Is Good Psychiatric Management Good Enough to Treat BPD?

Following the development over 20 years ago of Dialectical Behavior Therapy (DBT) as a specific treatment for Borderline Personality Disorder (BPD), other specialized programs have emerged. Standardized therapies, such as Mentalization-Based Treatment (MBT), Transference-Focused Psychotherapy (TFP), Schema-Focused Treatment (SFT), have developed precise, manualized treatment approaches to BPD. All were developed and evaluated for efficacy in very controlled environments, such as a university system. Certified practitioners must undergo intensive training unavailable to many therapists. These treatments generally require at least 2-3 hours of therapy weekly for periods of one year or more. Because of time, financial, and insurance limitations, many of these programs must be modified from the rigorous platforms originally proposed. Yet many borderline patients insist on treatment with one of these popularized therapies, sensing that other therapies are inferior.

John Gunderson, a pioneer in the explication of BPD, has developed an alternative therapy approach, Good Psychiatric Management (GPM). Recognizing the difficulties in providing intensive, specialized treatments within the elaborate circumstances they were devised, GPM is designed to provide “good enough” therapy for most patients. (Handbook of Good Psychiatric Management for Borderline Personality Disorder--John G. Gunderson, M.D. With Paul Links, M.D., 2014) “Good enough” therapy is not inferior, but merely combines many of the principles of other treatments in a less regulated format. It can be supplemented by other treatment approaches, such as family or group therapy. No time limits or standardized presentations are imposed; therapy continues while there is progress. However, progress is expected, as improvements in dysphoria, behavioral self-control, interpersonal relationships, and social function are monitored.

GPM usually is presented as once a week individual therapy that incorporates psychoeducation about BPD and how treatment progresses, and setting goals toward symptom reduction. Focus is on the patient’s reactions to interpersonal stressors in everyday life. Studies comparing GPM to DBT and other specific treatments exhibit comparable positive outcomes. GPM is not intended to replace other, more intensive therapies, but can present a reliable, organized approach to the treatment of many individuals coping with the symptoms of BPD. Although GPM is the name of a specific, prescriptive model for the treatment of BPD, we should expect that “Good Psychiatric Management” is the goal of all psychiatric treatment.