Psychotherapists' response to borderline personality disorder: A core conflictual relationship theme analysis

Abstract

This study examined therapists' emotional and cognitive responses to patients with borderline personality disorder (BPD) versus patients with major depressive disorder (MDD). Therapists' narratives (N=80) were elicited using the Relationship Anecdotes Paradigm interview method and then scored according to the core conflictual relationship theme–Leipzig/Ulm method (CCRT-LU; Albani et al., 2002). The emotional valences of therapists' responses were significantly more negative toward patients with BPD. Therapists differentially experienced patients with BPD as typically withdrawing and patients with MDD as attending within sessions. Therapists felt less satisfied in their therapeutic role with BPD despite a consistent wish to help patients. Findings support the utility of the CCRT-LU method in investigating therapist relational experiences and underscore the challenges for BPD treatment.

RÉSUMÉ

Cette étude a examiné les réponses émotionnelles et cognitives des thérapeutes face à des patients avec un trouble de la personnalité borderline (TPB) versus des patients présentant un trouble dépressif majeur (TDM). Les récits des 80 thérapeutes ont été obtenues à l'aide de la méthode d'entretien du paradigme d'anecdotes relationnelles, puis marqués selon la méthode d'analyse des thèmes relationnels conflictuels centraux Leipzig/Ulm (CCRT-LU; Albani et al., 2002). Les valences émotionnelles des réponses des thérapeutes étaient beaucoup plus négatives envers les patients atteints de TBP. Les thérapeutes percevaient les patients borderlines comme se distanciant et les patients avec trouble dépressif comme demandant durant les séances. Les thérapeutes se sentaient moins satisfaits de leur rôle thérapeutique avec TPB malgré leur souhait d'aider les patients. Les résultats démontrent l'utilité de la méthode CCRT-LU pour investiguer les expériences relationnelles des thérapeutes et soulignent les défis pour le traitement du TPB.

Abstract

Este estudo analisou as respostas cognitivas e emocionais dos terapeutas a pacientes com perturbação de personalidade borderline (BPD) versus pacientes com perturbação depressiva Major (MDD). Narrativas terapêuticas (N=80) foram evocadas usando o método da entrevista Relationship Anecdotes Paradigm e posteriormente cotadas de acordo com o tema central de conflito relacional com o método Leipzig/Ulm (CCRT-LU; Albanietal., 2002). As valências das respostas emocionais dos terapeutas foram significativamente mais negativas para pacientes com BPD. Os terapeutas experienciaram diferenciadamente os pacientes com BPD tipicamente como ausentes e pacientes com MDD como presentes nas sessões. Os terapeutas sentiram-se menos satisfeitos no seu papel terapêutico com a BPD, apesar de apresentarem um consistente desejo de ajudar pacientes. Os resultados suportam a utilidade do método CCRT-LU na investigação das experiências relacionais dos terapeutas e realçam os desafios no tratamento da BPD.

Abstract

Keywords:

• personality disorders
• psychoanalytic/psychodynamic therapy
• psychotherapist training/supervision/development
• CCRT

Acknowledgements

The research is partially supported by a postgraduate research scholarship (to M. Bourke) and a New South Wales Health personality disorders grant (to B. Grenyer). We give special thanks to the participants in this study, without whom this work would not have been possible.