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Livesley, W.J. (2012). Moving Beyond Specialized Therapies for Borderline Personality Disorder: The Importance of Integrated Domain-Focused Treatment. Psychodyn. Psych., 40(1):47-74.

(2012). Psychodynamic Psychiatry, 40(1):47-74

Moving Beyond Specialized Therapies for Borderline Personality Disorder: The Importance of Integrated Domain-Focused Treatment

W. John Livesley, M.D.

This article argues the recent emphasis on specializing treatments for borderline personality disorder needs to be replaced by a more integrated and evidence-based approach that combines effective methods from all therapies. This proposition is based on evidence that specialized treatments for borderline personality disorder do not differ significantly from each and that they are not more effective than good structured care designed to meet the needs of patients with the disorder. It is also argued that current therapies are limited because they do not recognize or accommodate the extensive heterogeneity of borderline personality disorder and its complex etiology. These factors make a one-approach-fits-all strategy inappropriate for treatment.

An integrated approach is proposed as an alternative to the specialized therapies that makes use of all effective interventions regardless of their conceptual origins and delivers them in a coordinated way. A two-component framework is proposed for organizing integrated treatment: 1. a system for conceptualizing borderline personality disorder based on current empirical knowledge about the structure, etiology, and stability of borderline pathology that serves as a guide when selecting and delivering interventions; and 2. a model of therapeutic change based on the general literature on psychotherapy outcome and specific studies of PD treatments. This framework proposes that integrated treatment be organized around principles of therapeutic change common to all effective therapies supplemented with more specific treatment methods taken from the different therapies as needed to tailor treatment to individual patients and treat specific problems and psychopathology.

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