Abstract
Abstract
Background
Despite increasing evidence for the effectiveness of psychotherapy for Borderline Personality Disorder (BPD), estimates show that approximately half of those in treatment do not clinically improve or reach reliable change criteria. There are limited qualitative descriptions of treatment factors associated with non-response from the perspectives of those struggling to improve.
Method
Eighteen people (72.2% female, mean age 29.4 (SD = 8)) with experience of receiving psychotherapeutic treatment for BPD were interviewed to obtain their perspectives on hindering factors in treatment and what may be helpful to reduce non-response. The data in this qualitative study was analysed thematically.
Results
Four domains were created from the insights patients shared on non-response and what may be needed to mitigate it. The focus of Domain 1 was that therapy cannot be effective until two factors are in place. First, the patient needs sufficient safety and stability in their environment in order to face the challenges of therapy. Second, they need to be able to access therapy. Domain 2 described factors the patients themselves contribute. The themes in this domain were described as phases that need to be progressed through before therapy can be effective. These phases were ceasing denial that help is warranted and deserved, taking responsibility for behaviours that contribute to unwellness, and committing to the hard work that is required for change. Domain 3 described how the lack of a safe alliance and ruptures in the safety of the relationship with the therapist can contribute to non-response. Domain 4 was comprised of factors that patients identified as supportive of moving through the barriers to response. The first theme in this domain was prioritising the safety of the therapy relationship. The second theme was giving a clear diagnosis and taking a collaborative approach in sessions. The final theme described the importance of focusing on practical goals with the patient to create tangible life changes.
Conclusion
This study found that non-response is complex and multifaceted. First, it is clear that systems need to be in place to support access to adequate care and foster life stability. Second, considerable effort may be needed at the engagement phase of therapy to clarify expectations. Third, attention to specific interpersonal challenges between patients and therapists is an important focus. Finally, structured work to improve relationships and vocational outcomes is indicated.
Publisher
Springer Science and Business Media LLC
Subject
Biological Psychiatry,Psychiatry and Mental health,Clinical Psychology
Reference94 articles.
1. Álvarez-Tomás I, Ruiz J, Guilera G, Bados A. Long-term clinical and functional course of borderline personality disorder: a meta-analysis of prospective studies. Eur Psychiatry. 2019;56(1):75–83. https://doi.org/10.1016/j.eurpsy.2018.10.010.
2. Alvarez-Tomás I, Soler J, Bados A, Martín-Blanco A, Elices M, Carmona C, Bauzà J, Pascual J. Long-term course of borderline personality disorder: a prospective 10-year follow-up study. J Pers Disord. 2016;31:1–16. https://doi.org/10/gf5jqr.
3. American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-5. Vol. 5. 5th ed. American Psychiatric Association; 2013.
4. Antonsen BT, Kvarstein EH, Urnes Ø, Hummelen B, Karterud S, Wilberg T. Favourable outcome of long-term combined psychotherapy for patients with borderline personality disorder: Six-year follow-up of a randomized study. Psychother Res. 2017;27(1):51–63 https://doi.org/10/gfzczr.
5. Austin MA, Riniolo TC, Porges SW. Borderline personality disorder and emotion regulation: insights from the polyvagal theory. Brain Cogn. 2007;65(1):69–76. https://doi.org/10.1016/j.bandc.2006.05.007.
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