Tailoring psychotherapy in patients with personality disorders: Matching the level of psychological strengths to the level of stabilizing versus destabilizing psychotherapy.

BACKGROUND: Clinical evidence suggests that patients high on psychological strengths profit more from destabilizing psychotherapy, whereas patients low on strengths profit more from stabilizing psychotherapy. This matching hypothesis was tested. METHODS: This quasi-experimental study was conducted between 2003 and 2008 in 735 patients with personality disorders from 6 psychotherapy centers in the Netherlands. Patients were assigned to different levels of stabilizing and destabilizing psychotherapies. Levels of psychological strengths were measured. We used multilevel modeling to estimate outcome at 12 months after baseline. The propensity score controlled for initial differences at baseline. RESULTS: The findings show that destabilizing psychotherapies have slightly better outcomes than stabilizing psychotherapies. Patients high on psychological strengths improve slightly more than patients low on psychological strengths. The observed interaction effect contradicted our hypothesis. CONCLUSION: The results imply that destabilizing psychotherapies can be considered as first treatment option for patients both high and low on psychological strengths.

Relationship between patient characteristics and treatment allocation for patients with personality disorders.

Within a large multi-center study in patients with personality disorders, we investigated the relationship between patient characteristics and treatment allocation. Personality pathology, symptom distress, treatment history, motivational factors, and sociodemographics were measured at intake in 923 patients, who subsequently enrolled in short-term or long-term outpatient, day hospital, or inpatient psychotherapy for personality pathology. Logistic regressions were used to examine the predictors of allocation decisions. We found a moderate relationship (R(2) = 0.36) between patient characteristics and treatment setting, and a weak relationship (R(2) = 0.18) between patient characteristics and treatment duration. The most prominent predictors for setting were: symptom distress, cluster C personality pathology, level of identity integration, treatment history, motivation, and parental responsibility. For duration the most prominent predictor was age. We conclude from this study that, in addition to pathology and motivation factors, sociodemographics and treatment history are related to treatment allocation in clinical practice.