An 18-Month Psychotherapy of Borderline Personality Disorder

Patients with borderline personality disorder (BPD) will be provided with an empirically
supported form of psychotherapy for BPD patients called transference-focused psychotherapy
(TFP) and medication treatment, if indicated. The primary goal of the current study is to
detect changes in psychological, psychosocial and work functioning over the course of
18-months of TFP. Previous research has shown that TFP is an effective treatment for BPD over
the course of one year, significantly reducing symptoms. An 18-month treatment period will
most likely allow patients to achieve significant and lasting gains in work and psychosocial
functioning. Each patient will be assessed prior to (baseline), at 3-month intervals
throughout, and at the termination of the 18-month treatment period for symptoms, vocational
status, and psychosocial functioning. In addition, patients and therapists will complete
self-report measures every three months about the therapeutic relationship. After the
18-month treatment period, a final, brief assessment of vocational status, symptoms, and
psychosocial functioning will occur.

The therapists doing TFP are professional psychiatrists, psychologists, and social workers
who have been trained by Dr. Otto Kernberg in this special form of psychotherapy. In this
therapy, the patient and therapist meet in the therapists' private office for 50-minute
sessions two times a week on a weekly basis (except for vacations) for 18 months.

Hypothesis: It is hypothesized that patients in Transference Focused Psychotherapy (TFP) will
manifest differential responses to the treatment, depending upon pre-treatment patient
psychological and psychiatric characteristics. The investigators expect that some patients
will show significant positive changes in symptoms, work, and social functioning at the end
of 18 months, and that these positive changes will manifest in psychological and
neuropsychological measures. The investigators will investigate the pre-treatment
psychological variables (e.g. trait sociability, constraint, and negative affect) and
neuropsychological functioning (executive attention, capacity to inhibit behavior, memory
functioning) that will be predictive of patient improvement with treatment at the end of 18
months. By the end of the treatment, the investigators expect some patients to approach
normal levels of enjoyment and enrichment of their experiences in work and social
functioning. As all analyses will occur at the end of the study, response to TFP will not be
assessed during the course of treatment. Therefore, patients will not be moved to a different
intervention during the course of the study.

Research Question: The investigators have found in our pilot work that symptom change occurs
in the first 12 months of TFP followed by substantial work and psychosocial changes in
subsequent months. The primary goal of the current pilot project is to demonstrate that TFP
over an 18-month treatment period is associated with significant improvement in work and
intimate relations, reflecting significant personality changes that should enhance patients'
overall effectiveness and gratification in their lives.

Inclusion Criteria:

- We are recruiting female patients between the ages of 18-35 who meet DSM criteria for
BPD.

Exclusion Criteria:

- We are excluding patients who meet the following criteria:

- psychotic disorders

- a current major depressive episode

- bipolar I disorder

- current substance dependence

- antisocial personality disorder.

- unable to undergo 18-months of twice weekly psychotherapy in NYC