An integrated approach to the treatment of personality disorder

Background: Several treatments are effective in treating personality disorder and outcome does not differ substantially across treatments. These findings point to the importance of generic mechanisms and an eclectic approach that combines effective interventions from different models.Aim: To develop a framework for integrated, eclectic treatment using an array of interventions drawn from different treatment modes and delivered in an integrated way.Method: Literature review of treatment outcome and conceptual analysis of the nature of personality disorder and the process of change was used to identify principles for organizing treatment.Results: Four ideas are proposed for organizing treatment and coordinating interventions. First, treatment is based on generic change mechanisms. Second, interventions are divided into general and specific treatment strategies. General treatment strategies are used throughout treatment to build the alliance, ensure therapeutic consistency, provide validation, and build motivation. Specific interventions are added to this framework as needed to treat specific problems. Third, treatment is conceptualized as a series of phases, each addressing different problems and domains of psychopathology. This framework is used to coordinate the selection of specific interventions. Finally, change in specific behaviours is described using the stages of change model that also provides an orderly way to combine interventions.Conclusions: An integrated and eclectic approach to treatment is consistent with current empirical evidence on treatment efficacy and the limitations of current treatments.