Evidence-Based Psychodynamic Therapies for the Treatment of Patients With Borderline Personality Disorder

Background: Borderline Personality Disorder (BPD) is a serious health issue associated with a high burden for the individual and society. Among the "Big Four" of evidence-based treatments for patients with BPD are two psychodynamic therapies that have evolved from classic psychoanalytic treatment with a change of setting and change of focus: Transference-Focused Psychotherapy (TFP) and Mentalization-Based Treatment (MBT).

Aims: This overview provides a comparison of the two treatments in terms of stance, clinical concepts, costs and key interventions. Furthermore, the current literature on the efficacy of both treatments is reviewed.

Results: While TFP focuses on the content of disintegrated representations of self and other, MBT focuses on the processing of mental states. Both treatments diverge in their clinical concepts and interventions for the treatment of BPD.

Conclusion: Although both treatments are regarded as effective in treating BPD, no direct comparison of both treatments has been made so far. Future studies are needed to investigate mechanisms of change and derive recommendations for a differential indication.

Specialized therapies for BPD have favorable drop-out rates and outcome compared to non-specialized ones.

MBT and TFP have very diverse clinical concepts and interventions for the treatment of BPD.

Both, MBT and TFP show efficacy in RCTs.

No trial has directly compared MBT and TFP; there is no evidence base for differential indication.