Transference-focused psychotherapy v. treatment by community psychotherapists for borderline personality disorder: randomised controlled trial

Background Transference-focused psychotherapy is a manualised treatment for borderline personality disorder. Aims To compare transference-focused psychotherapy with treatment by experienced community psychotherapists. Method In a randomised controlled trial (NCT00714311) 104 female out-patients were treated for 1 year with either transference-focused psychotherapy or by an experienced community psychotherapist. Results Significantly fewer participants dropped out of the transference-focused psychotherapy group (38.5% V. 67.3%) and also significantly fewer attempted suicide (d=0.8, P=0.009). Transference-focused psychotherapy was significantly superior in the domains of borderline symptomatology (d=1.6, P=0.001), psychosocial functioning (d=1.0, P=0.002), personality organisation (d=1.0, P=0.001) and psychiatric in-patient admissions (d=0.5, P=0.001). Both groups improved significantly in the domains of depression and anxiety and the transference-focused psychotherapy group in general psychopathology, all without significant group differences (d=0.3-0.5). Self-harming behaviour did not change in either group. Conclusions Transference-focused psychotherapy is more efficacious than treatment by experienced community psychotherapists in the domains of borderline symptomatology, psychosocial functioning, and personality organisation. Moreover, there is preliminary evidence for a superiority in the reduction of suicidality and need for psychiatric in-patient treatment.