Common strategies for cultivating a positive therapy relationship in the treatment of borderline personality disorder.

Abstract

A positive therapeutic relationship is widely recognized as an important factor that contributes to the effectiveness of clinical outcomes in psychotherapy for borderline personality disorder (BPD). All psychotherapy approaches for the treatment of BPD emphasize the importance of the relationship, yet with BPD clients, a positive relationship is often slow to develop, inconsistent, and difficult to maintain. The interpersonal sensitivity and reactivity that characterize borderline pathology often evokes countertherapeutic reactions in psychotherapists. Therapist contributions to the interaction frequently impede the development and maintenance of a positive relationship. This paper outlines 5 strategies that are common across psychotherapies for BPD for cultivating a positive therapeutic relationship: (a) cultivating emotional awareness, (b) structuring treatment, (c) being responsive, (d) supervision or team involvement, and (e) exploring ruptures. We discuss how these strategies serve to increase the effectiveness of treatment with individuals with BPD by decreasing intense emotional arousal and reactivity of both the client and the therapist.