Borderline Personality Disorder: Treatment from the Contextual Perspective

In relation to the psychotherapy of borderline personality disorder (BPD), the contextual model embraces the subjective components that operate alongside the more readily objectifiable elements of the medical model. The latter include the guidelines of the various psychodynamic and cognitive approaches, the randomized control trials of these approaches, follow-up studies, and data from MRI and other neurophysiological tests. The contextual model focuses on less easily measurable factors that comprise the real relationship between therapist and patient, including the heterogeneity in the BPD domain. Another component consists of patient expectations at the outset, the placebo effect of having an ally in the person of the therapist, and the nature of the patient's primary unconscious conflicts. These combined elements exert a major influence vis-à-vis the efficacy of treatment, such that the precise nature of the therapeutic method emerges as of less importance in the eventual outcome—so long as the method is a bona fide theory-driven intervention, conducted by therapists with sufficient knowledge of alternative approaches and with the flexibility to utilize other approaches temporarily, in accordance with the exigencies of the patient's current life. This amounts to an integrated approach.