Lecture – Tailoring Psychotherapy for Borderline Personality Disorder

Available with English captions.

Presented by Shelley McMain, PhD, Centre for Addiction and Mental Health – The Alfred Stanton Lecture

Borderline personality disorder (BPD) is a severe and debilitating disorder. It is further complicated by considerable variety within the BPD population.

Research supports the benefits of several evidence-based treatments for BPD. However, most best-practice recommendations about effective treatments are based on findings from randomized controlled trials (RCTs). These studies report average treatment effect sizes.

According to Shelley McMain, PhD, RCT findings lead to the assumption that there is an average BPD patient. This thinking can lead to average treatments. Average treatment effects do not reliably estimate the impact of treatment on a given individual. They also do not allow for varying responses to treatment.

However, McCain explains, treatment potency, including elements and dose, can be tailored to patients based on individual characteristics and ability to respond to increase the probability of success.

Lecture highlights include:

  • An overview of personalized treatment, including a look at emerging evidence related to personalizing treatment
  • A discussion of evidence from diverse research methodologies that contribute to the understanding of how to personalize therapy and optimize treatment outcomes for people diagnosed with BPD
  • A review of evidence related to four levels through which treatment decisions can be assessed: diagnosis, treatment context, relationship, and specific interventions
  • Implications for research and clinical practice are also discussed

McCain discusses the ways that clinicians can tailor treatments to individuals. Clinicians, she says, must understand the biological, genetic, lifestyle, and environmental factors underlying a patient’s condition. They must also assess the moderators, such as coexisting conditions, that could affect an individual’s response to treatment. These moderators can also help determine the format and length of treatment that could produce an optimal result.

To help clinicians determine more personalized and effective BPD treatments, McCain calls for changes in treatment research methods. Although RTCs can be helpful to address some questions related to BPD treatment, she says that clinicians over-rely on these studies.

McCain believes that more attention should be paid to idiographic research. Studies that focus more on the unique symptoms and experiences of each BPD patient, she says, could lead to clinicians implementing the best treatments and strategies for their patients.