Contemporary Inpatient Treatment for Severe Personality Disorders: The Reversal of The Perspective

The contemporary proposal of an alternative model for personality disorders (DSM-5, Section III-AMPD), toward a psychiatric nosology in terms of levels of severity of impairment in self and the interpersonal functioning, has allowed the alignment between descriptive psychiatry and psychodynamic clinical and theoretical frameworks that use the same dimensions for the diagnostic evaluation and the empirical research of the treatment of severe personality disorders (SPD). In this work, starting from the proposition that the true therapeutic potential of a current authentic inpatient program lies in the interactional presence of the staff and the patients; and from a perspective of Transference-Focused Psychotherapy—Extended (TFP-E), as a transdiagnostic and a superordinate theoretical and clinical framework that integrates all the modalities of staff intervention, with the therapeutic mechanisms of action guided to specifically overcome the psychostructural alterations of patients with SPD; likewise, the configuration of a hospital care program is described. In congruency with the specific objectives of this program, the organizational and administrative structure, as well as the principles that govern its instrumentation, are explicited. In addition, the precepts that guide the strategic, tactical and technical therapeutic interventions, along with the requirements that guarantee and preserve a stable functioning of the same, are explained.