In an RCT by Sandahl, Herlitz, Ahlin, and Ronnberg (1998), PDT and CBT were compared concerning their efficacy in the treatment of alcohol abuse. PDT yielded significant improvements on measures of alcohol abuse, which were stable at a 15-month follow-up. PDT was significantly superior to CBT in the number of abstinent days and in the improvement of general psychiatric symptoms. F)%&0%<$*0!10%6)*2<$(4!&$6)%&0%! At present, seven RCTs are available for PDT in BPD (Bateman & Fonagy, 1999, 2009; Clarkin, Levy, Lenzenweger, & Kernberg, 2007; Doering et al., 2010; Giesen-Bloo et al., 2006; Gregory et al., 2008; Munroe-Blum & Marziali, 1995). Of these studies, several showed that PDT was superior to TAU (Bateman & Fonagy, 1999; Doering et al., 2010; Gregory et al., 2008). Bateman and Fonagy (1999, 2001) studied psychoanalytically oriented partial hospitalization treatment for patients with BPD. The major difference between the treatment group and the control group was the provision of individual and group psychotherapy in the former. The treatment lasted a maximum of 18 months. PDT was significantly superior to standard psychiatric care, both at the end of therapy and at the 18- month follow-up. In a recent RCT, Transference-Focused Psychotherapy (TFP) based on Kernberg’s model (Clarkin, Yeomans, & Kernberg, 1999) was compared to a treatment carried out by experienced community psychotherapists in borderline outpatients (Doering et al., 2010). TFP was superior with regard to borderline psychopathology, psychosocial functioning, personality organization, inpatient admission, and dropouts. Another RCT compared PDT (‘dynamic deconstructive psychotherapy’) with TAU in the treatment of patients with BPD and co-occurring alcohol use disorder (Gregory et al., 2008). In this study, PDT, but not TAU, achieved significant improvements in outcome measures of parasuicide, alcohol misuse, and institutional care (Gregory et al., 2008). Furthermore, PDT was superior with regard to improvements in borderline psychopathology, depression, and social support. No difference was found in dissociation. This was true although TAU participants received higher average treatment intensity. Another recent RCT found mentalization-based treatment (MBT) to be superior to manual-driven structured clinical management with regard to the primary (suicidal and self-injurious behaviors, hospitalization) and secondary outcome measures (e.g., depression, general symptom distress, interpersonal functioning) (Bateman & Fonagy, 2009). With regard to the comparison of PDT to specific forms of psychotherapy, one RCT reported PDT as equally effective as an interpersonal group therapy (Munroe-Blum & Marziali, 1995). PDT yielded significant improvements on measures of borderline-related symptoms, general psychiatric symptoms, and depression, and was as effective as an interpersonal group therapy. Power, however, may have been insufficient to detect differences between treatments (N1 ¼ 22, N2 ¼ 26). Giesen-Bloo et al. (2006) compared PDT (TFP) with schema-focused therapy (SFT), a form of CBT. Treatment duration was three years with two sessions a week. The authors reported statistically and clinically significant improvements for both treatments. However, SFT was found to be superior to TFP in several outcome measures. Furthermore, a significantly higher dropout risk for TFP was reported. This study, however, had serious methodological flaws. The authors used scales for adherence and competence for both treatments, for which they adopted an identical cutoff score of 60 indicating competent application. According to the data published by the authors (Giesen-Bloo et al., 2006, p. 651), the median competence level for applying SFT methods was 85.67. For TFP, a value of 65.6 was reported. While the competence level for SFT clearly exceeded the cutoff, the competence level for TFP just surpassed it. Furthermore, the competence level for SFT is clearly higher than that for TFP. Accordingly, both treatments were not equally applied in terms of therapist competence. Thus, the results of that study are questionable. The difference in competence was not taken into account by the authors, neither with regard to the analysis of resulting data nor in the discussion of the
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