Psychotherapy for personality disorders: Questions of clinical utility.

Patients with personality disorders (PDs) represent a particular burden for the health system and the clinicians attempting to treat them. The current commentary complements reviews of outcome studies on treatments for PDs by focusing on the clinical utility as defined by the American Psychological Association. As such, extending that notion, clinical utility of a treatment comprises aspects of implementation and training in the model as well as qualities of the therapeutic technique and relationship. Our review suggests that a certain caution needs to be applied when reading outcome studies based on specific methodological caveats. In specific contexts, inpatient and day hospital treatments have some initial appeal in reducing symptoms, in particular for the treatment of more severe forms of Cluster A and B PDs. In general, treatments for PDs are long-term treatments, administered in rather high dosage, which tends to be true irrespective of the treatment model. For specific treatment targets, there is emerging evidence on effectiveness of short-term interventions. The therapeutic relationship with patients with PDs may be characterized by strains and interactional difficulties that may be addressed using clinically adapted treatment strategies. To be effective, therapists should have an open-minded and flexible approach to therapy, which is particularly central from an integrative perspective. Finally, we state that a key element for implementation of an effective treatment model is a manual-based training that, albeit controversial, remains a key component allowing for the trainee therapist to self-monitor his or her progress and get specific help in supervision as part of the learning process. We advocate that clinicians and administrators should consider these points as being specifically related with clinical utility of treatments for PDs because they contribute to optimize the implementation process of a therapy approach to a specific context