Patients with personality disorders in private specialist practice.

BACKGROUND Private practitioners with contracts with the regional health authorities have an important place among the treatment options provided by the psychiatric specialist health service. Little information is available on the part such specialists in private practice should play in the treatment of patients with personality disorders. This study describes private practitioners' experiences with this patient group and the patients' satisfaction with the treatment. MATERIAL AND METHOD 46 patients were referred to specialists in private practice as part of a treatment study of patients with personality disorders. 26 private practitioners took part. The patient population had extensive problems with a high level of symptoms, interpersonal difficulties and poor work functioning. A follow-up investigation of the patient group was conducted after three years. The therapists answered questionnaires about their own practices and the patient therapy. RESULTS At the time of the three-year follow-up, a third of the patients were still in therapy. The median number of therapy sessions was 43 (range 2-258 hours). On the whole, the therapists found the treatments interesting from a professional point of view, and the majority of the patients were satisfied with the therapy. Some treatments were complicated by irregular attendance, substance abuse, risk of suicide or other serious symptoms. 29 % of the patients were dissatisfied with the therapy, particularly patients with substance abuse. INTERPRETATION Psychotherapy with a specialist in private practice with a contract with regional health authorities allows for flexibility with respect to the duration of treatment for patients with a personality disorder. Substance abuse problems and acting-out behaviour present a challenge to treatment which may be difficult to handle in private practice. Treatment in private specialist practice presupposes the possibility of acute hospitalisation or access to other health services in the event of crises and complicating substance abuse.