Dynamic Patterns in the Voices of a Patient Diagnosed with Borderline Personality Disorder, and the Therapist throughout Long-Term Psychotherapy

Abstract

This case study identified the subjective change in a patient diagnosed with Borderline Personality Disorder (BPD) by analyzing the dynamic patterns that emerged during discursive interaction with her therapist during a successful long-term psychotherapy. A qualitative analysis was conducted by applying the Model of Analysis of Discursive Positioning in Psychotherapy (MAPP), tracking voices and the personal positions of the patient and therapist in all sessions. Subsequently, dynamic patterns were identified and the hypothetical attractors were defined (i.e., the most stable patterns in the interaction of voices) using the Space State Grid (SSG) technique. Five sessions (representing the initial, middle and final stages) were selected to describe the trajectory of the patient’s subjective change. These sessions highlight the presence of different attractors and depict the intersubjective interaction that developed during the process. The results suggest a process of subjective transformation from a monological to a dialogical dimension, a change supported by therapeutic interaction based on propositional and reflective discursive aspects; a transition from a state of dissociation of the patient to a reorganization of her subjectivity. The most relevant characteristics of this process as an emergent quality of psychotherapy and its relation to the patient’s positive outcomes are discussed.

Keywords:

• Voices and personal positions
• subjective change trajectory
• dynamic patterns
• attractors

Disclosure statement

No potential competing interest was reported by the authors.

Notes

1 For example, in a session the patient could express an independent voice, and the therapist could respond from a propositional voice, but in the next speech turn the patient could switch to a reflective voice, while the therapist could remain in his propositional voice. In this case, a trajectory in which two system states are active is represented by two points in two different cells of the graph.

Additional information

Funding

The authors acknowledge the institutions that funded the study. The Chilean national research and development agency (ANID), under grant number (FONDECYT) 1150639, the scholarship for doctoral studies in Chile (21161623), and Millennium Science Initiative Program / Millennium Institute for Research on Depression and Personality-MIDAP ICS13_005.