It is no longer tenable to suggest that personality disorder is untreatable. Patients deserve treatment. There is increasing evidence that psychoanalytic treatment is effective in treating borderline personality disorder. Our trial had a longer follow-up period than any other RCT of BPD and a low dropout rate. It has demonstrated long-lasting changes, with patients showing a marked reduction in service usage.
The questions now concern who should be treated, where and with what type of therapy. We neither know who should be treated as an inpatient, day patient, or outpatient nor who responds best to a psychoanalytically based program and who to a behavioral program, or if patients need both for different aspects of their problems.
What we do know is that both types of treatment are helpful in improving the lives of individuals with BPD, and managed care companies need to support services with appropriate conceptual models and an organized and thoughtful pattern of service.
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