesof feelings in others and between others.Utilization of these feelings assources of information (countertransference) has led to considerablechanges in technique and practice of psychoanalytically informed clinicianscompared with those of the classical analysts, who often worked within a one mind psychology and were discomfited by powerful feelings stirredup by patients.REFERENCES1.National Institute for Mental Health in England (2003) Personality disorder: no longera diagnosis of exclusion.www.doh.gov.uk/mentalhealth/personalitydisorder.pdf2.Bateman A., Fonagy P.(2000) Effectiveness of psychotherapeutic treatment ofpersonality disorder.Br.J.Psychiatry, 177: 138 143. 266 __________________________________________________________________ PERSONALITY DISORDERS3.13Psychotherapy for Borderline Personality Disorder:Some Tentative Interpretations of the Available Empirical FindingsRoel Verheul1In this commentary on Michael Stone s excellent review, I will primarilydiscuss some issues surrounding the available empirical evidence for theeffectiveness of psychotherapeutic treatments for borderline personalitydisorder (BPD).In my opinion, it is possible to conclude more from theavailable studies than Stone actually does.First of all, Stone does not compare the outcome results of the treatmentmodels of Linehan (i.e [ Pobierz całość w formacie PDF ]