Letters to the Editor
Re: Day Treatment for Personality Disorders
Dear Editor: Dr Paris’ article on the treatment of BPD and Dr Livesley’s article on strategies for treating personality disorder, both in July’s Journal, were good reviews serving to combat undue pessimism in the treatment of those disorders (1,2).
Both authors refer to day treatment as an evidence-based alternative for patients in crisis (1, p 439; 2, p 446). It is important to understand that the day treatment program we studied, using a randomized controlled design, is not for patients in crisis (3,4). This program is designed for patients who are able to tolerate intensive self- and behavioural exploration. It corresponds to Livesley’s stage of “exploration and change” (2, p 448) in the sequence of strategies for treating personality disorder. Such day treatment programs are highly specialized, requiring competent leadership and several years of staff training to become effective (5). Day treatment programs should be distinguished from day hospitals, which are units designed as an alternative to inpatient care (6). Ideally, day hospitals for patients with personality disorders might operate on Livesley’s principles of “safety and managing crises” and “containment” (2, p 446).
References
1. Paris, J. Recent advances in the treatment of borderline personality disorder. Can J Psychiatry 2005;50:435–41.
2. Livesley, WJ. Progress in the treatment of borderline personality disorder. Can J Psychiatry 2005;50:442–50.
3. Piper WE, Rosie JS, Azim HFA, Joyce AS. A randomized trial of psychiatric day treatment for patients with effective and personalitiy dosirders. Hospital and Community Psychiatry 1993;44:757–63.
4. Piper WE, Rosie JS, Joyce AS, Azim HFA. Time-limited day treatment for personality disorders: integration of research and practice in a group program. Washington (DC): America Psychological Association; 1996.
5. Steinberg PI, Roise JS, Joyce AS, O’Kelly JG, Piper WE, Lyon D, and others. The psychodynamic psychiatry service of the University of Alberta hospital: a thirty year history. Int J Group Psychother 2004;54:521–38.
6. Rosie JS. Partial hospitalization: a review of recent literature. Hosp Community Psychiatry 1987;48:1291–9.
John Rosie, MBChB,MRCPsych
Anthony Joyce, PhD
John G O’Kelly, MB, MRCPsych
Paul Steinberg, MD
Edmonton, Alberta
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