Review Article
Chloe Forster, Natasha Bert
Abstract
Purpose: Despite increased understanding about ‘what works’ for people with personality disorder, there remains a significant gap in knowledge about how these interventions work. This systematic review summarises and critiques the existing literature about mechanisms of change in psychotherapies for people with personality disorder. Method: Relevant literature was identified through systematic electronic searches of online databases and key journals. Results: Twenty one empirical papers were identified which indicated that the therapeutic alliance, rupture resolution, therapist interpretations, reflective functioning (mentalizing), skills use, emotion regulation, experiential avoidance, personality organisation, and cognitive change are possible mechanisms of change in individual psychotherapeutic interventions for people with personality disorder. Conclusions: There is greater evidence for the role of the therapeutic alliance and resolution of its rupture in change processes compared to other potential mechanisms of change. Identifying mechanisms of change has implications for clinical practice, and these are discussed. Further research into change processes for people with personality disorder is required.