Personality Difficulties

NICE CG78 recommendation for BPD. Comprehensive programme required.

Dialectical Behaviour Therapy is a comprehensive, evidence-based psychological therapy originally developed by Marsha Linehan for people with severe emotional dysregulation and chronic suicidality, particularly borderline personality disorder (BPD). It combines behavioural change strategies with acceptance-based approaches drawn from Zen mindfulness practice. DBT is structured as a programme rather than a standalone individual therapy.

NICE CG78 recommendation for BPD.

Mentalisation-Based Therapy is a structured psychological therapy that focuses on improving the ability to understand one’s own and others’ mental states — thoughts, feelings, intentions, and motivations. Developed by Peter Fonagy and Anthony Bateman, it was originally designed for borderline personality disorder but is now used more broadly.

RCT evidence for BPD (Giesen-Bloo et al.).

Schema Therapy is an integrative psychological therapy developed by Jeffrey Young for people with long-standing emotional and relational difficulties that have not responded to standard CBT. It combines cognitive, behavioural, attachment, and experiential approaches to address deeply ingrained patterns known as Early Maladaptive Schemas (EMS).

Widely used in UK NHS personality disorder services.

Cognitive Analytic Therapy (CAT) is a time-limited, relationally focused integrative psychological therapy that draws on cognitive psychology, psychoanalytic object relations theory, and activity theory (Vygotskian developmental psychology). Developed by Anthony Ryle in the 1980s, CAT helps people understand and change longstanding patterns of thinking, feeling, and relating that cause ongoing distress. It places particular emphasis on understanding how early relational experiences shape current patterns, and uses unique collaborative tools — including reformulation letters and diagrams — to make these patterns visible and open to change.

RCT evidence for severe personality pathology.

Transference-Focused Psychotherapy is a specialist, manualised psychodynamic therapy developed for severe personality pathology, particularly borderline personality disorder. It focuses on understanding and integrating split, unstable internal representations of self and others through the therapeutic relationship.