Abstract
This book begins with a disclaimer—Livesley wishes that borderline personality disorder (BPD) had a different name. (The author is known for suggesting that categories of personality disorder are not valid and should be described using trait dimensions.) But Livesley goes on to note that whatever you call the syndrome, it is a major clinical problem. In my experience, BPD challenges clinicians, who often ask for consultations on these patients.
However, breakthroughs in research have now shown that most cases of BPD are treatable. One question for the clinician is how to choose among the alphabet soup of acronyms that describe the various methods that have thus far been tested. This book suggests that all approaches have value and that the best ideas can be integrated into a single model of therapy. And to create structure within potential chaos, therapy should be offered in a sequence of modules (safety, emotional regulation, interpersonal problems, and developing a sense of self).
Another question that clinicians need to address is the length of therapy for BPD. Traditional psychodynamic therapies have had a habit of becoming interminable, ending only with the retirement or death of the therapist. Livesley suggests 4 options: (1) brief therapy for crisis intervention (5-10 sessions), (2) short-term therapy for regulation and control (20-30 sessions), (3) longer-term therapy for interpersonal problems (50 plus sessions), and (4) long-term therapy for sense of self (additional 20-30 sessions). Thus, a good number of patients would be treated briefly, and therapy would not last more than a maximum of 2 years. These parameters generally correspond to therapies that have been tested in clinical trials, with the caveat that we do not really have data showing whether treatment lasting more than a year actually makes a difference in outcome.
The pages of this book offer many practical tips and give useful clinical examples. For psychotherapists who are not sure how they can apply the complex theoretical constructs of current psychotherapies, the approach is practical, advising clinicians above all to keep things simple and consistent.