People with personality disorders are often high functioning, but their interpersonal vulnerabilities and self-sabotaging behaviors can put them beyond the reach of most mental health clinics. Mount Sinai’s Center for the Intensive Treatment of Personality Disorders welcomes these patients—often in full crisis mode at the time they seek help—and has become the largest treatment center in the New York metropolitan area and a major referral site. It is also one of the most unique and successful programs of its kind in the country.
“We conceptualize disorders of personality as interpersonal/relational vulnerabilities,” said Andrew Twardon, PhD, Director of the Center for the Intensive Treatment of Personality Disorders. “As a result, we consider specialized, intensive, group-based treatment to be far more efficacious than individual psychotherapy alone. And that makes our treatment model different from most other treatment centers in the country or the rest of the world.”
What also sets the Center apart is its ability to handle all types and severities of borderline, narcissistic, paranoid, schizotypal, or schizoid personality disorders. Typically, these are treated in outpatient settings or in residential centers through one-on-one, patient-to-provider engagement that often requires many years of treatment and yields limited results. For the last 15 years, Dr. Twardon has been developing a new conceptual and interventional platform for patients with severe and complex personality disorders.
At its core, the Center’s treatment is predicated on intense engagement. “Personality disorders are interpersonal manifestations of complex attachment problems, regulating how people bond and relate with one another,” said Dr. Twardon. “Dysregulations of the attachment system, the relational vulnerabilities, are re-activated when patients join the intensive treatment milieu consisting of daily therapy groups, individual sessions, psychiatric management, community meetings, and crisis interventions.” Primary providers and the clinical team typically work with each patient across all modalities multiple times per week focusing on the exploration and modification of relational, attachment-based, vulnerabilities, and corresponding interpersonal/behavioral problems.
The Center’s treatment model is flexible. Instead of being locked into a single approach for each patient, it offers a matrix of interventions and techniques that target specific dimensions and symptoms of personality disorders. These evidence-based therapeutic approaches include psychodynamic therapy, which explores both the conscious and unconscious aspects of the person’s symptoms, conflicts, and behavior; dialectical behavior therapy (DBT), which uses cognitive-behavioral treatment for symptoms of borderline personality disorder; and mentalization-based therapy, a specialized approach that examines the patient’s mental representations, attachment patterns, and emotion regulation. The treatment also includes mindfulness and (Zen) meditation training, as well as aspects of Buddhist psychology to help patients improve self-regulation and enhance their capacity for self-transformation and psychological well-being.
“People with personality disorders require highly specialized treatment, and what we provide is, to some extent, a psychological analog of brain surgery," said Dr. Twardon. "We essentially re-open old emotional/psychological wounds, which gives us the unique opportunity to carefully explore and directly address the vulnerability, instead of just patching it up.”
Statistics from an observational study the Center conducted from 2014 to 2016 showed a 57 percent reduction in hospitalizations for the 12-month period before treatment to the 12 months during treatment. Equally impressive is the 84 percent decline in inpatient days over the same period.
“We’ve demonstrated that the mental health field needs to start thinking differently about personality disorders,” said Dr. Twardon. “We’ve managed to treat some of the most complex and severe patients and make them much less interpersonally vulnerable, and that’s a remarkable development because they’re now able to take their lives to a new and better place.”
Andrew Twardon, PhD
Director of the Center for the Intensive Treatment of Personality Disorders, and Assistant Professor of Psychiatry