An 18-Month Psychotherapy of Borderline Personality Disorder
Condition: Borderline Personality Disorder
MeSH terms: Personality Disorders; Borderline Personality Disorder
Study type: Interventional

Summary: 
      The purpose of the study is to examine the impact of an 18-month psychotherapy treatment for
      borderline personality disorder. The investigators will examine changes in psychosocial and
      work functioning in patients with borderline personality disorder using an 18-month
      psychotherapeutic treatment.

      The investigators are recruiting female patients between the ages of 18-35 who meet DSM
      criteria for BPD.

      The investigators are excluding patients who meet the following criteria:

        -  psychotic disorders

        -  a current major depressive episode

        -  bipolar I disorder

        -  current substance dependence

        -  antisocial personality disorder.

        -  unable to undergo 18-months of twice weekly psychotherapy in NYC (due to the COVID19
           pandemic in person meetings are suspended (see detailed description) but will be
           restated once this is considered safe again)

      Participants in the study will receive 18-months of twice weekly psychotherapy, free of
      charge, as well as compensation for follow-up assessments. They may be currently taking
      psychiatric medication.

      Participants will be assessed using semi-structured diagnostic interviews, self-report
      instruments, and computerized tasks in an initial assessment session lasting about 6-8 hours.
      They will also be assessed using computerized tasks. Follow-up assessments will occur
      throughout the treatment as well as after the treatment, lasting about 1-4 hours. The
      investigators will also be collecting information on their treatment history and psychiatric
      medication as part of the study.
    

Detailed description: 
      Patients with borderline personality disorder (BPD) will be provided with an empirically
      supported form of psychotherapy for BPD patients called transference-focused psychotherapy
      (TFP) and medication treatment, if indicated. The primary goal of the current study is to
      detect changes in psychological, psychosocial and work functioning over the course of
      18-months of TFP. Previous research has shown that TFP is an effective treatment for BPD over
      the course of one year, significantly reducing symptoms. An 18-month treatment period will
      most likely allow patients to achieve significant and lasting gains in work and psychosocial
      functioning. Each patient will be assessed prior to (baseline), at 3-month intervals
      throughout, and at the termination of the 18-month treatment period for symptoms, vocational
      status, and psychosocial functioning. In addition, patients and therapists will complete
      self-report measures every three months about the therapeutic relationship. After the
      18-month treatment period, a final, brief assessment of vocational status, symptoms, and
      psychosocial functioning will occur.

      The therapists doing TFP are professional psychiatrists, psychologists, and social workers
      who have been trained by Dr. Otto Kernberg in this special form of psychotherapy. In this
      therapy, the patient and therapist meet for 45-minute sessions two times a week on a weekly
      basis (except for vacations) for 18 months. Due to the ongoing worldwide pandemic meetings of
      the therapist and the patient will take place over a secured internet connection for the time
      being. Once it is considered safe again, the therapy sessions will take place in the
      therapists' private office

      Hypothesis: It is hypothesized that patients in Transference Focused Psychotherapy (TFP) will
      manifest differential responses to the treatment, depending upon pre-treatment patient
      psychological and psychiatric characteristics. The investigators expect that some patients
      will show significant positive changes in symptoms, work, and social functioning at the end
      of 18 months, and that these positive changes will manifest in psychological and
      neuropsychological measures. The investigators will investigate the pre-treatment
      psychological variables (e.g. trait sociability, constraint, and negative affect) and
      neuropsychological functioning that will be predictive of patient improvement with treatment
      at the end of 18 months. By the end of the treatment, the investigators expect some patients
      to approach normal levels of enjoyment and enrichment of their experiences in work and social
      functioning. As all analyses will occur at the end of the study, response to TFP will not be
      assessed during the course of treatment. Therefore, patients will not be moved to a different
      intervention during the course of the study.

      Research Question: The investigators have found in our pilot work that symptom change occurs
      in the first 12 months of TFP followed by substantial work and psychosocial changes in
      subsequent months. The primary goal of the current pilot project is to demonstrate that TFP
      over an 18-month treatment period is associated with significant improvement in work and
      intimate relations, reflecting significant personality changes that should enhance patients'
      overall effectiveness and gratification in their lives.
    

Intervention name(s): Transference-focused Psychotherapy (TFP)
Intervention type(s): Other
Intervention description(s): Participants receive 18 months of bi-weekly TFP. Each sessions lasts 45 minutes. During sessions, a therapist employs assorted psychodynamic techniques tailored specially for symptoms and relational difficulties associated with BPD. A participant processes interpersonal experiences with her therapist in sessions alongside her therapist and gains therapeutic insight into her problematic ways of relating to her self and others.
Intervention model: Single Group Assignment
Intervention model description: Our study is a longitudinal (i.e., 18-month) treatment outcome study using a within-subjects design with repeated measures. We do not include a control group or a TAU group in our study design.
Masking: None (Open Label)
Primary purpose: Treatment