Motive-oriented therapeutic relationship in brief psychodynamic intervention for patients with depression and personality disorders

Self-Knowledge in Personality Disorders: An Emotion-Focused Perspective

Emotional knowledge about one's own and others' emotional experience are central features of mental health and may be characteristic of therapeutic processes leading to good outcome. Clients with personality disorders (PDs) often lack in their ability to access and accept emotional experiences, or to reflect on emotion and use it in adaptive ways. The present theoretical and clinical review discusses self-knowledge, and lack thereof, in personality disorders, from an emotion-focused perspective. A first section differentiates between two fundamental types of meaning construction processing. The second section describes, from an integrative therapy perspective, how self-knowledge may be facilitated in psychotherapy by the client-therapist interaction. A subsequent section discusses lack of awareness of one's own emotions in the construction of meaning associated with PDs. The final section describes initial studies that demonstrate change occurring in constructing emotional self-knowledge as a correlate of treatment. The concepts of the review are illustrated throughout with three clinical cases of PD.

Emotion Regulation and Social Cognition as Functional Targets of Mechanism-Based Psychotherapy in Major Depression With Comorbid Personality Pathology

This article characterizes functional systems as targets of integrated modular psychotherapy for episodes of major depression (MD) with a comorbid condition of borderline personality disorder (BPD) or chronic depression (CD). Both types of comorbidities to MD are conceptualized as a trait-like concept dominated by impairments in interpersonal functioning. Despite differences in psychopathology, existing data show significant similarities in impairments of emotion regulation and social cognition in BPD and CD, thought to reflect common disease mechanisms linked to early-life adversity. The preexistence of BPD and CD and related functional impairments inhibits the remission of episodic MD and calls for mechanism-based interventions that complement existing treatments of MD by targeting these dysfunctions. Contemporary methods of psychotherapy already provide interventions to address such complicated states of comorbidity by specifically improving dysfunctions of emotion regulation and social cognition. We suggest a layout of modular interventions that can address identified dysfunctions in comorbid MD.

You Won't Get Me: Therapist Responses to Patient Impression Management Tactics

In psychotherapy, therapist and patient influence each other constantly. We aimed to investigate how therapists respond to patient impression management and influence tactics. For 60 videotaped intake interviews, judges rated therapist responses to patient tactics as neutral, desired, or undesired from the patient perspective. Judges rated the therapist responses in 57% as neutral, in 40% as desired, and in 2% as undesired by the patients. The proportions of response outcomes varied across tactics. Therapist responses were unrelated to therapist and patient sex. Therapist experience was related to their responses to the tactic Supplication. Overall, some patient tactics seem to be more challenging for therapists than others. Awareness of such response tendencies can help therapists prepare their reactions to certain patient impression management and influence tactics. Implications for training and research are presented.

Effects of motive-oriented therapeutic relationship in a ten-session general psychiatric treatment of borderline personality disorder: a randomized controlled trial

BACKGROUND

Motive-oriented therapeutic relationship (MOTR) was postulated to be a particularly helpful therapeutic ingredient in the early treatment phase of patients with personality disorders, in particular with borderline personality disorder (BPD). The present randomized controlled study using an add-on design is the first study to test this assumption in a 10-session general psychiatric treatment with patients presenting with BPD on symptom reduction and therapeutic alliance.

METHODS

A total of 85 patients were randomized. They were either allocated to a manual-based short variant of the general psychiatric management (GPM) treatment (in 10 sessions) or to the same treatment where MOTR was deliberately added to the treatment. Treatment attrition and integrity analyses yielded satisfactory results.

RESULTS

The results of the intent-to-treat analyses suggested a global efficacy of MOTR, in the sense of an additional reduction of general problems, i.e. symptoms, interpersonal and social problems (F1, 73 = 7.25, p < 0.05). However, they also showed that MOTR did not yield an additional reduction of specific borderline symptoms. It was also shown that a stronger therapeutic alliance, as assessed by the therapist, developed in MOTR treatments compared to GPM (Z55 = 0.99, p < 0.04).

CONCLUSIONS

These results suggest that adding MOTR to psychiatric and psychotherapeutic treatments of BPD is promising. Moreover, the findings shed additional light on the perspective of shortening treatments for patients presenting with BPD.