People with personality disorders do not usually form good relationships with therapists. Although this is in keeping with their problems with relationships elsewhere, it can be a major problem in any form of therapy. The problem is particularly marked with psychotherapy, in which long-held views are challenged by the therapist. The consequence is that many patients drop out of care, and sometimes no amount of therapeutic skill can maintain them in care. (6) In long-term follow-up studies continued contact with the patient is almost a therapeutic achievement in itself. (7)
Any study of personality disorder is likely to have a large proportion of drop-outs and this complicates the interpretation of the effects of treatment. The exception is when patients are treated in restricted settings such as prisons and other closed facilities, (8) but as these circumstances are abnormal it is difficult to generalize from them.
Therefore treatments that aid adherence to an appropriate intervention are likely to be of value in personality disorder. The evidence suggests that cognitive and behavioural approaches, particularly those that work in a collaborative way, are helpful in this regard as both primary and adjunctive therapies. (91 H and 12>
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