Yale New Haven Psychiatric Hospital, 184 Liberty Street, New Haven, CT 06519 USA.
Austen Riggs Center, Stockbridge, Massachusetts USA.
Borderline Personal Disord Emot Dysregul. 2014 Nov 11;1:16. doi: 10.1186/2051-6673-1-16. eCollection 2014.
The objective was to review established literature on approaches to the psychotherapy of borderline personality disorder with specfic reference to suicide in order to determine if there were common factors across these efforts that would guide future teaching, practice and research. The publications from the proponents of five therapies for the treatment of suicidal behavior in individuals with borderline personality disorder (BPD), were reviewed and discussed by the members of the Group for the Advanced of Psychiatry, Psychotherapy Committee (GAPPC). Twenty nine published research and summary reports were reviewed of the specific treatments noted above along with two other reviews of common factors for this group of treatments. We used expert consensus as to the salient articles for review and the appropriate level of abstraction for the common factor definition. We formulated a definition of effectiveness and identified six common factors: 1) negotiation of a specific frame for treatment, 2) recognition and insistence on the patient's responsibilities within the therapy, 3) provision to the therapist of a conceptual framework for understanding and intervening, 4) use of the therapeutic relationship to engage and address suicide, 5) prioritization of suicide as a topic to be actively addressed whenever it emerges, and 6) provision of support for the therapist in the form of supervision, consultation or peer support. We discuss common factors, their formulation, and implications for development and teaching of psychotherapeutic approaches specific to suicide in patients with borderline personality disorder and note that there should be greater attention in practice and education to these issues.
目的是回顾关于边缘型人格障碍心理治疗方法的已有文献，特别是参考自杀问题，以确定这些努力是否存在共同因素，从而为未来的教学、实践和研究提供指导。精神病学、心理治疗委员会（GAPPC）的成员对五种治疗自杀行为的疗法的支持者的出版物进行了审查和讨论。对上述特定治疗方法的 29 项已发表的研究和总结报告进行了审查，以及对这组治疗方法的共同因素的另外两项审查。我们根据专家共识确定了用于审查的重要文章以及共同因素定义的适当抽象水平。我们制定了有效性定义，并确定了六个共同因素：1）协商治疗的具体框架，2）识别并坚持患者在治疗中的责任，3）为治疗师提供理解和干预的概念框架，4）利用治疗关系来接触和解决自杀问题，5）将自杀作为一个优先主题，只要出现就积极解决，6）以监督、咨询或同行支持的形式为治疗师提供支持。我们讨论了共同因素、它们的形成，以及对发展和教授针对边缘型人格障碍患者自杀的心理治疗方法的影响，并指出在实践和教育中应该更加关注这些问题。
