Treatment of Borderline Personality Disorder: A Guide to Evidence-Based Practice


Organizing a vast body of scientific literature, this indispensable book presents the state of the art in understanding borderline personality disorder (BPD) and distills key treatment principles that therapists need to know. Rather than advocating a particular approach, Joel Paris examines a range of therapies and identifies the core ingredients of effective intervention. He offers specific guidance for meeting the needs of this challenging population, including ways to improve diagnosis, promote emotion ...
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Organizing a vast body of scientific literature, this indispensable book presents the state of the art in understanding borderline personality disorder (BPD) and distills key treatment principles that therapists need to know. Rather than advocating a particular approach, Joel Paris examines a range of therapies and identifies the core ingredients of effective intervention. He offers specific guidance for meeting the needs of this challenging population, including ways to improve diagnosis, promote emotion regulation and impulse control, maintain appropriate therapeutic boundaries, and deal with suicidality and other crises. Highly readable, practical, and humane, the book also explains the latest thinking on the causes of BPD and how it develops.
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Editorial Reviews

Doody's Review Service
Reviewer: Aaron Plattner, MD (Pine Rest Christian Mental Health Services)
Description: This book reviews the data about borderline personality disorder (BPD) and how that impacts the treatment.
Purpose: The purpose is to provide clinicians with evidence-based information about what BPD, how it is being treated, what treatments are successful and not successful, and the future of this disease.
Audience: Clinicians at any level who are caring for patients with BPD or will care for these patients are the intended audience.
Features: The book addresses all areas of BPD, defining what it is, discussing possible causes, exploring different aspects of treatment strategies, and suggesting future directions for research.
Assessment: As a PGY-2 resident, I found this book very helpful as I worked with BPD patients both in and out of the hospital. BPD can be a very intimidating disease as different clinicians diagnose and treat BPD very differently, leaving residents unsure of the correct way to address the disorder. This book provides a clear, evidence-based background and treatment strategies for BPD. The case studies are very helpful as they highlight main points. Readability would be improved by using a numbered note system for referencing research articles in the text and moving the citations to the end of the chapter or the end of the book, rather than using in-text parenthetical citations. In addition, the title is a bit misleading in that it infers that only the treatment of BPD is covered, but the disease is discussed in its entirety.
Journal of Psychiatric Practice

"A unique reference that comprehensively reviews a broad and complicated history of ideas and research in an easy-to-read format replete with a colorful back story and editorial commentary by a true clinical and scientific expert....Paris provides a complete overview of the history of research on BPD in a way that practically informs a coherent clinical approach to treating individuals with the diagnosis....Paris manages to lighten the reader's load by dividing the literature into manageable chapters, which include case vignettes that deftly illustrate the clinical relevance of the scientific material that is presented. Another help to the reader is that Paris concludes each chapter with easy-to-remember pearls presented in a bulleted list entitled 'Clinical Implications'....This book serves as a much-needed reference for practicing clinicians during a time when psychiatry at large has solidly shifted to more evidence-based approaches and the empirical basis for treating BPD has been more firmly established....What Paris does most effectively and helpfully in this book is provide a means for the practicing clinician to gain expertise in a specialized, empirically informed approach to treating BPD, without the need for allegiance to a particular 'brand name' validated approach....The style of the book is highly readable and surprisingly conversational....The book reads almost as if it were a direct supervision by Paris himself, a highly respected clinician-researcher who is a major figure in the development of our field's understanding of BPD....Highly recommended to clinicians of all levels of experience looking to familiarize themselves with the evidence base for the treatment of BPD. It is ideal for trainees and teachers as well as academics and private practitioners. Even for researchers, it is a valuable orienting review text that does a good job of demonstrating the ties between scientific findings and treatment approaches for BPD."--Journal of Psychiatric Practice
From the Publisher

"Paris has done a remarkable job of providing guidance for clinicians on how to understand and treat BPD. The book presents the latest scientific information in an engaging and readable manner, and offers research-based guidelines for assessment and clinical management. Professionals and students will appreciate the vivid case examples and straightforward tone of this book. Readers will come away with a clear and broad understanding of how to use science to guide the treatment of people who suffer from BPD."--Alexander L. Chapman, PhD, Department of Psychology, Simon Fraser University, Canada

"Few people can claim the extraordinary level of experience in studying and treating borderline personality disorder that Paris brings to this book. Even fewer could write such a readable, clinically rich, and wise account of these patients, which seamlessly integrates exciting new empirically based findings. Anyone who has encountered a patient with BPD will covet this book, and, after having read it, will be far better prepared to manage future encounters."--John G. Gunderson, PhD, Director, Center for the Treatment of Borderline Personality Disorder, McLean Hospital, Harvard Medical School

"An invaluable resource that is filled with authentic information from one of the world's experts on this widespread and disabling condition. Reviewing the origins of borderline personality disorder, Paris presents the latest research findings and provides practical guidance and advice to practitioners and trainees, derived from his many years of experience learning about and helping patients. This book is an essential addition to my 'borderline library'!"--John M. Oldham, MD, Senior Vice-President and Chief of Staff, Menninger Clinic

"Paris has concisely presented and reviewed an enormous amount of clinical research in borderline personality disorder (BPD). He addresses issues head on and clearly separates the wheat from the chaff. This book is an excellent clinical introduction for the beginning mental health practitioner and provides an up-to-date review for experienced clinicians. It covers the current state of clinical research and evidence-supported psychotherapeutic interventions in BPD comprehensively yet succinctly, and would be a valuable classroom text."--Kenneth R. Silk, MD, Professor and Director, Personality Disorders Program, Department of Psychiatry, University of Michigan Health System

Bulletin of the Menninger Clinic

"This volume begins with a critical summary of current research on the treatment of borderline personality disorder. Noting that treatments used with apparent success in clinical trials are not readily available for many borderline patients, in succeeding chapters Paris presents a number of treatment principles that derive from these methods and from the clinical wisdom he has accumulated from many years of practice and research on borderline personality disorder....This book's refreshing and no-nonsense style is highly accessible, and Paris' conclusions may relieve students who are often frightened when assigned to work with borderline patients....I highly recommend this book and believe it will be helpful to experienced clinicians as well as to social work, psychology, and medical students, interns, and residents who are interested in working with severely personality-disordered patients."--Bulletin of the Menninger Clinic
The British Journal of Psychiatry

"Paris approaches a subject he knows very well by critically reviewing the available psychosocial and pharmacological therapies for borderline personality disorder (BPD). He explores evidence-based treatments and translates the research, with numerous examples from his own lengthy clinical experience, into a set of practical guidelines with recommendations for clinicians for improving diagnosis, treatment planning, and clinical management....This is a sensible and thoughtful book with practical applications for anyone interested in, or working with, individuals with BPD."--The British Journal of Psychiatry
Psychiatric Services

"Providing good treatment to people with borderline personality disorder comes with many challenges: assessing safety, managing boundaries, selecting appropriate therapeutic interventions, and even making the correct diagnosis. Treatment of Borderline Personality Disorder, calling upon both clinical experience and a rigorous review of the research literature, provides a guide to each of these facets of patient care....This book is written by one of the foremost experts in borderline personality disorder....Written with clarity and offers sophisticated and advanced analysis that will be instructive to anyone offering treatment to persons with this disorder, regardless of the clinician's level of experience. The summary of research is concisely written in a straightforward and clinically applicable manner....Throughout, the author offers the field's best practices for diagnosis and care as well as his own expertise. Case examples illustrate key points....This is an excellent resource, offering a balance of science, wisdom, and insight designed to improve the treatment of those affected by borderline personality disorder."--Psychiatric Services
The Journal of Nervous and Mental Disease

"[Paris] has gone far in bringing together the evidence from extensive clinical experience and systematic research to create order in a formerly chaotic field. Replete with clinical vignette, his book is ideal as a teaching guide for graduate students and residents, and an up-to-date source of contemporary knowledge for experienced clinicians."--The Journal of Nervous and Mental Disease
Psychiatric Rehabilitation Journal

"Joel Paris gives a thorough overview of the dilemmas in correctly diagnosing and providing the best possible service to individuals living with aspects of this disorder. Dr. Paris's professional experience in treatment and research, combined with an easy-to-read writing style, make this an interesting and educational text for service providers with a range of clinical experience....This guide provides and excellent overview to mental health and rehabilitation practitioners so that they can consider this information to enhance their work."--Psychiatric Rehabilitation Journal
Advocate Magazine e-newsletter

"Written for clinicians, the book is helpful for anyone interested in BPD. It discusses symptoms and diagnosis and psychosocial and pharmacological treatment options."--Advocate Magazine e-newsletter
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Product Details

  • ISBN-13: 9781593858346
  • Publisher: Guilford Publications, Inc.
  • Publication date: 7/25/2008
  • Edition description: New Edition
  • Pages: 260
  • Product dimensions: 6.20 (w) x 9.00 (h) x 1.00 (d)

Meet the Author

Joel Paris, MD, is a Research Associate at the Sir Mortimer B. Davis-Jewish General Hospital in Montreal. Since 1994, he has been a Full Professor at McGill University and served as Chair of its Department of Psychiatry from 1997 to 2007. He has supervised psychiatric evaluation with residents for over 30 years and has won many awards for his teaching. Dr. Paris is a past president of the Association for Research on Personality Disorders. Over the last 20 years, he has conducted research on the biological and psychosocial causes and the long-term outcome of borderline personality disorder. Dr. Paris is the author of 153 peer-reviewed articles, 11 books, and 36 book chapters. He is also Editor in Chief of the Canadian Journal of Psychiatry.

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Table of Contents

I Definitions

1 Making the Diagnosis 3

2 The Boundaries of BPD 25

3 Personality and Development 44

II Causes

4 Risk Factors 61

5 A General Model 86

III Treatment

6 Outcome 97

7 Pharmacotherapy 113

8 Psychotherapy 132

9 Guidelines for Management 150

10 Therapeutic Interventions 169

11 Problems in Therapy 183

12 Suicidality and Hospitalization 203

13 Research Directions 219

References 225

Index 255

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Sort by: Showing all of 3 Customer Reviews
  • Posted May 23, 2009

    Boats Against the Current

    A Psy.D. now, I have been "on the floor" with borderlines since 1991. I have observed hundreds of them and worked "in the trenches" with scores of them. I still do.

    I figured, "Joel is a famous name in BPD; let's get that sucker." I read. I read. And I read. I kept hoping. But I also found myself trying my best not to throw it out my third-floor window.

    I've been down the borderline road with Sharon Ekleberry, with Teddy Millon, with Otto Kernberg, with Bill Meissner, with Aaron Beck and Art Friedman, with Bessel van der Kolk, with Judith Herman, with Michael Stone, with John Gunderson, with Jim Masterson, with Harold Searles, with Lorna Benjamin, with Neil Bockian and Valarie Porr, with Paul Mason, with Stan Greenspan, with Pia Mellody, with John Preston, with Glenn Gabbard, with Linda Dimeff and Kelly Koerner, and even with Joel's hero, the esteemed (me, =too=, baby) Marsha Linehan. I am =not- some Johnny-come-lately to this topic. I have written a dozen or more professional pieces on the matter.

    This book =stinks=.

    I have never ever said this before about a "clinician's book." But I simply don't know what else =to= say.

    If you're a professional looking for Clues to the Mystery, this is not where you're going to find them. Paris defies almost every major theory and millennial-era, empirical convention there is on this diagnosis. He seems to understand little or nothing about the borderline spectrum, about the non-physical causes of BPD, about the nature of traumatic memories and the repression thereof (which he denies is possible), about the various degrees of borderlinism, about the co-morbidity with other personality disorders, about the obvious co-morbidity with the bipolar spectrum disorders in many BPD patients, about the "moving target" nature of BPD expression from one session to another, about the very useful psychodynamic and behavioristic -- as well as cognitive -- conceptualizations of BPD... I could go on and on.

    Worse, he says one thing (often a dozen times), and then says... another, refuting what he said before (e.g.: relative to environmental vs. biogenetic factors). His emphasis is ostensibly on efficacy research into the diverse treatments out there for BPD, but there is nothing of any meaningful clarity that emerges from all his citations. In his view, one treatment is as good as any other.

    And =that= is simply =not= the case.

    Frankly... I stuck it out for 150 pages and skimmed the rest. But I was still dumbfounded.

    If you're looking for something useful at the more or less introductory level, try =Stop Walking on Eggshells=, =I Hate You; Don't Leave Me=, or =New Hope for People with Borderline Personality Disorder=.

    If you're on the way to licensure, read the best APA material, then head off into =Personality Guided Therapy=, =Cognitive Therapy of the Personality Disorders=, =Cognitive Behavioral Therapy of Borderline Personality Disorder=, =My Work with Borderline Patients=, and =Integrative Treatment of Borderline Personality Disorder=.

    If you're a veteran in the trenches looking for theory in depth, Otto Kernberg, Bill Meissner, John Gunderson, Jim Masterson, Neil Bockian, Judith Lewis Herman, Bessel van der Kolk and the man who saw it all coming a century ago, Pierre Janet.

    But fer crissake, don't bother with this. Google "Joel Paris False Memory Syndrome" and see why.

    4 out of 4 people found this review helpful.

    Was this review helpful? Yes  No   Report this review
  • Posted June 20, 2012

    GOOD BOOK, if you care about scientific rigor in psychology. Ke

    GOOD BOOK, if you care about scientific rigor in psychology.

    Kernberg (1991) raises the concern that by having
    avoided research, “our psychoanalytic institutes are characterized
    by an atmosphere of indoctrination rather than
    of free scientific exploration” (p. 55).

    Was this review helpful? Yes  No   Report this review
  • Anonymous

    Posted February 8, 2010

    No text was provided for this review.

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