De la régulation à l’approfondissement de l’affect en psychothérapie : l’exemple du trouble de la personnalité borderline

Abstract

ObjectivesIt appears that Borderline Personality Disorder is a psychopathological condition which is difficult to treat, in particular because of dysfunctions in the central domain of affective regulation. From an integrative, yet critical, perspective, the aim of the present review article is to summarize the main therapeutic models which focus on affect or, more broadly emotions, in the treatment of patients presenting with Borderline Personality Disorder. Two main concepts have been found in relation with affect in psychotherapy as core mechanisms of change (1) affect regulation, (2) deepening of affective experience. Through the lenses of these concepts, we aim at examining current psychotherapeutic models – which are based on behavioral and humanistic theory – for Borderline Personality Disorder. MethodsA literature review according to the criteria above was undertaken and three main psychotherapy models were found: (1) Dialectical-behavior therapy, (2) Clarification-oriented therapy and (3) Emotion-focused therapy. ResultsEach model is presented very briefly with regard to the relevance for our purpose, in particular the relevance of affect regulation and deepening of affective experience as core mechanisms in the treatment of Borderline Personality Disorder. Technical means of how each model proposes to work with affects or emotions in the sessions are cited and discussed. As such, mindfulness techniques are discussed with regard to the dialectical-behavior therapy, clarification techniques are discussed within a multi-phase model for the clarification-oriented psychotherapy and experiential two-chair work is presented in the context of emotion-focused therapy. The models are discussed with regard to the presumed sequentiality from affect regulation to deepening of affective experience, as well as with regard to the degree of importance of the therapeutic relationship, the role and status of the therapist, the nature of the therapist's directivity, the perspective adopted by the patient facing his/her affects, the type of affect regulation and the notion of emotion transformation. ConclusionsIt appears that each therapy model has its own specific implications in terms of the therapist role and tasks, the patient's role and tasks with regard to his/her own affects and in terms of the quality of the collaboration between the patient and the therapist. It seems possible to articulate – or integrate – therapeutic models with very different underlying epistemological origins. Without resolving all the issues related to integration in psychotherapy facing a particularly vulnerable patient population, it must also be acknowledged that treatment of patients with Borderline Personality Disorder remains a difficult endeavor for therapists. It is our conviction that clear concepts, as well as their creative articulation, as discussed in the present review, may help clinicians and researchers alike to ultimately deliver better treatments.