People with Borderline Personality Disorder are regular visitors to General Practices - and among the patients who most stretch the capabilities of a General Practice. The Centre for Psychotherapy in Newcastle, Australia, offers a special outpatient service for people with BPD that utilises two of the most effective therapeutic approaches - the Conversational Model and Dialectic Behaviour Therapy. Two principals from the Centre will discuss what, in their experience, works with BPD, and how general practitioners can best manage patients with BPD in their practices.
Over the two presentations they discuss issues such as; the complex emotional dance between doctor and the BPD patient; the use of medications; when and whether to hospitalise; the long term management of BPD; co-morbidity and diagnosis; and problems of finding suitable resources that are effective with BPD
The Conversational Model was developed by Professor Russell Meares and Bob Hobson initially in Manchester in the late 1960s. They wanted to develop a user-friendly and jargon free adaptation of psychoanalysis that was tailored to working with patients with borderline personality disorder, at that time thought to be untreatable. Professor Meares has continued to develop this model over the past 30 years at Westmead hospital in Sydney, culminating in a waiting list controlled trial of this model that produced excellent outcomes for patients with borderline personality disorder after one year of psychotherapy, and maintaining those gains five years later.
Dialectical Behaviour Therapy (DBT) was developed by Marsha Linehan for treating women with Borderline Personality Disorder who deliberately self-harmed. It is now used with both genders, adolescents and adults, and with people whose primary difficulties lie in areas of substance abuse and eating disorder. The comprehensive model has patients attending individual therapy and group-based skills training weekly with phone support for generalisation of skills outside of therapy. DBT is a combination of Cognitive Behavioural Therapy, mindfulness practice, acceptance-based principles and dialectical strategies with the purpose of addressing life-threatening and self-harming behaviours, behaviours that interfere with therapy, major quality of life issues and the acquisition of life skills.
This recorded live web-cast has been organised by the Australian College of Psychological Medicine. The ACPM would like to express appreciation to the Central Sydney General Practice Network for financial support provided to assist in the production of this webcast.
Senior clinical psychologist at the Centre for Psychotherapy, conjoint senior lecturer with the School of Psychology at the University of Newcastle and psychotherapy educator with the Hunter New England psychiatry training program. He has worked with people with borderline personality disorder for the past 20 years, the last 10 using DBT. He provides education and supervision to psychiatry registrars and postgraduate clinical and health psychologists. The Centre for psychotherapy has previously replicated Linehan’s original research and is currently running an RCT comparing DBT with the Conversational Model.
Dr Nick Bendit
Dr. Nick Bendit is a staff specialist in psychiatry and conjoint lecturer at the University of Newcastle. He works at the Centre for Psychotherapy, a public outpatient psychotherapy unit treating patients with borderline personality disorder and eating disorders. He has a 20 year history of working in psychotherapy both in private practice and public health. At the Centre for Psychotherapy he uses dialectical behaviour therapy (DBT) and the conversational model (an adapted psychodynamic model). He is involved in teaching and supervision of psychiatry trainees and postgraduate psychologists.
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