Eclectic Therapeutic Relationship with BPD Clients: Examining the Eclectic Therapeutic Relationship with Clients with Borderline Personality Disorder

Abstract

Borderline Personality Disorder (BPD) or Emotionally Unstable Personality Disorder (EUPD) clients are characterised by behavioural symptoms of acts of deliberate self-harm, difficulty controlling anger, and instability in relationships, besides others. While specific therapies address specific problem behaviours, an integrated or eclectic approach enables clinicians to adopt a comprehensive therapy plan (Livesley, 2008). Since the therapeutic relationship with BPD clients is characterised by frequent ruptures and fluctuations, it is necessary to understand how the eclectic stance approaches the therapeutic relationship with BPD clients. This study explores these questions through in-depth interviews with seven self-identified eclectic therapists who have worked with BPD clients. Using Thematic Network Analysis, it was found from the interviews that eclectic therapists choose the stance because of the flexibility it offers them, and because of definite client and setting factors. This stance, they suggested, helps in mutual decision-making and leads the therapist to make constant adjustments to the client‘s level. The process of rapport-building was seen to be an on-going process, where the therapist acts as a facilitator, and often works against resisting traits of the clients. Therapists also talked about ruptures in the relationship due to certain factors and identified means through which these can be repaired. Finally, they identified their reactions to BPD clients as consisting of both positive reactions, and negative and unconscious reactions, which require monitoring. The results of this study yield an understanding about the reasons behind the decision to take an eclectic stance, and how it affects the therapeutic relationship. Keywords: Borderline personality disorder, Eclectic therapy, Therapeutic alliance.