What role does psychotherapy play in the management of personality disorders, and which types are most effective?

Role of Psychotherapy in Personality Disorders

Psychotherapy plays a central role in managing personality disorders by providing supportive interventions that facilitate learning and development of new behaviours and coping strategies. These strategies focus on problem solving, emotion regulation, impulse control, managing interpersonal relationships, and reducing self-harm. Psychological interventions should be adapted in duration and intensity to the individual's needs, especially when standard protocols are ineffective, and delivered within a multidisciplinary context to enhance effectiveness. People with personality disorders should not be excluded from health or social care services or treatments for comorbid conditions based solely on their diagnosis NICE NG66.

Most Effective Types of Psychotherapy

For borderline personality disorder, evidence supports the use of comprehensive dialectical behaviour therapy (DBT), particularly for women prioritising reduction of recurrent self-harm. Psychological treatments should be chosen considering the service user's preferences, severity of disorder, motivation, and ability to engage in therapy. Structured care with an explicit theoretical approach and therapist supervision is recommended, with sessions possibly twice weekly. Brief psychological interventions under three months are not advised outside specialised services NICE CG78.

For antisocial personality disorder, the evidence base is limited, but interventions targeting antisocial behaviours, impulsivity, aggression, and comorbid disorders are used. Engagement strategies emphasising optimism and positive therapeutic relationships are important. Contingency management may be considered to reduce substance misuse and promote service engagement NICE NG66,NICE CG77.

Overall, cognitive behavioural therapy (CBT) approaches tailored to the specific personality disorder and individual needs are commonly used, with longer-term, structured, and multidisciplinary interventions showing better outcomes NICE NG66,NICE CG78.