Hi
I think one of things we need to recognise with treating personality disorder is thatthere is a difference between reducing symptoms and producing character change. Pure CBT models are able to offer some symptom reduction but not a cure. This is similar to CBT and Chronic Fatigue Syndrome. Treatment leads to symptoms reduction not a cure.
Neither Linehan’s or Young’s model are strictly cognitive behavioural and both would acknowledge a considerable intake from psychodynamic approaches in developing their theories.
Wise mind, rational mind and emotional mind is hardly a cognitive behavioural concept and equates reasonably well with id, ego and super ego. Similarly Young’s ideas of modes is cast directly in this frame i.e. child and parental modes (id and superego) and a single adult mode i.e. ego.
Linehan introduces the idea of conflict with the dialectic; change or no change, safety or relationship. These are more psychodynamic concepts than pure CBT. I think it is the fact the pure CBT didn’t work with personality disorder that has actually led to the development of more in-depth approaches integrating stuff from other models.
What is interesting is the new Dutch study (Archives of General Psychiatry) showing apparent character change and a significant cure rate for borderlines using either Young’s Schema Focused Therapy or Kernberg and Clarkin’s Transference Focused Therapy. This is long term therapy twice a week for three years with outstanding results.
Looking at the April 2006, Journal of Clinical Psychology articles I think the paper on pure CBT with Borderlines is the weakest by far. One of the things that appears a commonality amongst the other papers is the need to help the borderline client build some type of reflective space. Until there is space to think then pure CBT is difficult to apply.
Linehan’s approach appears to be effective in reducing dysfunctional borderline behaviours particularly suicidal and parasuicidal behaviours. It does not appear to produce underlying character change as indicated in the Dutch study above.
I think we need to acknowledge that the therapies that are working with borderline clients are hybrids and we are seeing a maturing of CBT where it integrates many of the psychodynamic concepts such as drives or motivations (see Grosse Holtforth and Castonguay), resistance and defence see (Leahy), object relations (Young).
Regards
Chris
In the Room
http://gandalwaven.typepad.com/intheroom/