title: Psychotherapy for suicidal patients with borderline personality disorder: an expert consensus review of common factors across five therapies.
abstract: The objective was to review established literature on approaches to the psychotherapy of borderline personality disorder with specfic reference to suicide in order to determine if there were common factors across these efforts that would guide future teaching, practice and research. The publications from the proponents of five therapies for the treatment of suicidal behavior in individuals with borderline personality disorder (BPD), were reviewed and discussed by the members of the Group for the Advanced of Psychiatry, Psychotherapy Committee (GAPPC). Twenty nine published research and summary reports were reviewed of the specific treatments noted above along with two other reviews of common factors for this group of treatments. We used expert consensus as to the salient articles for review and the appropriate level of abstraction for the common factor definition. We formulated a definition of effectiveness and identified six common factors: 1) negotiation of a specific frame for treatment, 2) recognition and insistence on the patient's responsibilities within the therapy, 3) provision to the therapist of a conceptual framework for understanding and intervening, 4) use of the therapeutic relationship to engage and address suicide, 5) prioritization of suicide as a topic to be actively addressed whenever it emerges, and 6) provision of support for the therapist in the form of supervision, consultation or peer support. We discuss common factors, their formulation, and implications for development and teaching of psychotherapeutic approaches specific to suicide in patients with borderline personality disorder and note that there should be greater attention in practice and education to these issues.
authors.affiliation: Yale New Haven Psychiatric Hospital, 184 Liberty Street, New Haven, CT 06519 USA.
authors.forename: William
authors.initials: W
authors.lastname: Sledge
authors.affiliation: Austen Riggs Center, Stockbridge, Massachusetts USA.
authors.forename: Eric M
authors.initials: EM
authors.lastname: Plakun
authors.affiliation: Cornell University College of Medicine, New York, NY USA.
authors.forename: Stephen
authors.initials: S
authors.lastname: Bauer
authors.affiliation: Columbia University Medical Center, New York, NY USA.
authors.forename: Beth
authors.initials: B
authors.lastname: Brodsky
authors.affiliation: NYU School of Medicine, New York, NY USA.
authors.forename: Eve
authors.initials: E
authors.lastname: Caligor
authors.affiliation: Case Western Reserve University, Cleveland, OH USA.
authors.forename: Norman A
authors.initials: NA
authors.lastname: Clemens
authors.affiliation: University of California, San Francisco, CA USA.
authors.forename: Serina
authors.initials: S
authors.lastname: Deen
authors.affiliation: Boonshoft School of Medicine, Wright University, Dayton, OH USA.
authors.forename: Jerald
authors.initials: J
authors.lastname: Kay
authors.affiliation: Georgetown University School of Medicine, Washington, DC USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Lazar
authors.affiliation: Columbia University Medical Center, New York, NY USA.
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Mellman
authors.affiliation: State University of New York, Brooklyn, NY USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Myers
authors.affiliation: Baylor College of Medicine, The Menninger Clinic, Houston, TX USA.
authors.forename: John
authors.initials: J
authors.lastname: Oldham
authors.affiliation: Weill Medical College of Cornell University, New York, NY USA.
authors.forename: Frank
authors.initials: F
authors.lastname: Yeomans
keywords: Behavior therapy; Borderline Personality Disorder; Common factors in psychotherapy; Psychodynamic therapies