Self-Contempt, the Working Alliance and Outcome in Treatments for Borderline Personality Disorder: An Exploratory Study

Abstract

Objective. We examined the role of expressed self-contempt in therapy for borderline personality disorder (BPD). Based on previous literature on BPD, we assumed an association between the self-contempt and the core symptoms of BPD. We also studied the progression of expressed self-contempt during the treatment and its effect on the alliance and the outcomes of treatment.

Method. We rated the expressed self-contempt in 148 tape-recorded sessions with patients with BPD (N = 50), during a brief psychiatric treatment. We rated self-contempt at three time-points, using an observer-rate scale. Self-reported questionnaires were used to assess symptoms and the working alliance.

Results. There are some associations between self-contempt and BPD symptoms. Expressed self-contempt did not change during the treatment. One measure of self-contempt was associated with a weaker alliance rated by the patients and with a stronger alliance rated by the therapists. The expression of high self-contempt was not predictive of outcomes when the initial level of problems was controlled for.

Conclusions. The results highlight the importance to examine the complex effects of self-contempt in BPD undergoing treatment in a differentiated manner and suggest to clinicians and researchers to be attentive to this specific emotional state, and change therein, in psychotherapy.

Keywords: Self-contempt; Borderline Personality Disorder; Brief Treatment; Therapeutic Alliance; Emotion

Trial registration: ClinicalTrials.gov identifier: NCT01896024.

Acknowledgements

We thank Isabelle Griffiths, who revised the English languages of the manuscript.

Additional information

Funding

The present study was funded by the Swiss National Science Foundation Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung [grant numbers SNSF 100019_152685 and 100014_134562/1 to Dr. Kramer].