Gunderson Personality Disorders Institute
Clinician training to support patients with borderline personality disorder
The Gunderson Personality Disorders Institute at McLean Hospital was founded in 2013 to elevate awareness and training for evidence-based treatments for borderline personality disorder (BPD) and accompanying psychiatric conditions.
Led by director Lois W. Choi-Kain, MEd, MD, the Gunderson Institute offers conferences and workshops for clinicians. By providing training to clinicians, the institute aims to increase quality of care and access to treatment for patients with BPD.
For more information, contact the Gunderson Institute.
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The Gunderson Institute offers specialty learning opportunities focused on the assessment and treatment of adults and teens with borderline personality disorder.
Course topics include mentalization-based treatment (MBT)—offered in conjunction with the Anna Freud Centre for Children and Families, dialectical behavior therapy (DBT), general psychiatric management (GPM), and transference-focused psychotherapy (TFP)—offered in conjunction with the TFP-New York.
General Psychiatric Management
General/good psychiatric management (GPM) was developed by John G. Gunderson, MD, as a generalist approach to treating borderline personality disorder (BPD) that could be used widely and implemented by any mental health treatment provider.
GPM is a generalist, evidence-based treatment for adults with BPD, shown to be as effective as dialectical behavior therapy in a large, well-conducted randomized controlled trial (McMain et al., 2009, 2012). It is a manualized but flexible treatment that integrates the essential ingredients of BPD-specific treatments, encouraging a practical approach that can be implemented by any mental health clinician to provide “good enough” care for patients struggling with BPD even in the absence of more resource-intensive, specialized treatments (Gunderson & Links, 2014).
The Gunderson Institute offers advanced training in GPM, including the only available certification to train others in this important treatment method. The official GPM trainers listed below are certified to present and teach GPM.
- Carl Fleisher, MD – Los Angeles, California
- Robin Kissell, MD – Los Angeles, California
- Sara Masland, PhD – Los Angeles, California
- Teresa Carreno, MD – Miami, Florida
- Dan Price, MD – Portland, Maine
- Marina Nikhinson, MD – Baltimore, Maryland
- Claire Brickell, MD – Boston, Massachusetts
- Lois W. Choi-Kain, MD, MEd – Boston, Massachusetts
- Brandon Unruh, MD – Boston, Massachusetts
- Victor Hong, MD – Ann Arbor, Michigan
- Brian Palmer, MD, MPH – Rochester, Minnesota
- Richard Hersh, MD – New York, New York
- Ben McCommon, MD – New York, New York
- Zeina Saliba, MD – Washington, DC
- Paul Links, MD, FRCPC – Ontario, Canada
- Deanna Mercer, MD, FRCPC – Ontario, Canada
- James Ross, MD, MHPE, FRCPC – Ontario, Canada
- Maria Elena Ridolfi, MD – Fano, Italy
- Patrick Charbon, MD – Lausanne, Switzerland
- Ueli Kramer, PhD – Lausanne, Switzerland
- Marcelo Brañas, MD – Sao Paulo, Brazil
- Marcos Croci, MD – Sao Paulo, Brazil
- Eduardo Martinho, MD – Sao Paulo, Brazil
Why We Focus on BPD
BPD, a complex mental illness often characterized by unstable moods, behaviors, and relationships, has historically been viewed by clinicians as untreatable. An April 2015 article in The New York Times referred to BPD as “an intractable condition,” but this is misinformation that persists about the disorder.
Many psychiatrists avoid treating borderline patients and even avoid giving individuals this diagnosis because they think it is demeaning. In the 1990s, when psychiatry began to trend toward a biological basis for disorders and symptoms, the training of most psychiatrists focused on treatment with medication for what was thought to be chemical imbalances. Because no medication has ever been shown to be particularly productive, psychiatry turned its back on BPD, even when it was proven that patients with the disorder can be treated effectively.
When dialectical behavior therapy (DBT)—a specific type of cognitive behavior psychotherapy developed in the late 1980s—proved to be effective in treating BPD, that contradicted the prevailing myth that this was a disorder of people who were untreatable. The myth that they’re not very treatable with medications persists still, and this is what many psychiatrists have held on to.
Not only is BPD treatable it has a pretty good treatment outcomes. However, still few clinicians are trained to treat these patients.
To address this problem, thanks to philanthropic support in 2013 McLean launched what is now the Gunderson Personality Disorders Institute. The institute teaches workshops on effective therapies for BPD, like GPM and mentalization-based treatment (MBT), which focuses on helping people to differentiate and separate their own thoughts and feelings from those around them. Workshops provide interactive training exercises as well as a wide range of materials that clinicians and residents can bring back to their organizations.
According to institute director, Lois W. Choi-Kain, MEd, MD, the most common response from clinicians who attend the workshops is that they are “more hopeful and clearer about what they can do at the entry level.”
“Part of the stigma is that clinicians would treat people with BPD with methods that worked for other disorders, and when those treatments didn’t work they blamed the patient and called the patient untreatable,” said Choi-Kain. “A more general approach like GPM teaches us that the first step is identifying BPD as something that is diagnosable. GPM is an organizational framework with which clinicians can approach these very complex patients.”
“An increasing number of institutions are showing interest in learning how to better address and treat this disorder, which we hope will raise more awareness and increase much-needed resources in addressing BPD,” added Choi-Kain.
Research Helps to Make BPD Care More Accessible
In just the past few decades, a number of highly specialized psychotherapies entered the clinical scene as effective evidence-based therapies for BPD. The spread of these intensive therapies—dialectical behavior therapy (DBT), mentalization-based treatment (MBT), schema-focused therapy (SFT), transference-focused psychotherapy (TFP), and systems training for emotional predictability and problem solving (STEPPS)—have collectively helped turn the tide of the notion that BPD was an untreatable condition.
While this increase in effective treatment options has been good news, still many in the field were convinced that BPD should be primarily treated by specialists, which dramatically limits access to care. More recently, however, structured generalist management approaches, such as general psychiatric management (GPM) and structured clinical management (SCM), have also been proven to work for patients with BPD.
In a research review published in the March 2017 issue of Current Behavioral Neuroscience Reports, Choi-Kain and colleagues summarized care advances for adults with BPD, including a better understanding of the effectiveness of BPD treatments both old and new. According to their research, there are merits to specialized and generalized approaches.
Unfortunately, findings about BPD medication are not as positive. Compared to growing evidence that a variety of psychotherapies can be effective for treating BPD, the search for a reliable medication treatment has been less successful. However, this may be due, in part, to a lack of research.
To date, no medication has been approved by the U.S. Food and Drug Administration for BPD or proven to definitively manage its primary symptoms—interpersonal impairments and functional difficulties. Clinical application of the available evidence is hampered by the limited number of studies, small sample sizes, brief observation periods, and exclusion of co-occurring diagnoses—in a population for whom both psychiatric and medical diagnoses are the rule rather than an exception.
Psychotherapy-based research, however, has addressed these co-occurrences. Such investigations have found that both generalist and specialist approaches are not only effective at treating the primary symptoms of BPD, but also its most common co-occurring disorder, depression.
While generalist approaches to BPD treatment are already expanding access to evidence-based care, researchers have also been working to find the most essential ingredients of DBT, the most well-researched treatment for BPD.
A recent study has shown that a pared-down version of DBT—involving a skills training group combined with weekly case management—effectively reduced risk of self-harm, suicidality, and hospitalization. As compared to standard DBT treatment, such a simplified model could be more easily taught to mental health providers. This suggests that many more patients could be reaping the same core benefits provided by standard DBT treatment.
Specialized care, of course, still has its place. For certain complex forms of BPD, it appears that specialized therapies and adaptations of specialized therapies may be the best approach. For instance, research shows that slightly modified forms of standard DBT are effective at simultaneously treating the primary symptoms of BPD and certain other coexisting conditions, such as alcohol and drug misuse, eating disorders, and PTSD.
Today, researchers are evaluating methodologies for determining which patients should receive generalized care vs. specialized care, while others continue to study further treatment adaptations for patients with complex dual diagnoses. However, while we wait for these results, it is heartening to know that effective borderline personality disorder treatments are already available.