An exploration of the emotional experiences of therapists when working with individuals with borderline personality disorder

Abstract

Abstract for literature review: Despite reviews exploring the emotions experienced by emergency and nursing staff when working with individuals with Borderline Personality Disorder (BPD), to date there is no review summarising the experiences of therapists. Therefore, the aim of this review is to systematically review the available literature about the emotions therapists experience when working therapeutically with clients with BPD. Psycinfo, Scopus, Medline, Web of Knowledge and CINAHL were searched to identify relevant articles. The inclusion criteria for the search were; therapists or counsellors working with adult clients with BPD, utilising any therapy. The comparators were any other clients accessing therapy and the outcomes considered were emotions, reactions, attitudes and health outcomes. 16 papers were identified; 12 quantitative papers and four case studies. Therapists experience a wealth of strong emotions when working with clients with BPD. There were two client characteristics which influenced the emotions experienced by therapists, client burnout at the beginning of therapy and level of patient functioning. Therapist characteristics which may influence emotions were specialist training, primary discipline, experience, age, therapist expectations and the boundaries therapists set. In conclusion the author recommended that therapists are provided with sufficient support, such as supervision, to prevent strong emotions impacting upon the therapeutic relationship. Therapists may also benefit from accessing specialised training in BPD such as mindfulness, Dialectical Behaviour Therapy or Mentalisation Based Therapy. To date this area has not been researched using robust qualitative methodologies and the use of these would allow a greater understanding of the emotional experiences of therapists. Abstract for empirical paper: Individuals with Borderline Personality Disorder (BPD) may present with high risk behaviours such as deliberate self-harm, suicidal thoughts or attempts. Therapists report a variety of emotional experiences when engaging with this client group. Dialectical Behaviour Therapy (DBT) is a multi-modal psychological intervention designed for use with BPD. It has been hypothesised that the structure of DBT and its key components may provide support to the therapist and prevent negative emotional experiences. The aim of this study was to explore the emotional experiences of therapists whilst implementing a DBT approach. Nine semi-structured interviews were conducted and the transcripts analysed using Interpretative Phenomenological Analysis. The analysis established five themes within the data; 1) Developing an allegiance to DBT; 2) Learning to share responsibility; 3) Adjusting to the boundaries in DBT; 4) DBT contains therapists’ emotions; and 5) Needing support from others; i) Consult providing a secure base; ii) Needing support from the wider organisation. In conclusion, therapists' emotions appeared to be contained by DBT and therefore it may be an attractive approach to utilise for clinical work with individuals with BPD.