How Personality Disorders Change in Psychotherapy: a Concise Review of Process


Purpose of Review

The present review summarizes the current state of the art in psychotherapy processes during treatments for clients with personality disorders. We outline some methodological challenges in the discipline of process research, give a brief historical account on process research, and then focus on specific processes studied from an empirical perspective.

Recent Findings

The current review acknowledges the centrality of the therapeutic relationship, in particular the therapeutic alliance, therapist empathy, and responsiveness in explaining outcome across treatment modalities for personality disorders. The review describes evidence from three overall and overlapping lines of inquiry that have garnered scientific interest in the past years.


For emotional change (regulation, awareness, and transformation), socio-cognitive change (mentalizing, meta-cognition, and interpersonal patterns), and increase in insight and change in defense mechanisms, evidence is moderate to strong for these processes to contribute to healthy change in treatments for personality disorders, in particular borderline personality disorder. Avenues of future studies are outlined.

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Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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This study was supported by Swiss National Science Foundation grant 100014_179457/1 (to Dr. Kramer). This article is based on a keynote address the first author delivered on November 8th, 2019 at the 13th Annual Meeting of Project Air Strategy, University of Wollongong, NSW (Australia).

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Correspondence to Ueli Kramer.

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Hélène Beuchat and Loris Grandjean each declare no potential conflicts of interest.

Ueli Kramer has received a grant from the Swiss National Science Foundation (100014_179457/1).

Antonio Pascual-Leone is a salaried professor at the University of Windsor. Part of his work is the publication of original research. However, his employer has no specific investment in what he publishes, and his salary is unrelated to this particular publication or this particular topic of research.

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Kramer, U., Beuchat, H., Grandjean, L. et al. How Personality Disorders Change in Psychotherapy: a Concise Review of Process. Curr Psychiatry Rep 22, 41 (2020).

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  • Process research
  • Personality disorders
  • Borderline personality disorder
  • Psychotherapy integration
  • Methodology