Outpatient treatment for borderline personality disorder

The Center for Intensive Treatment of Personality Disorders [CITPD] offers specialized, intensive, time-limited, outpatient treatment for all personality disorders and personality-related problems and symptoms. We provide help to those who may have trouble in one or more of the following domains:

• Interpersonal Relationships and Behavior such as problems with intimacy and trust, recurrent suicidal gestures or behaviors due to perceived rejection, impulsivity and recklessness, relational or family conflicts, exploitation and violation of others as well as aggression and violence.
• Dysregulation of affect and mood, which may come in the shape of emotional volatility and outbursts, excessive anger at self or others, excessive anxiety, shyness, inhibitions, and the fear of rejection, and self-inflicted injuries including cutting or self mutiliation
• Dysregulation of cognition including confusion about one’s identity or self-image, dissociative symptoms like depersonalization, confusion about sexual or gender identity , difficulties in making decisions and excessive perfectionism, as well as unusual perceptual experiences or thoughts

In general, personality disorders can be understood as a pervasive, neurocognitive [brain-mind] dysregulation of personality and the self, resulting in unusual, exaggerated or extreme subjective experience and/or behavior in otherwise typical interpersonal situations. Personality disorders are usually caused by complex and individually unique interaction of multiple genetic and environmental variables regulating our biological, psychological and interpersonal development. In the course of evolution, human brain, mind and consciousness have become “hardwired” to develop and maintain a distinct sense of self – an embodied, persistent experience of “I / me” as a phenomenological center of our own subjectivity. As we mature and transition from childhood to adulthood, one’s self and personality become central in making each of us consistently distinct and unique among others. Given “good enough” conditions, self, identity and personality develop relatively intact. However, if the hereditary and / or situational conditions are not wholesome enough, a disorder of personality - a lifelong psychological and psychiatric condition permeating all aspect of one’s life, interpersonal and intimate relations with other people in particular, may develop.

CITPD Treatment

Personality disorders often require a multidimensional / multivariable treatment approach targeting multiple aspects of functioning simultaneously. Although no one treatment is exclusively effective for all types of personality and personality disorders, research evidence and clinical practice demonstrate that a well designed treatment program, combining several different approaches, can be very effective for most patients.

At our Center, we believe that any psychiatric treatment and psychotherapy in particular, is a unique, intricate and highly personal process of self-examination and self-transformation involving a complex sequence of interactions and interventions between the therapist[s] and the patient[s]. It often entails a dialectic between validation and strengthening of what is adaptive in one’s behavior and an effort to change that which is maladaptive and / or self - destructive.

The CITPD treatment model offers specialized, person-centered, multidimensional / multivariable matrix of interventions where specific dimensions and symptoms of personality disorders are targeted by specialized treatment variables and techniques. CITPD’s integrated, intensive treatment draws extensively from the following evidence-based theraputic approaches:

Psychodynamic Therapy - a specialized treatment for a wide spectrum of mental disorders and psychological / psychiatric conditions, including personality disorders, depression, anxiety, impulse control, sexual problems, identity, self and personal difficulties. It explores both conscious and unconscious aspects of current symptoms, conflicts and behaviors and utilizes specialized, interactive treatment strategies, techniques and modalities to enable patients to understand and to change themselves. Internal, interpersonal and relational, current and past aspects of one’s functioning are explored and modified to reduce symptoms and to develop more realistic, healthy and adaptive way of being and living.

Dialectical Behavior Therapy [DBT] - a comprehensive cognitive-behavioral treatment for symptoms of Borderline Personality Disorder and many other difficult-to-treat psychological and psychiatric disorders. It has been particularly effective in the management and reduction of suicidal and parasuicidal behaviors, self injurious / self-destructive behaviors, anger, impulsivity, interpersonal problems and emotional dysregulation. It combines cognitive- behavioral techniques and Zen mindfulness practices with a dialectical philosophy of change viewed as a synthesis of opposites. It offers comprehensive behavioral analysis of disordered functioning and practical skills training developed specifically to enhance personal and interpersonal effectiveness, emotional stability and overall mastery of one’s behavior.

Mentalization-Based Therapy– a specialized approach to treatment of personality disorders based on adult attachment theory. It examines one’s mental representations, attachment patterns, and emotion / self regulation. Treatment addresses deficits in these areas and progresses towards increasing “reflective function” or the capacity to represent, reflect, and relate to internal states in the self and others. In the course of therapy, collaborative communication, language and reflective skills are explored and practiced, and the increased capacity to “mentalize” becomes an alternative to self-destructive, dysregulated “acting out” of internal subjective states.

Cognitive Therapy- an approach to treatment involving a thorough examination and change of maladaptive patterns of perception, thinking, feeling and behavior, both unconscious and conscious. It identifies and confronts hidden, irrational or distorted systems of core beliefs, self-image and self / other-representations which may result in psychiatric symptoms and / or dysregulated cognition, affect or behavior. It utilizes a wide spectrum of cognitive and behavioral techniques focused on direct transformation of problematic and maladaptive aspects of one’s functioning.

Psychopharmacological treatment– a direct intervention at the biological level of the brain and nervous system functioning. Each patient undergoes a comprehensive psychiatric evaluation and, if indicated, receives psychotropic medication[s] prescribed to treat specific symptoms of his / her psychiatric condition. Each patient’s pharmacotherapy is carefully monitored by attending psychiatrist and psychiatry residents and is integrated with ongoing psychotherapy.

Mindfulness and Meditation training – a specialized approach to self-transformation utilizing Buddhist meditative techniques and Buddhist psychology of consciousness.

CITPD Treatment Tracks

CITPD currently offers three specialized, intensive treatment tracks, as described below:

• The Morning [AM] Track has been designed for individuals seeking specialized treatment for a serious personality disorder or personality-related problem[s] combined with another, serious and persistent, co-occurring psychiatric condition. The Morning Track does not require prior experience with personality-focused psychotherapy and offers additional clinical support to its psychologically more fragile and vulnerable patients. The Morning Track is open Monday – Friday, 9:45 AM – 12:00 PM and consists of five intensive therapy groups per week, one weekly session of individual therapy and ongoing medication management, as needed.
• The Afternoon [PM] Track is for individuals seeking intensive treatment for a serious personality disorder or personality-related problem[s]. Most patients in the Afternoon Track have had substantial work and / or school experience, as well as significant history of relationships and / or psychotherapy prior to their admission to CITPD. The Afternoon Track is open Monday – Friday and consists of five intensive therapy groups per week, one weekly session of individual therapy and ongoing medication management, as needed. Intensive treatment is offered in two separate time slots 1:00 – 3:15 [PM1] and 3:30 – 5:45 [PM2]
• The Evening Track has been designed for individuals who work or attend school on a full-time basis and seek specialized treatment for a personality disorder or wide spectrum of primarily personality-related interpersonal problems. It is also available to all current and former CITPD patients who successfully completed at least 3 months of intensive treatment. The Evening Program consists of one intensive therapy group per week [Thursdays 6:00 – 7:15], one weekly session of individual therapy and ongoing medication management, as needed. A Dialectical Behavior Therapy [DBT] Skills Group is available [Tuesdays 6:00 – 7:15], if indicated.

In addition, CITPD offers intensive treatment for:

• Young Adults -designed for individuals 18 – 24 years old who seek specialized treatment for a serious personality disorder or personality-related problem[s]. Patients are matched with and join one of the three Tracks described above based on their treatment needs.
• Gender Identity problems– designed for individuals who seek specialized treatment for a serious personality disorder combined with gender dysphoria. Patients are matched with and join one of the three Tracks described above based on their treatment needs.

Treatment in each CITPD Track lasts 6 months and can be extended up to 12 months in 3-month intervals.

Admission to CITPD is based on a comprehensive assessment and review by CITPD multidisciplinary treatment team using the following criteria:

• principal or secondary DSM-V diagnosis of a Personality Disorder
• ability and willingness to participate in intensive, group-based treatment
• commitment to 5 days per week attendance and 6-month-long treatment cycle
• commitment to drug-free functioning and / or enrollment in concurrent substance abuse treatment, if needed
• ability and willingness to comply with program guidelines assuring safety of self and others

A full spectrum and continuum of psychiatric care are provided through other emergency, inpatient and outpatient services available within the Mount Sinai Department of Psychiatry.

CITPD is dedicated to serving individuals without regard to race, creed, color, ethnic background, sexual orientation or past history.

CITPD Treatment Team

CITPD’s treatment team consists of clinical psychologists, psychiatrists, psychiatric social worker as well as psychiatry and medical residents, psychology interns, fellows and externs undergoing their clinical training at Mount Sinai West Hospital Department of Psychiatry.