Manualized Supportive-Expressive Psychotherapy Versus Nonmanualized Community-Delivered Psychodynamic Therapy for Patients With Personality Disorders: Bridging Efficacy and Effectiveness
Abstract
Objective Time-limited manualized dynamic psychotherapy was compared with community-delivered psychodynamic therapy for outpatients with personality disorders. Method In a stratified randomized clinical trial, 156 patients with any personality disorder diagnosis were randomly assigned either to 40 sessions of supportive-expressive psychotherapy (N=80) or to community-delivered psychodynamic therapy (N=76). Assessments were made at intake and 1 and 2 years after intake. Patients were recruited consecutively from two community mental health centers (CMHCs), assessed with the Structural Clinical Interview for DSM-IV Axis II Personality Disorders, and included if they had a diagnosis of any DSM-IV personality disorder. The outcome measures included the presence of a personality disorder diagnosis, personality disorder severity index, level of psychiatric symptoms (SCL-90), Global Assessment of Functioning Scale score, and number of therapy sessions. General mixed-model analysis of variance was used to assess group and time effects. Results In both treatment conditions, the global level of functioning improved while there were decreases in the prevalence of patients fulfilling criteria for a personality disorder diagnosis, personality disorder severity, and psychiatric symptoms. There was no difference in effect between treatments. During the follow-up period, patients who received supportive-expressive psychotherapy made significantly fewer visits to the CMHCs than the patients w…
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The limited available research does not support the concern that manualized treatments constrict psychoanalysts and reduce treatment effectiveness.
“The limited research available does not support this concern.”
From A study demonstrating efficacy of a psychoanalytic psychotherapy for panic disorder: Implications for psychoanalytic research, theory, and practice (2009) · cites this paper as Vinnars et al. 2005
Vinnars et al. (2005) found no significant outcome difference between manualized time-limited supportive-expressive psychotherapy and nonmanualized community-delivered psychodynamic psychotherapy for personality disorder patients; both reduced the number meeting personality disorder criteria and the severity of personality disorders and psychiatric symptoms.
“The authors did not find a significant difference in outcome between the two treatment conditions, and both led to reductions in the number of patients who met the criteria for personality disorder diagnoses, and in the severity of personality disorders and psychiatric symptoms.”
From A study demonstrating efficacy of a psychoanalytic psychotherapy for panic disorder: Implications for psychoanalytic research, theory, and practice (2009) · cites this paper as Vinnars et al. 2005
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References 32 · Cited by 112
- Authors
- Vinnars, B., Barber, J. P., Norén, K., Gallop, R., & Weinryb, R. M.
- Venue
- American Journal of Psychiatry
- Published
- 2005-10-01
- Volume
- 162
- Issue
- 10
- Pages
- 1933-1940
- ISSN
- 0002-953X (ISSN-L)
- 1535-7228
- OpenAlex
- W2115658723
- Cited by
- 112
- References
- 32
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 2 · 2023: 3 · 2022: 7 · 2021: 2 · 2020: 5 · 2019: 3 · 2018: 2 · 2017: 2 · 2016: 6 · 2015: 6 · 2014: 7 · 2013: 5 · 2012: 7
- FWCI
- 8.87
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of Mental Health (MH 61410, MH 49902, MH 45178, R01MH061410, R01MH049902)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
- Keywords
- personality disorders, psychodynamic psychotherapy, manualized psychotherapy, treatment efficacy, treatment effectiveness, community mental health centers, outpatients, psychiatric symptoms, Global Assessment of Functioning
- MeSH terms
- Adult, Community Mental Health Services, Female, Follow-Up Studies, Humans, Male, Manuals as Topic, Personality Disorders, Psychiatric Status Rating Scales, Psychoanalytic Therapy, Psychotherapy, Psychotherapy, Brief, Severity of Illness Index, Comorbidity, Treatment Outcome, Diagnostic and Statistical Manual of Mental Disorders
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