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Letters to the Editor |

Hope for Sustaining a Positive 3-Year Therapeutic Relationship With Patients With Borderline Personality Disorder

Brin F. S. Grenyer, PhD
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Copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.

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Arch Gen Psychiatry. 2007;64(5):609-609. doi:10.1001/archpsyc.64.5.609-a
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The recent article by Giesen-Bloo and colleagues1 comparing schema-focused and transference-focused psychotherapy for borderline personality disorder is remarkable on 2 accounts. First, it gives hope to psychotherapists that sustaining a positive clinical relationship with patients with borderline personality disorder over 3 years of twice-weekly therapy is both possible and worthwhile. Second, it is one of the very few studies that show differential effectiveness between 2 therapy types, given that research from the past 30 years has consistently failed to find differential effects between treatment types.2 In contrast, research has shown that the therapeutic alliance,3 therapist effectiveness,4 and researcher allegiance5 powerfully relate to clinical changes. In this context, it is surprising that Giesen-Bloo and colleagues do not address these issues in their article. Such data might help readers to understand their findings, including the puzzling but large difference in dropout rates between treatments, and understand the allegiance-boosting effect that allowing patient-therapist contact between therapy sessions might have had in the schema-focused group.

AUTHOR INFORMATION

Correspondence: Dr Grenyer, Illawarra Institute for Mental Health, School of Psychology, University of Wollongong, Wollongong, NSW 2522, Australia (grenyer@uow.edu.au).

Financial Disclosure: None reported.

REFERENCES

Giesen-Bloo  J, van Dyck  R, Spinhoven  P, van Tilburg  W, Dirksen  C, van Asselt  T, Kremers  I, Nadort  M, Arntz  A. Outpatient psychotherapy for borderline personality disorder: randomized trial of schema-focused therapy vs transference-focused psychotherapy. Arch Gen Psychiatry 2006;63649- 658
PubMed
Wampold  BE, Mondin  GW, Moody  M, Stich  F, Benson  K, Ahn  H. A meta-analysis of outcome studies comparing bona fide psychotherapies: empirically, “all must have prizes.” Psychol Bull 1997;122203- 215
Zuroff  DC, Blatt  SJ. The therapeutic relationship in the brief treatment of depression: contributions to clinical improvement and enhanced adaptive capacities. J Consult Clin Psychol 2006;74130- 140
PubMed
Okiishi  J, Lambert  MJ, Nielsen  SL, Ogles  BM. Waiting for supershrink: an empirical analysis of therapist effects. Clin Psychol Psychother 2003;10361- 373
Luborsky  L, Diguer  L, Seligman  DA, Rosenthal  R, Krause  ED, Johnson  S, Halperin  G, Bishop  M, Berman  JS, Schweizer  E. The researchers own therapy allegiances: a “wild card” in comparisons of treatment efficacy. Clin Psychol Sci Pract 1999;695- 106

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Giesen-Bloo  J, van Dyck  R, Spinhoven  P, van Tilburg  W, Dirksen  C, van Asselt  T, Kremers  I, Nadort  M, Arntz  A. Outpatient psychotherapy for borderline personality disorder: randomized trial of schema-focused therapy vs transference-focused psychotherapy. Arch Gen Psychiatry 2006;63649- 658
PubMed
Wampold  BE, Mondin  GW, Moody  M, Stich  F, Benson  K, Ahn  H. A meta-analysis of outcome studies comparing bona fide psychotherapies: empirically, “all must have prizes.” Psychol Bull 1997;122203- 215
Zuroff  DC, Blatt  SJ. The therapeutic relationship in the brief treatment of depression: contributions to clinical improvement and enhanced adaptive capacities. J Consult Clin Psychol 2006;74130- 140
PubMed
Okiishi  J, Lambert  MJ, Nielsen  SL, Ogles  BM. Waiting for supershrink: an empirical analysis of therapist effects. Clin Psychol Psychother 2003;10361- 373
Luborsky  L, Diguer  L, Seligman  DA, Rosenthal  R, Krause  ED, Johnson  S, Halperin  G, Bishop  M, Berman  JS, Schweizer  E. The researchers own therapy allegiances: a “wild card” in comparisons of treatment efficacy. Clin Psychol Sci Pract 1999;695- 106

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