hey. it can be good to get on the soap box every now and then. sounds to me that he truely is ignorant. sorry... but... that really is the way that it strikes me.

i think the reason that health insurance providers don't really cover therapy is that long term therapy is very expensive for them to cover and short term therapies (which are easier to study) don't seem to have such very good outcomes with treating personality disorders (or dysthymia, for that matter).

so there is political pressure from the insurance companies. there is also considerable pressure from psychiatrists who often don't like to treat personality disorders because their most standard form of treatment (medication) isn't so very effective.

basically... when peoples needs exceed our ability to help them... people often attempt to 'blame the victim' in a way that helps them feel better about themselves. that is my take on the situation.

psychodynamic theorists are often more willing to take personality disorders seriously. the psychodynamic diagnostic manual (PDM) came out last year and they had some very sensible things to say about personality disorders / styles. more sensible than the DSM IMHO. they viewed personality disorders as extremes on personality styles, basically. i've heard that future editions of the DSM might demote personality disorders further (political pressure from insurance companies, drug companies, psychiatrists).

Marsha Linehan is IMHO the best CBT therapist who writes on BPD. she modified CBT into DBT. if your lecturer / teacher thinks that there aren't good outcomes for psychotherapy for borderline personality disorder then it won't be hard for you to find evidence that DBT and short term psychodynamic (mentalisation based therapies) have been shown to be effective.

of course the therapy is long term. that is understandable when you consider that personality disorders are indeed 'ingrained styles of relating to the world'. changing habitual ways of coping will indeed take time.

Linehan considers that for every personality 'disorder' there is a related personality 'style' that is a 'healthy version' (if you like). she says of borderline individuals, for example, that they will always be the 'colourful' people of this world. bubbly. emotionally intense. vibrant. avoidant people will always be the sensitive / shy people of this world. and so on... it is only when the person repeatedly adopts one or two ways of coping and that coping strategy leads to problems that a dx of a personality disorder may be warranted.

but of course people can change.

people DO change.

they change according to context (more than the majority of the current literature would have us suppose). they change through time (more than the current literature would have us suppose too). part of the motivation for emphasising the long term problem is attempting to help them keep their status as mental 'disorders' (so people can get treatment for such conditions).

Schore has some interesting things to say on how early attachment relationships seem to be especially important with respect to later personality development. this is similar to the literature on attachment. different attachment styles (ambivalent / borderline; avoidant etc) seem to become different personality traits / ways of interrelating to the world.

methinks your teacher needs to read...