Monday, September 23

Opening Plenary: Transform clinical challenges into opportunities for change

Chairs : Ueli Kramer and Michaela Swales

Meta-analytic studies conclude that psychotherapies for personality disorders tend to work. This evidence base is most convincing for borderline personality disorder, in addition to the broad and varied population of personality disorders. Several therapy approaches are described. However, a) response rates for the studied approaches are under 70%, and b) these therapy approaches do not always give clear indications on what to do at specific choice points. The present opening plenary of the 7th ESSPD conference brings together seven experts in specific approaches for personality disorders, all with at least some level of evidence. Each expert will interact with a patient played by an actor on choice points representing hot spots in therapy with personality disorders. The moderators will stimulate a reflection among the group of experts on convergences and divergences observed, intended and real lasting effects of therapy interventions.


Alvise Orlandini (Italy), Transference-focused psychotherapy
Lois Choi-Kain (USA), Good psychiatric management
Oliver Püschel (Germany), Clarification-oriented psychotherapy
Svenja Taubner (Germany), Mentalization-based treatment
Remco van der Wijngart (The Netherlands), Schema-focused therapy
Alan Fruzzetti (USA), Dialectical-behavior therapy

Actor: Natascha Van Dam (Belgium)

Plenary: Changing the wheels: Dimensional conceptions of personality disorders

Chair: Michaela Swales

The change in classification in personality disorders in ICD-11, as well as DSM-5, has generated much discussion and is changing the landscape in research and clinical practice. In this plenary session, three experts will discuss core questions in our field of personality disorders from the perspective of this new context.  Each expert will give their perspective on the questions followed be a brief discussion amongst the group and with the audience. What is a personality disorder, really? How can we assess personality disorder, and personality pathology? How can dimensional constructs contribute to lessen stigma among those affected, and their loved ones? What are the implications of changing the wheels for prevention and intervention?

Bo Bach (Denmark)

Christopher Hopwood (Switzerland)

Carla Sharp (USA)

Tuesday, September 24

Master Clinician Semi-Plenaries 
Antisocial personality: are we getting better at offering interventions they want and can benefit from?

Anthony Bateman, MD

Treatment in the community of people with characteristics of antisocial personality (ASPD) – failure to conform to social norms with respect to lawful behaviours; irritability and aggressiveness; impulsiveness; disregard for the feelings and safety of others; and disregard for one’s safety and for the consequences of one’s behaviour – is problematic. Most studies evaluating interventions for antisocial behaviour have not looked at personality disorder itself, and no intervention has been established as the treatment of choice. In community clinical services clinicians tend to avoid offering treatment and patients show a high drop-out rate from any treatment offered.

The contribution of ASPD to violent criminal behaviour is clear. In this session a mentalizing perspective on understanding the relationship between ASPD and violence will be summarised and an outline given of the intervention process that results from this. Mentalization Based Treatment (MBT) integrates cognitive and relational components and provides a structured therapeutic process during which the patient’s mind becomes the focus of treatment, centring on their capacity to accurately interpret the meaning of actions in terms of mental states (e.g. beliefs, thoughts, feelings, or desires). People with ASPD show impaired recognition of basic emotions in themselves and others, impaired capacity to link mental states to behaviour, difficulty with perspective-taking problems and in reading others’ mental states. They perform far worse than controls on subtle tests of mentalizing. Antisocial behaviour and violence tend to occur when an understanding of others’ mental states is developmentally compromised, most often from early trauma, and prone to being lost when the attachment system is activated by perceived threats to self-esteem, such as interpersonal rejection or disrespect. Normally, mentalizing, recognising the subjective state of the victim for example, prevents interpersonal violence. Interventions for ASPD should be geared to enabling individuals to examine more reflectively their own states of mind and understand others’ minds, and to behave more prosocially. Some evidence for this approach will be discussed.


Lars Mehlum, PhD

Suicide is a leading cause of death globally in youths, and suicidal behaviour and self-harm are major public health concerns.. To develop effective treatment approaches is critical for preventing premature deaths. Promising interventions have indeed been identified in recent years, and though many questions are still left unanswered, we have sufficient knowledge to effectively treat adolescents who self-harm, attain reasonably favourable treatment response rates and long-term outcomes. In this presentation we will review key findings from clinical studies with emphasis on what seem to be effective and practical treatment strategies, for whom and for what they work best and through what mechanisms of change they operate. The presentation will highlight some common tricky dilemma and pitfalls clinicians face when working with self-harming adolescents and their families and offer solutions and strategies that have been developed and tested over recent years. While keeping a focus on the here and now and the need for rapid progress in the treatment of suicidal and self-harming behaviour, the presentation will also discuss implications for longer-term change and sustainability of treatment gains.


Presidential Discussion

In this presidential discussion, the ESSPD President chairs the discussion on how psychotherapy for personality disorders work. Both state-of-the-art presentations of current research within a functional domain perspective will be presented and discussed by each expert. Then the group moves beyond the state of the art and outlines the perspectives of what is required in the mechanistic conception of psychotherapy for individuals with personality disorders. What are research designs that foster a knowledge base on mechanisms? What are understudied areas which will boost a differentiated understanding? Which are take-home messages for the practice of psychotherapy?

Ueli Kramer (Switzerland)

Sabine Herpertz (Germany)

Shelley McMain (Canada)

Kenneth N. Levy (USA)

Wednesday, September 25

Semi-Plenaries: Master Clinicians

Martin Bohus, MD

Trauma Genesis of BPD – Consequences for Treatment and Nosology
The data are precise: no other personality disorder reports as clearly on severe traumatic experiences in childhood and adolescence as BPD: around 40% report long-term sexual and physical abuse, and around 80% report emotional neglect or emotional abuse. This has important implications for treatment development: In recent years, specific treatment programs for BPD patients with co-occurring PTSD after childhood abuse have been developed and evaluated. The effect sizes of d= 1.5 are significantly higher than those of conventional treatment programs. New developments in DBT now focus on the revision of traumatic invalidation networks. This approach is also currently being evaluated.
The presentation will provide an overview of the latest developments in the trauma-focused treatment of BPD, with an emphasis on DBT, and give an outlook on a fundamental change and reorientation of the diagnostic classification of this disorder.


Elsa Ronnningstam. PhD

Recent developments in studies and treatment strategies have highlighted the range and complexity in pathological narcissism, PN, and narcissistic personality disorder, NPD. This has inspired different approaches to understand and mobilize changes towards improvement in narcissistic pathology, which can occur in different treatment modalities as well as in different life contexts.

This presentation will focus on summarizing recent major empirical and clinical contributions that can be integrated and guide assessment and treatment of PN and NPD. The dimensional diagnostic approach to NPD applied in DSM 5 Section III and ICD 11 has encouraged attention to the range of functioning and interactive fluctuations in narcissistic pathology. Neuroscience and studies of attachment, self-esteem and emotion regulation, especially emotional trauma, shame, and aggression, have furthered identification of common underpinnings in narcissistic pathology. Studies of interactions between PN and comorbid conditions such as substance use, depressive disorder and other personality disorders have also contributed to advance assessment and treatment strategies.

Recent developments in treatment modalities and therapeutic interventions have pointed to different mechanisms and paths that can implicate change in narcissistic personality pathology. Patient related factors, i.e., motivation, curiosity, reflective ability, life stage, and functioning including both work and close relationships, are essential for progress in treatment. Similarly, commitments to therapeutic contract, goals, and problem focus are necessary. Present range of modalities and interventions now allow for adjusting treatment to the individual patient’s motivation and capabilities. Symptomatic and functional improvements as well as challenges and obstacles for change will be discussed.

Closing Plenary: Changing contexts: dissemination of good practice in personality disorders

Chairs: Ueli Kramer and Michaela Swales

Providing specialized assessment and treatment in a fast-changing world can be challenging. Cultural diversity, disruptive political contexts, social changes and needs of special populations, including youth, are additional challenges to be taken into account. This plenary aims to lay out the groundwork for a worldwide dissemination strategy of good practice in assessment and treatment of personality disorders. It starts off with the illustration of the situation in Lithuania, followed by the discussion of proposed solutions related with the increased use of technology in assessment, treatment and training, the broad dissemination of knowledge on a population level, as well as to targeted groups in need of help.


Rasa Barkauskiene (Lithuania)

Anthony Bateman (United Kingdom)

Ulrich Reininghaus (Germany)

Brin Grenyer (Australia)

Lois Choi-Kain (USA)

CME Courses

Grote Markt


Family Interventions for Borderline Personality and Related Problems

Alan E. Fruzzetti

Most conceptualizations of BPD and related problems recognize that social and interpersonal factors contribute to the development and maintenance of BPD-related difficulties (cf. Gunderson, Fruzzetti, Unruh & Choi-Kain, 2018; Fruzzetti, Shenk & Hoffman, 2005).  Moreover, considerable evidence suggests that interventions with parents and partners can improve outcomes for both individuals in treatment and their relationships (Fruzzetti, Gunderson & Hoffman, 2014; Fruzzetti & Hoffman, 2002; 2019; Payne & Fruzzetti, 2024).  However, family interventions are not yet consistent parts of most treatments for BPD. 

This workshop will provide: a) a model for intervening with parents and partners that could be utilized by therapists working from a variety of treatment perspectives; b) an overview of key relationship processes that link individual distress and emotion dysregulation (as core features of BPD) to problematic relationship patterns; c) a skills-oriented approach to working with parents and partners directly (including the Family Connections program); and d) specific, practical couple or family therapy interventions that can help improve relationships and individual treatment outcomes.  This workshop will include some teaching/lecture but will focus primarily on demonstrations and practice. Participants are encouraged to bring cases for discussion and practice.


Transference-Focused Psychotherapy (TFP)

Stephan Doering, Vienna

This workshop gives an introduction to Transference-Focused Psychotherapy (TFP), which is a psychodynamic treatment for Borderline Personality Disorder. TFP has been manualized and has demonstrated its efficacy in the treatment of borderline patients in randomized-controlled trials. Thus, it can be regarded empirically validated.

TFP was developed by Otto F. Kernberg and is based on psychoanalytic object relations theory. A distinguishing feature of TFP in contrast to many other treatments for BPD is the belief in a psychological structure that underlies the specific symptoms a borderline individual suffers from. In other words, the focus of treatment is on a deep psychological make-up — a mind structured around a fundamental split that determines the patient’s way of experiencing self and others and the environment. In such a psychological organization, thoughts and feelings about self and others are split into dichotomous experiences of good or bad, black or white, all or nothing.

TFP is a twice-per-week outpatient individual psychotherapy that combines psychodynamic principles with a structured setting and a treatment contract. The treatment focuses on the transference (the patient’s moment-to-moment experience of the therapist) because it is believed that the patient lives out his/her predominant object relations dyads in the transference. Once the treatment frame is in place, the core task in TFP is to identify these internal object relations dyads that act as the “lenses” which determine the patient’s experience of the self and the world. It is believed that the information that unfolds within the patient’s relation with the therapist provides the most direct access to understanding the make-up of the patient’s internal world for two reasons. First, it has immediacy and is observable by both therapist and patient simultaneously so that differing perceptions of the shared reality can be discussed in the moment. Second, it includes the affect (feelings) that accompanies the perceptions, in contrast to discussion of historical material that can have an intellectualized quality.

Suggested reading:

Yeomans FE, Clarkin JF, Kernberg OF. Transference-focused Psychotherapy for Borderline Personality Disorder. A Clinical Guide. Focusing on Object Relations. Washington, DC: American Psychiatric Publishing 2015.


Therapeutic Assessment in Clients with Personality Disorders 

Hilde De Saeger & Jan Henk Kamphuis

Overcoming (understandable) Epistemic Hypervigilance (Fonagy, Luyten, Allison, 2015) is a particularly salient concern in working with clients with personality pathology. Therapeutic Assessment (TA), a semi-structured model of clinical assessment (Finn, 1996, 2007), is both philosophically as well as procedurally well-suited to overcome such motivational challenges (Kamphuis & Finn, 2018). TA distinguishes itself from traditional assessment methods by prioritizing collaborative exploration, maintaining a “not knowing” attitude, and consistently striving to understand the client. The assessor’s attitude emphasizes curiosity, humility, and empathy, fostering self-efficacy, epistemic trust, and facilitating self-discovery and validation in clients. Evidence suggests that TA (De Saeger et al. 2014; Aschierri et al., 2022) can be an effective intervention, and is specifically tested in clients with personality pathology. More specifically, it has demonstrated a robust ability to prepare, motivate, and inspire patients for therapy, co-constructing focus and goals for treatment. In the context of treatment-resistant personality pathology, we belief this is of crucial treatment utility (Kamphuis, Noordhof & Hopwood, 2021). The present workshop aims to explore the foundational principles of the TA model and illustrate the semi-structured approach flow in the context of a case-analysis.


Levels of Emotional Awareness: Clinical and Research Applications

Richard D. Lane, M.D., Ph.D.

The alternative model of personality disorders requires impairments in self and interpersonal functioning. Limitations in emotional awareness may be central to both. Training can improve emotional awareness, and the cognitive-developmental theory that explains the skill and the scale that measures it (Levels of Emotional Awareness Scale [LEAS]) may be useful in guiding as well as tracking progress in psychotherapy for personality disorders.

The cognitive-developmental theory of “levels of emotional awareness” (LEA) addresses fundamental elements of emotion processing including the ability to make the transition from bodily sensations and action tendencies to the experience of specific differentiated emotional feelings, the ability to be aware of multiple feelings that may be contradictory or counter-intuitive, and the appreciation of how complex combinations of feelings may differ in self and other. This workshop will review the basic theory of LEA, its measurement using the LEAS, the application of the model to the practice of psychotherapy and findings from preclinical and clinical research, including evidence that in patients with borderline personality disorder higher emotional awareness is associated with lower risk for suicide attempts and non-suicidal self-injury. Participants will gain experience with the 5-level scoring system, followed by case vignettes that illustrate the clinical expression of the different levels and how the model may be used as a guide to treatment to improve functioning in the self and interpersonal domains. Case examples from the audience will be encouraged and questions pertaining to research and clinical applications will be welcomed.


Data processing in R: An introductory workshop on basic concepts and recent developments
Lars Schulze, Freie Universität Berlin

While the teaching of statistical concepts is emphasized in psychological education, the same cannot be said for the preceding steps of data wrangling. This leads to the unfortunate situation that inexperienced researchers lack basic knowledge for data processing, although these steps usually require most of the time in data analysis. The recent rise of artificial intelligence (AI) presents a significant advancement for researchers to write a lot of reproducible code in a short time – in most cases. However, without a basic understanding of central concepts and ideas, researchers now commonly face situations where they seem stuck in a loop of non functioning lines of code, which they try to debug. This is mostly the result of badly prompted AI tools. This workshop primarily aims to teach basic concepts of data processing in R, like “What is tidy data?”, “What is %>% or |>?”, “How can I transform my data from wide to long format or combine it with another dataset?”; but will also discuss AI-based tools such as ChatGPT, or Copilot. Please note, this workshop is intended for students “tipping their toes” in the R environment and will focus on general data processing (and not the calculation of statistical models) using functions from the tidyverse.