Residential Intensive Short-Term Dynamic Psychotherapy, Part 2: Long-Term Follow-Up in the Treatment of Personality Disorders.

Abstract

Objective: Intensive short-term dynamic psychotherapy (ISTDP) has been shown to be effective with patients with common mental disorders, including personality disorders. In the Netherlands, a 6-month residential version (R-ISTDP) of this traditionally outpatient therapy for patients with treatment-resistant personality disorders was developed and tested. This study focused on changes that occurred directly after treatment and 1-10 years after discharge.

Methods: All patients admitted to the R-ISTDP program between 1995 and 2005 were assessed at admission, discharge, and a variable follow-up of 1-10 years. In this single-arm trial, treatment outcome was measured in terms of symptom severity (with the Symptom Checklist-90-R [SCL-90-R]), general functioning (with the Global Assessment of Functioning [GAF] Scale), employment status, social welfare benefits, and living situation. Demographic variables and psychopathology indicators were included as predictors. Because of the variable distribution of length of follow-up, outcome data from 155 patients were evaluated by using mixed-models analysis.

Results: From admission to discharge, significant and large improvements were seen in SCL-90-R total scores (d=1.2) and GAF scores (d=0.9). From discharge over the course of 10-year follow-up, SCL-90-R total scores remained stable, and GAF scores further improved (d=1.5). At follow-up 1-10 years after discharge, more patients had returned to work compared with pretreatment. No statistically significant association between any of the predictors and outcome was found.

Conclusions: Patients with treatment-resistant personality disorders showed substantial improvements at discharge from R-ISTDP. Although several limitations of this naturalistic study design must be considered, these findings are important in demonstrating stable long-term improvement after R-ISTDP.