The recent article by Giesen-Bloo and colleagues1 comparing schema-focused and transference-focused psychotherapy for borderline personality disorder is remarkable on 2 accounts. First, it gives hope to psychotherapists that sustaining a positive clinical relationship with patients with borderline personality disorder over 3 years of twice-weekly therapy is both possible and worthwhile. Second, it is one of the very few studies that show differential effectiveness between 2 therapy types, given that research from the past 30 years has consistently failed to find differential effects between treatment types.2 In contrast, research has shown that the therapeutic alliance,3 therapist effectiveness,4 and researcher allegiance5 powerfully relate to clinical changes. In this context, it is surprising that Giesen-Bloo and colleagues do not address these issues in their article. Such data might help readers to understand their findings, including the puzzling but large difference in dropout rates between treatments, and understand the allegiance-boosting effect that allowing patient-therapist contact between therapy sessions might have had in the schema-focused group.
Grenyer BFS. Hope for Sustaining a Positive 3-Year Therapeutic Relationship With Patients With Borderline Personality Disorder. Arch Gen Psychiatry. 2007;64(5):609. doi:10.1001/archpsyc.64.5.609-a