Borderline Personality Disorder Clients Research Articles

Therapeutic collaboration in a comfort zone: a non-improved borderline patient psychotherapy case study (Colaboración terapéutica en una zona de confort: estudio de un caso de psicoterapia de un paciente borderline que no experimentó mejoría)

ABSTRACT The quality of dyad interaction seems crucial to the client’s decision to drop out of psychotherapy. To characterize the client’s lack of change and the patterns of therapeutic collaboration in a dropout of psychodynamic therapy for Borderline Personality Disorder (BPD), we used the Therapeutic Collaboration Coding System (TCCS) to assess collaborative work and the Assimilation of Problematic Experiences Scale (APES) to rate client change. The software GridWare was used to characterize patterns of therapeutic collaboration and the R software to describe the client’s change. The dyad worked in a comfort zone for the client, with the therapist supporting the client’s problematic perspective and the client responding with Safety. The APES results showed that the client did not change, remaining in control through avoidance of thinking and discussing his problematic experience. Our results challenge the potential impact of therapists’ interventions on BPD clients’ comfort zones, suggesting that too much focus on their Therapeutic Zone of Proximal Development’s actual level might not be productive.

Musical encounters on the borderline. Patterns of mutuality in musical improvisations with Borderline Personality Disorder

This study focused on intersubjective relatedness with clients with Borderline Personality Disorder (BPD) within the field of Music Therapy. Clinical improvisation is increasingly recognized as a mean to develop or re-live patterns of mutuality, and by mutuality we mean the emergence of a polyphonic flow founded on the forces that constantly makes us balance between dependency and independency. Recent research addresses how people with BPD relate to others in Music Therapy. What is currently lacking is a detailed tracking of mutual aspects of the musical modality emerging in music therapy improvisations. This paper details research in this area, asking the question: in what ways do clients with BPD demonstrate capacities and difficulties to mutually attune to a music therapist in one piano improvisation?A Structured Piano Duet Improvisation paradigm (ABA’) was used that allowed periods of predictable interaction (A and A’), and more mutually attuned interaction (B). 20 BPD clients participated in one improvisation, at the beginning of their admission into hospital. The constant comparative method was used in which cycles of data collection, observation, coding and validation made it possible to abstract patterns of mutuality.Six categories of distorted patterns of mutuality were found: obsessive-rigid, associative-external, sensitive, agonistic, submissive, and aleatoric. Two dimensions were found to describe patterns of mutuality in improvisation: internal/external and affective/cognitive.The study identified a continuum of dysfunctions in intersubjective relatedness which can become a frame of reference to understand the interpersonal dynamics of a client in Music Therapy. This will help music therapists to be better prepared musically when working with BPD clients.

Emotional experiences of clients with borderline personality disorder in dialectical behavior therapy: An empirical investigation of in-session affect.

Borderline personality disorder (BPD) is a diagnosis characterized by intense and labile emotion; dialectical behavior therapy, a common treatment for BPD, aims to reduce the intensity and lability of clients' emotion through multiple methods, some of which occur in the therapy session, with the expectation that changes will generalize to the rest of clients' lives. However, little research has examined how BPD clients' affect presents and varies in session or whether affect in session reflects patients' patterns of affect outside of treatment. This study had 2 aims: (a) to explore changes in clients' positive and negative affect in therapy, and (b) to assess if the severity of client psychopathology relates to affect in treatment. Positive and negative affect ratings were collected from clients (N = 73) at the start and end of every individual therapy session (total sessions = 1,474). Hierarchical linear modeling and linear regression were used to examine patterns of affect and assess the relationship between affect and severity. Results indicated that positive affect increased while negative affect decreased between the start and end of sessions, with the same pattern of change in presession affect from week to week. In addition, increased BPD severity was associated with lower presession positive affect ratings and higher negative affect ratings. Further exploration is needed to assess which dialectical behavior therapy treatment processes contribute to changes in in-session affect and how in-session affect relates to treatment outcomes. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Leaving Distress Behind: A Randomized Controlled Study on Change in Emotional Processing in Borderline Personality Disorder

Objective: The marked impulsivity and instability of clients suffering from borderline personality disorder (BPD) greatly challenge therapists’ understanding and responsiveness. This may hinder the development of a constructive therapeutic relationship despite it being of particular importance in their treatment. Recent studies have shown that using motive-oriented therapeutic relationship (MOTR), a possible operationalization of appropriate therapist responsiveness, can enhance treatment outcome for BPD. The overall objective of this study is to examine change in emotional processing in BPD clients following the therapist’s use of MOTR. Method: The present paper focuses on N = 50 cases, n = 25 taken from each of two conditions of a randomized controlled add-on effectiveness design. Clients were either allocated to a manual-based psychiatric-psychodynamic 10-session version of general psychiatric management (GPM), a borderline-specific treatment, or to a 10-session version of GPM augmented with MOTR. Emotional states were assessed using the Classification of Affective-Meaning States (Pascual-Leone & Greenberg, 2005) at intake, midtreatment, and in the penultimate session. Results: Across treatment, early expressions of distress, especially the emotion state of global distress, were shown to significantly decrease (p = .00), and adaptive emotions were found to emerge (p < .05). Between-condition differences of change were found, including a significant increase in emotional variability and stronger outcome predictors in the MOTR condition. Conclusions: The findings indicate initial emotional change in BPD clients in a relatively short time frame and suggest the addition of MOTR to psychotherapeutic treatments as promising. Clinical implications are discussed.

Emotional Activation and Habituation During Imaginal Exposure for PTSD Among Women With Borderline Personality Disorder.

The current study examined patterns and outcomes of emotional activation and habituation during imaginal exposure for posttraumatic stress disorder (PTSD). Participants were 16 women with borderline personality disorder (BPD), PTSD, and recent suicidal and/or self-injurious behavior who received imaginal exposure for PTSD concurrently with dialectical behavior therapy. The intensity of global distress and 6 specific emotions were assessed before and after imaginal exposure trials. Results indicated that significant within-session habituation (WSH) occurred for global distress (Hedge's g effect size = -2.52) and fear (g = -0.80), whereas significant between-session habituation (BSH) occurred for global distress (g = -2.18), fear (g = -1.89), guilt (g = -1.14), shame (g = -0.74), and disgust (g = -0.41). BSH significantly predicted PTSD diagnostic status at posttreatment, whereas activation and WSH were unrelated to outcome. Clients who remitted from PTSD showed significantly more BSH in global distress than nonremitters (η(2) = .39). In addition, remitters reported reductions in sadness and anger across trials, whereas sadness and anger increased for those who did not remit (η(2) = .54 and .40, respectively). Overall, BPD clients exhibited patterns of activation and habituation during imaginal exposure comparable to other client populations, and there was no evidence of persistent emotional engagement or habituation problems.

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

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.

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

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.

Alliance ruptures and resolution during cognitive behaviour therapy with patients with borderline personality disorder

Objective: To explore the process of rupture resolution in cognitive behaviour therapy (CBT) with two good outcome clients with borderline personality disorder (BPD). Method: This study employed task-analytic methods to investigate whether the existing CBT rupture resolution model for depression could be validated. Quantitative analyses identified rupture-repair sequences and 41 rupture resolution attempts were systematically analysed. Results: The final model shared similarities with the existing model although additional components, including an “external observer” were identified. Focus on affective experience was also hypothesized to be important. Conclusions: The final theoretical rupture resolution model may be a useful tool when working with BPD clients in CBT. It is however recognized that further research on data from larger samples is needed. Clinical implications for managing alliance ruptures with BPD clients are discussed.

‘There's always this sense of failure’: an interpretative phenomenological analysis of primary care counsellors' experiences of working with the borderline client

This qualitative study explores the experiences of five primary care counsellors working in the NHS with clients identified as diagnosable with borderline personality disorder (BPD). Participants completed a semi-structured interview about their experiences of clinical work with BPD clients. Interview transcripts were analysed via Interpretative Phenomenological Analysis (IPA) and three master-themes were identified: recognition and implications; managing feelings of inadequacy; and managing dilemmas in the primary care context. Despite struggling to manage feelings of failure evoked by these clients, counsellors described feeling a sense of ethical responsibility, and adapted the traditional short-term model of counselling to ensure clients received ongoing, supportive work. Whilst NHS guidelines propose that BPD is best managed and treated in secondary care and specialist services, this study found that counsellors are working with this complex group of clients in primary care and require specialist supervision and support in managing unconscious process issues emerging from the work.

P-1159 - Self-injurious or suicidal behavior? utilizing dialectical behavior therapy in community based crisis response with borderline personality disorder clients within the act team model

Self-injurious behavior is often understood by clinicians to be synonymous with suicidal behavior. This presentation will focus on addressing contemporary conceptual and treatment issues that play role in understanding self-injurious and suicidal behavior of BPD clients within the context of clinical treatment and a community response.

Attitudes and perceptions of mental health nurses towards borderline personality disorder clients in acute mental health settings: a review of the literature

Journal of Psychiatric and Mental Health NursingVolume 17, Issue 7 p. 657-662 Research in brief Attitudes and perceptions of mental health nurses towards borderline personality disorder clients in acute mental health settings: a review of the literature L. WESTWOOD, L. WESTWOOD Student NurseSchool of Nursing Midwifery and Social WorkThe University of ManchesterManchester, UKSearch for more papers by this authorJ. BAKER phd mphil msc bnurs (hons) rmn cpn, J. BAKER phd mphil msc bnurs (hons) rmn cpn LecturerSchool of Nursing Midwifery and Social WorkThe University of ManchesterManchester, UKSearch for more papers by this author L. WESTWOOD, L. WESTWOOD Student NurseSchool of Nursing Midwifery and Social WorkThe University of ManchesterManchester, UKSearch for more papers by this authorJ. BAKER phd mphil msc bnurs (hons) rmn cpn, J. BAKER phd mphil msc bnurs (hons) rmn cpn LecturerSchool of Nursing Midwifery and Social WorkThe University of ManchesterManchester, UKSearch for more papers by this author First published: 15 August 2010 https://doi.org/10.1111/j.1365-2850.2010.01579.xCitations: 34Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume17, Issue7September 2010Pages 657-662 RelatedInformation

Dialectical behavior therapy as a precursor to PTSD treatment for suicidal and/or self‐injuring women with borderline personality disorder

This study examined the efficacy of dialectical behavior therapy (DBT) in reducing behaviors commonly used as exclusion criteria for posttraumatic stress disorder (PTSD) treatment. The sample included 51 suicidal and/or self-injuring women with borderline personality disorder (BPD), 26 (51%) of whom met criteria for PTSD. BPD clients with and without PTSD were equally likely to eliminate the exclusionary behaviors during 1 year of DBT. By posttreatment, 50-68% of the BPD clients with PTSD would have been suitable candidates for PTSD treatment. Borderline personality disorder clients with PTSD who began treatment with a greater number of recent suicide attempts and more severe PTSD were significantly less likely to become eligible for PTSD treatment.

'Caring Across Thorns' – Different care outcomes for borderline personality disorder patients in Taiwan

To explore the contributing factors and effects of Taiwan's mental health nurses' decision-making patterns on care outcomes for patients with borderline personality disorder. Patients with borderline personality disorder have been identified as difficult to care for. Taiwan's mental health nurses have complained about the lack of successful outcomes with existing care regimes, and few studies have explored these nurses' perceptions of how their decision-making process impacts quality of care for their clients. Descriptive qualitative research. Data collected through semi-structured, face-to-face, in-depth interviews were analysed by qualitative content analysis. Fifteen mental health nurses were purposively recruited from a psychiatric centre in northern Taiwan. The informants' caring outcomes for borderline personality disorder patients were involved with interactions of the following five themes: (a) shifting from the honeymoon to chaos stage, (b) nurses' expectations for positive vs. negative outcomes, (c) practicing routine vs. individualised nursing care, (d) adequate or inadequate support from healthcare team members and (e) differences in care outcomes (satisfactory experiences, unsatisfactory experiences and superficial relationships). A conceptual framework of a 'two-stage care process' was developed to depict the relationships among these five themes with different care outcomes. Although Taiwan's mental health nurses reported more unsatisfactory than satisfactory care outcomes, more satisfactory patient outcomes might be obtained by nurses' positive attitudes, unrelenting efforts towards promoting the health of these patients and receiving timely and constant support from healthcare team members. Mental health nurses should not give up too readily on borderline personality disorder clients, but adopt a positive attitude and coach them in learning to relax and work with others. Nurses are encouraged to establish supportive team relationships to motivate each other to work for positive care outcomes, to better understand their clients' needs and to develop individualised in addition to routine care strategies.

Integrating Dialectical Behavior Therapy and Prolonged Exposure to Treat Co-Occurring Borderline Personality Disorder and PTSD: Two Case Studies

Despite the high rate of trauma and PTSD among individuals with borderline personality disorder (BPD), no studies have specifically evaluated the treatment of PTSD in a BPD population. These case studies illustrate the use of a protocol based on prolonged exposure therapy that can be integrated into standard dialectical behavior therapy to treat co-occurring PTSD in BPD clients. Two women with BPD and chronic PTSD were treated and results indicate a significant improvement in PTSD symptoms as well as a variety of secondary outcomes. Despite having recent and extensive histories of suicidal and nonsuicidal self-injurious behavior, as well as ongoing low to moderate urges to engage in these behaviors, neither client self-injured or attempted suicide during the PTSD treatment. These preliminary findings demonstrate the potential efficacy of combining an exposure treatment for PTSD with standard DBT, while also showing that exposure-based PTSD treatments can be implemented safely and effectively with BPD clients.

Dialectic Behaviour Therapy: A 12-Month Collaborative Program in a Local Community Setting

AbstractThis study focuses on examining the efficacy of dialectic behaviour therapy (DBT) on female clients who meet the criteria of borderline personality disorder (BPD) within a community setting. A clinical sample of 11 women with BPD was provided with a 6-month DBT program that was collaboratively developed and delivered by Logan Women's Health service and Logan Central Adult Mental Health. Results indicate that DBT is an effective treatment for parasuicidal behaviour and decreased the frequency of medically severe suicide attempts. In addition, the duration of telephone contact, face-to-face contact and number and duration of hospital admissions decreased during the DBT program. The participants' psychological, social and occupational functioning improved. Of significance, depression levels also decreased on completion of the program. Future studies would benefit from a larger sample and a control group. This study demonstrates that DBT is an effective treatment for BPD clients within an Australian community setting and has many clinical benefits.

Symptom correlates of posttraumatic stress disorder in clients with borderline personality disorder

Limited research has examined the clinical and functional impact of concurrent posttraumatic stress disorder (PTSD) in people with borderline personality disorder (BPD). Such information is particularly lacking for BPD clients with the most disabling symptoms: those who meet criteria for severe and persistent mental illness. We evaluated individuals with severe mental illness to assess whether PTSD in individuals with BPD was associated with more severe symptoms and impaired functioning than BPD alone and replicated these findings in an independent sample. In both the studies, the clients with PTSD and BPD reported significantly higher levels of general distress, physical illness, anxiety, and depression than those with BPD alone. Because individuals with both of these disorders are likely to require more intensive clinical services to reduce distress and improve functioning, work is needed to develop and evaluate interventions designed to address these comorbid conditions.

Linehan's Dialectical Behaviour Therapy (DBT) for borderline personality disorder: Overview and adaptation

Dialectical Behaviour Therapy (DBT) is a structured, time-limited, cognitive behavioural treatment originally developed for Borderline Personality Disorder clients who have chronic parasuicidal problems. The therapy integrates individual psychotherapy with concurrent skills training, access to skills generalisation and team consultation for therapists. Initial outcome studies by Linehan and colleagues conducted in the US suggest that the therapy successfully lowers attrition rate, parasuicidal episodes and psychiatric in-patient days. The effect on parasuicidal behaviour and psychiatric inpatient days appear to outlast the therapy by at least a year. This paper overviews the therapy and examines how it may be used in day-to-day clinical practice in other cultural settings. We suggest that any adaptation or modification to DBT should be done in the context of a theoretical model of which psychological processes underlie the treatment effects and with due attention to the advantages and disadvantages of working within the NHS structure.