THE DEVELOPMENT OF A PSYCHODYNAMIC TREATMENT FOR PATIENTS WITH BORDERLINE PERSONALITY DISORDER: A PRELIMINARY STUDY OF BEHAVIORAL CHANGE John F. Clarkin, PhD, Pamela A. Foelsch, PhD, Kenneth N. Levy, PhD, James W. Hull, PhD, Jill C. Delaney, MSW, and Otto F. Kernberg, MD This study examines the effectiveness of a modified psychodynamic treatment called Transference Focused Psychotherapy (TFP) designed specifically for patients with borderline personality disorder (BPD). Twenty-three female patients diagnosed with DSM-IV BPD began twice-weekly TFP. Patients were assessed at baseline and at the end of 12 months of treatment with diagnostic instruments, measures of suicidality, self-injurious behavior, and measures of medical and psychi- atric service utilization. Compared to the year prior to treatment, the number of patients who made suicide attempts significantly decreased, as did the medical risk and severity of medical condition following self-in- jurious behavior. Compared to the year prior, study patients during the treatment year had significantly fewer hospitalizations as well as number and days of psychiatric hospitalization. The dropout rate was 19.1%. This uncontrolled study is highly suggestive that this structured and manualized psychodynamic treatment modified for borderline patients shows promise for the ambulatory treatment of these patients and war- rants further study. Borderline personality disorder (BPD) is a highly prevalent and chronic psy- chiatric problem and constitutes one of the most important sources of long-term impairment in both treated and untreated populations (Weissman, 1993; Oldham, et al., 2000). Approximately 11% of psychiatric outpatients and 19% of inpatients meet the DSM-IV (American Psychiatric Journal of Personality Disorders, 15(6), 487-495, 2001 © 2001 The Guilford Press 487 From the Personality Disorders Institute and Department of Psychiatry, Weill Medical College of Cornell University. This research was supported in part by grant MH-53705-02from the National Institute of Men- tal Health, Washington, DC. (PI: Dr. Clarkin), and the DeWitt Wallace Reader’s Digest Fund. The authors wish to thank Jack Barchas, MD, for institutional support. We acknowledge the consultation of Marsha Linehan, PhD, to this study, the assistance of Heidi Heard, PhD, in training with the PHI and THI, and the suggestions of Gerhard Dammann, MD. The authors wish to thank our colleagues who served as therapists in the study. We would also like to thank Ann Appelbaum, MD, Michael Stone, MD, and Frank Yeomans, MD, for providing therapy su- pervision. Finally, we would like to thank members of the Personality Disorders Institute. Address correspondence to John F. Clarkin, PhD, Personality Disorders Institute, Macy Villa, The New York Presbyterian Hospital-Weill Medical College of Cornell University, Westchester Division, 21 Bloomingdale Road, White Plains, NY 10605; E-mail: jclarkin@med.cornell.edu.