Tailoring psychotherapy in patients with personality disorders: Matching the level of psychological strengths to the level of stabilizing versus destabilizing psychotherapy

Background: Clinical evidence suggests that patients high on psychological strengths profit more from destabilizing psychotherapy, whereas patients low on strengths profit more from stabilizing psychotherapy. This matching hypothesis was tested. Methods: This quasi-experimental study was conducted between 2003 and 2008 in 735 patients with personality disorders from 6 psychotherapy centers in the Netherlands. Patients were assigned to different levels of stabilizing and destabilizing psychotherapies. Levels of psychological strengths were measured. We used multilevel modeling to estimate outcome at 12months after baseline. The propensity score controlled for initial differences at baseline. Results: The findings show that destabilizing psychotherapies have slightly better outcomes than stabilizing psychotherapies. Patients high on psychological strengths improve slightly more than patients low on psychological strengths. The observed interaction effect contradicted our hypothesis. Conclusion: The results imply that destabilizing psychotherapies can be considered as first treatment option for patients both high and low on psychological strengths.

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