Clinicians' experiences in combining medication and psychotherapy in the treatment of borderline patients.

Combining pharmacotherapy and psychotherapy in the treatment of borderline personality disorder is increasingly common, yet the experiences of clinicians who use the two modalities have not been studied. Forty psychotherapists were surveyed about their prescribing practices with borderline patients. Results corroborate the clinical impression that therapists' decisions about medication use are influenced by psychosocial factors as well as by target symptoms. Therapists were most likely to prescribe medications when they felt pessimistic about patients' capacity to benefit from psychotherapy and were rarely willing to prescribe medications for patients who had a history of substance abuse or suicide attempts. An average of 47 percent of the borderline patients in the therapists' practices misused prescription medications. Patients were most likely to abuse medications after experiencing an interpersonal loss or failure.