Many people who begin therapy for borderline personality disorder, deep-seated attachment difficulties, or obsessive traits stop treatment before they have a chance to benefit. New case study research suggests that an approach centred on rebuilding a person’s sense of self may help people remain engaged long enough to see meaningful improvement.
The research, conducted at Japan’s AeOn Institute and published in the Psychreg Journal of Psychology, followed three adults who received an approach called Self Concept Therapy. All three had complex psychological profiles, including borderline personality disorder, suspected childhood abuse, narcissistic traits, and hypochondriasis linked to health anxiety that worsened during the Covid-19 pandemic.
Dropout from psychotherapy is a long-standing problem, particularly among people with personality disorders and complex trauma, with rates reaching as high as half of all patients. This is significant because people who leave treatment early may experience worsening feelings of helplessness rather than improvement, potentially making it harder to seek help again in the future.
Self Concept Therapy is based on the idea that identity consists of three layers: a core true self, an emotional and mental layer, and outward behaviour. Treatment begins by helping clients reconnect with a stable inner sense of self before progressing to emotional awareness and, finally, changes in unhelpful thoughts and behaviours.
In the study, a woman in her thirties with ADHD, autism, borderline personality disorder, and depression completed 54 sessions. During treatment, she ended a dependent relationship, changed jobs, and reported greater emotional stability.
A man referred following a child protection concern completed 28 sessions and showed improved emotional control in his relationship with his son. A woman with severe health anxiety completed 21 sessions and was eventually able to stop taking antidepressant medication.
All three clients completed their full courses of treatment without dropping out. The researchers describe this as clinically significant given how often people with these conditions disengage from therapy. Standardised psychological tests taken before and after treatment showed reductions in anxiety, depression, and attachment-related distress across all three cases.
The findings were not entirely straightforward. One client showed an increase in certain narcissistic traits during treatment, even as intimacy avoidance and obsessive tendencies improved. This suggests that the approach may require closer monitoring and potentially longer treatment courses for some people with narcissistic traits.
The author notes several limitations, including the small sample size, the involvement of only one therapist, and the fact that all three clients were highly educated and reflective. These factors mean the findings may not generalise to everyone.
Even so, the research adds to growing interest in therapies that target identity and self-worth rather than symptoms alone. The approach could offer a potential option for people who have struggled to remain engaged in more traditional forms of psychotherapy.
