A number of experts have concluded that all existing therapies of borderline disorder have significant limitations, and that changes are needed in this area. The most prolific and creative of these experts has been John Livesley, MD, PhD, Professor Emeritus in the Department of Psychiatry at the University of British Columbia in Canada. Dr. Livesley has recently summarized his thinking and integrated the thoughts of other experts in the field. In a recent book they have described the shortcomings of the current therapies and a new therapeutic model for the treatment of personality disorders. This model of therapy is called Integrated Modular Treatment (IMT).
IMT combines a number of treatment principles, strategies, and methods derived from all effective treatments and applies them to treat specific impairments. In this way, IMT improves on those models that apply to only a limited number of treatment approaches. Thus, the common treatment modules in IMT include a specified agreement on the rules of treatment; the treatment alliance between the patient and the therapist; the consistent adherence of the therapist to the therapeutic framework; the therapist’s validation of the content and validity of the patient’s experiences; the patient’s motivation to change; the patient’s learning processes used to acquire a clear understanding of themself and others, and the ability to carefully reflect on the mental states of both.
A “treatment module” in IMT is defined as “an interconnected series of therapist interventions that have a specific dysfunctional target.” Some modules are derived from therapeutic interventions that have been tested in empirical research trials. Others are recommended by therapists experienced and skilled in the treatment of specific domains and symptoms of personality disorders (psychopathology). IMT provides guidance for matching these categories of symptoms of the disorder with the appropriate treatment modules. IMT treatment modules are grouped into general or common modules that are present in all therapies, and specific modules designed to treat specific impairments that are not present in all patients. Both sets of modules are chosen from all current treatment models. The five phases of common and specific treatment modules in IMT are (1) safety, (2) containment, (3) regulation and modulation, (4) exploration and change, and (5) integration and synthesis. IMT has a comprehensive structure and may be confusing. By understanding and progressing through these five phases, the therapist and patient can limit this confusion.
As the treatment targets of the common modules are addressed and their associated goals are achieved, the patient and therapist progress to the specific treatment modules in IMT that best meet the individual needs of the patient. Specific modules are tailored to each patient according to their level of resilience and their individual symptoms. This practical approach of IMT provides the flexibility, scope, and depth of treatment lacking in current treatment models.
Because the description of IMT was published in 2016, more recently than the BPD-specific forms of therapy described, few therapists have significant knowledge about it and experience in using it to treat borderline disorder. Nevertheless, many experienced therapists, including myself, already utilize a similar, but less formalized model that will benefit from the more rigorous IMT approach. In addition, thought leaders in this field have expressed support for the IMT method. I believe IMT will become more commonly used and available in the near future. Until then, proceed with the borderline disorder therapist who is readily available to you and who is the best fit for you. If available, the approach recently presented by John Gunderson with Paul Links, Good Psychiatric Medicine for Borderline Personality Disorder, provides an excellent, intermediary alternative.