Cognitive Therapy

Giesen-Bloo etal. (2006) report on a multicentre randomised treatment study comparing the effectiveness of schema-focussed cognitive therapy (SFT) and psychodynamically based transference-focussed psychotherapy (TFP) in 88 patients with BPD. The intervention consisted of three years of SFT or TFP, with twice-weekly 50-minute sessions. Schema-focussed therapy employs a range of cognitive, behavioural and experiential techniques focussing on the therapeutic relationship, as well as past and present experiences. Recovery is predicted to occur when dysfunctional schema no longer control the individual's behaviour. In TFP, recovery is achieved through interpretation of the transference relationship, with a focus on present circumstances.

The primary outcome measure in this study was the BPD Severity Index-IV (Arntz et al, 2003); a secondary outcome measure was quality of life assessed by the EuroQol thermometer (The EuroQol Group, 1990) and the World Health Organization quality of life assessment (The WHOQOL Group, 1998). A range of additional clinical measures was also used. Intention-to-treat analysis showed statistically and clinically significant improvements for both interventions on all measures at one- two-, and three-year intervals. However, SFT was more effective than TFP on all measures and was associate with a lower drop-out rate. The authors urge caution in comparing their results with trials of dialectical behaviour therapy (DBT) and 'psychoanalytically oriented mentalization-based treatments' (MBT -for example, Bateman & Fonagy 1999; 2001). They identify differences in the primary objectives of these approaches - arguing that SFT and TFP aim for overall personality change while DBT and MBT prioritise reduction in self-destructive behaviour.

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