Dissertations / Theses on the topic 'Borderline personality disorder ; psychodynamic psychotherapy'

This thesis presents an in-depth exploration of psychotherapists’ lived experience of working with borderline personality (BPD) disorder in psychodynamic psychotherapy, using interpretative phenomenological analysis (IPA). The existing research literature suggests that working with borderline patients is very difficult, as they can evoke negative counter transference experiences in therapists and thus make the working alliance difficult to maintain. The stigmatising and negative attitude towards BPD, which is found amongst mental health professionals, can cause many therapists to avoid working with this patient population, leaving many patients without the necessary help for treatment. Some literature also suggests that psychodynamic therapy may not be helpful for the treatment of BPD in its traditional form, because of the neutrality of the model and borderline patients’ ‘reduced capacity to mentalise’. Instead, empathy and the therapeutic relationship have been reported to be significant factors. This qualitative study aimed to provide a rich and detailed examination of the experiences, which psychodynamic psychotherapists and counselling psychologists might have in their work with BPD patients. Five psychodynamic psychotherapists were interviewed twice in one unstructured and one semi-structured interview, and IPA was used to analyse the data. The five master-themes (Negative countertransference feelings; “Sitting in the dark together”; Hindrance in therapeutic work; Therapist omnipotence; Labelling as problematic) found in this study suggested that borderline patients could benefit from a modified version of psychodynamic 1 Note that the ‘psychodynamic’ and ‘psychoanalytic’ terms will be interchangeably used in this study. 2 The researcher, as a trainee-counselling psychologist, is in favour of using the word ‘client’. However, psychodynamic practitioners talk about their ‘patients’ rather than ‘clients’, and as this study focuses on psychodynamic therapists’ experiences, the researcher will use these two terms interchangeably. Thus, the word ‘patient’ here is applied in the psychodynamic and not in the medical sense. 9 psychotherapy with a focus on empathy and a bond between therapist and patient. Furthermore, the therapists’ awareness of negative countertransference feelings and emergent obstacles in the therapeutic work, as well as their understanding of BPD as a label and its effects on their borderline patients were crucial. Finally, the therapists’ experienced ‘omnipotent’ feelings, which may have emerged in response to their negative countertransference feelings. While these findings support many of the previous publications and accounts reported in the literature, they also shed new light on therapists’ experiences, which might have implications for the approach that psychotherapists and counselling psychologists take towards working with borderline individuals within the psychodynamic modality.

The objective of this study was to explore personal experiences of change of people diagnosed with borderline personality disorder (BPD) who had partaken in psychological therapy. The aim was to develop the first model of change grounded in service user experience so that this could inform recovery-oriented practice in relation to this client group. A constructivist grounded theory design was chosen. Eight people with a diagnosis of BPD who had completed group-based therapy programmes or were currently attending a peer support group were interviewed about their experiences of change using a semi-structured, open-ended format. An initial model was developed and refined through triangulation with three published accounts of experiences of change in the context of a BPD diagnosis. ‘Discovering “new ways of being” in interpersonal space’ was conceptualised as the core process underpinning pertinent activities and experiences relating to change in people diagnosed with BPD. This interactive, relational process was facilitated in environments that were felt to be both containing and open to conflict. It involved increasing levels of self-disclosure, information exchange, exploration of mental states, experimentation with new behaviours and the consolidation of new ways of being. The core process appeared to extend beyond the therapeutic setting if supported through a relationship with a secure base. Regardless of therapeutic allegiance, effective interventions for people diagnosed with BPD might share a common core change process. Further research is required into change processes in the context of individual psychological therapies and negative therapeutic experiences.

Borderline Personality Disorder (BPD) is a distressing difficulty prevalent within UK secondary-care settings. Previous qualitative studies have examined individual experiences of long term Mentalization-Based Therapy (MBT) groups for people with BPD. However, the psychoeducational component of MBT has not yet been researched coherently. The current study explored lived experiences of manualised MBT-psychoeducation groups for people with BPD within NHS secondary care settings. Eight participants took part in interviews about their recent participation in these groups. Interpretative phenomenological analysis was used to interpret individual meaning-making of these experiences. While some accounts were characterised by contradictions, MBT-psychoeducation was generally viewed as a challenging but predominantly beneficial experience. Three main themes emerged, comprising eight sub-themes. These highlighted individuals’ attempts to manage complex group processes, strategies for personalising knowledge, and the power and fear of increased self-reflection. Participant’s felt the group had impacted their sense of self, their understanding of others and their impulsivity, particularly within interpersonal relationships. Research and clinical implications of these findings are discussed. Particular importance is given to the implications of some individual’s perceived need for additional support or coping, the desire for further MBT group therapy and the possibility that these findings support propositions that the groups provide a useful mechanism to stimulate mentalizing.

The principal intention of this study was to explore the heuristic value of the story of the alchemical vessel in understanding borderline conditions and pursuing their psychotherapy. It establishes the pertinence of the case study as a method of exploring the content and process of psychotherapy. The essential nature of story-telling is examined and the hypothesis is made that psychotherapy, borderline conditions, the myth of the alchemical vessel and the case study all reflect instances of story-telling. Towards the end of examining their mutual reflection, and thus heuristic value, elements of Jungian theory, the phenomenology of borderline conditions and case material are examined. Through the examination of certain shared themes which emerge from the story of the alchemical vessel and the material of psychotherapy it is established that there is indeed a metaphoric resonance between the different stories. Furthermore this resonance is useful in that it provides a secure vantage point as well as guidance towards effecting transformation for the client. The validity of the metaphoric resonance is examined and areas of weakness highlighted. Some suggestions are made concerning further research.

Objective: To investigate the effectiveness of an adjunctive, community-based, Solution-focused therapy (SFT) group for Borderline Personality Disorder (BPD) in terms of change in clinical symptoms and the subjective experiences of participants. Methods: The study employed a mixed-methods, naturalistic, service-evaluation design in which 9 outpatients with Borderline Personality Disorder (BPD) attended 16-session SFT groups, and were assessed on clinically-relevant outcomes at baseline, 8 sessions and following group completion. Participants provided qualitative information about pre-intervention hopes and were interviewed post-group about their experience of the groups. Repeated-measures ANOVA was used to assess change in clinical symptoms during treatment, and a priori contrasts were conducted to explore significant results. Qualitative data was analysed inductively using semantic-level, thematic analysis as described by Braun and Clarke (2006). Results: Improvements were indicated across all clinical outcomes with the most robust evidence of significant effects for: phobic anxiety; paranoid ideation; psychoticism; interpersonal functioning; and symptom severity. Qualitative analyses indicated that the intervention successfully addressed the hopes of the participants and that they valued: normalisation; acceptance and safety; the opportunity to share and work together; mutual support; an informal and non-directive atmosphere; and assistance with the pursuit of personally meaningful goals. They reported noticing change, progress towards their goals, and a subjective sense that they were coping better and feeling better. Conclusions: The study provides some preliminary evidence for the effectiveness of the intervention and it may represent a more easily-accessible, resource-efficient, less intensive alternative to specialised services. More general implications in relation to approaches to treatment for BPD are discussed.

The aim of this paper was to illuminate the effect of mentalizationbased psychotherapy. The patients in the survey group were interviewed before and after treatment with regard to specific symptoms of borderline personality disorder and symptoms of other personality disorders with the semi structured interviews ZAN-BPD and SCID-II. Open interview questions that were worked up in a qualitative manner were as well put to the patients that had received the treatment program. A focus group interview with the staff working with the concept within the frame of the MBT-team of Psychiatry southwest in Stockholm was also carried out. The result shows on a group level between the pre and post measuring a reduction of specific borderline symptoms like impulsivity and cognitive symptoms. Symptoms referring to relations were stable and affective symptoms increased. All of the nine interviewed patients experienced that they to different extent felt more stable after treatment. That was an impression shared of the MBT team personnel. In the discussion part of the paper the discrepancy of the result that were gained from the two semi structured interviews and the questions put to patients and staff are discussed. Of interest to further research would be to study closer if there are common factors in background and comorbidity for the patients that seamed to have most benefit from treatment.

The present study aimed to investigate adolescents’ experiences of a therapeutic inpatient service utilising mentalization-based treatment (MBT) for borderline personality disorder (BPD) features, including deliberate self-harm. A qualitative research approach was chosen and eight adolescents were interviewed on their experiences. Interviews were analysed using interpretative phenomenological analysis (IPA; Smith, Flowers & Larkin, 2009). The analysis resulted in five superordinate themes and 17 corresponding subordinate themes. Adolescents described having felt uncontained, uncontainable and misunderstood, particularly prior to their admission. They talked about a process of seeking containment from others which in some cases led to their admission. Participants described feeling contained and understood in the inpatient service and developing a healthier relationship with self and others. Finally, they talked about their recovery as a long and challenging journey and expressed hope for the future. The study concluded that therapeutic inpatient treatment utilising MBT was experienced as beneficial by adolescents, though methodological limitations were acknowledged. Clinical implications were drawn and recommendations for future research were made.

Thesis (PhD)--Macquarie University, Division of Linguistics & Psychology, Department of Linguistics, 2006.
Bibliography: p. 319-326.
Introduction: the complex tale of self in psychotherapy -- Literature review -- Introduction to the corpora and general linguistic analysis -- Introduction to the lexicogrammatical analysis of scripts, chronicles and narratives -- Chronicles: this is my normality: the complex tale of the everyday -- Scripts: I am not normal: the complex tale of alienation -- Narratives: this is how I would like normal to be: the complex tale of normality as imagination and memory -- A complex tale of normality: lexicogrammatical features across scripts, chronicles and narratives -- The contexts of psychotherapy -- Generic structure -- A complex tale of self.
This thesis investigates the complex tales of self which emerge from conversations between psychotherapists and patients with borderline personality disorder. These patients struggle in establishing a border between themselves and significant others, which is itself fundamental to a deeper construal of their own existence. They are being treated within the Conversational Model of psychotherapy. The model is strongly oriented to techniques based on language and linguistic evidence and thus offers a linguistic site at which the study of the complex interaction of self and language can be made tractable.--Within a broad corpus of transcribed audio recordings of patient-therapist discourse, the principal focus of my linguistic study is the Conversational Model's claims about three conversational types-Scripts, Chronicles and Narratives. According to Meares, they present 'self as shifting state in the therapeutic conversation' (1998:876). The thesis investigates a selection of texts to represent these three conversational types, which I have chosen according to the claims in the Conversational Model literature. It tests the evidence of Meares' claims concerning the semantic characteristics which distinguish the three conversational types, as well as the linguistic evidence concerning the claims of change in the self in particular the presentation of 'self as shifting state' (1998:876). To achieve the levels of complexity required for this linguistic study of self, this thesis uses Systemic Functional Linguistics, which has a social, interactional orientation and a multidimensional and in particular, multistratal approach. The research demonstrates that therapeutically relevant aspects of the self can be productively described, across linguistic strata, in a consistent and reproducible way as a construction of meaning. The meanings which speakers offer in wordings can provide a reliable index for evaluating the emergence and maintenance of self. The Conversational Model's 'conversations' are confirmed as linguistically distinguishable text types and the research further shows that key terms of the Conversational Model can be defended theoretically on the basis of linguistic evidence, for example, the contrastive linearlnon-linear. Together the findings describe the complexity in the tale of self.--This investigation of the Conversational Model data also tests the claims of a functional linguistics at the same time that it evaluates the Conversational Model with respect to that model's consistent appeals to language as evidence. It establishes an opportunity to extend the dialogue between linguists and practitioners of the Conversational Model: the tools of the one group increase the reflective capabilities of the other.
Mode of access: World Wide Web.
xx, 385 p. ill

Clinicians’ attitudes and behaviors toward patients with borderline personality disorder (BPD) are affected by the label’s stigma. Complex posttraumatic stress disorder (CPTSD) was proposed as a comprehensive and less stigmatizing diagnostic category for clients with BPD and a history of complex trauma. Given considerable similarities across both disorders’ diagnostic criteria, the CPTSD framework holds promise as a means to improve therapists’ attitudes towards clients with BPD and a history of complex trauma. However, this quality of CPTSD had not yet been examined empirically. Using vignettes in a between-subjects experimental design, this study investigated whether CPTSD is a less stigmatizing label than BPD for trauma survivors. Participants were 322 practicing psychotherapists. Evidence of BPD stigma was found, as was an affinity for CPTSD. Results generally supported CPTSD as a less stigmatizing label than BPD; therapists presented with a CPTSD-labeled vignette were somewhat less likely to blame the client for her symptomatic behavior and expected slightly stronger working alliance with the client than therapists presented with the BPD-labeled vignette. However, therapists’ agreement with the BPD diagnosis and theoretical orientation were found to be more salient than diagnostic label in affecting concepts related to the stigmatization of BPD clients. Additionally, familiarity with CPTSD was related to more favorable attitudes toward the client and her course of treatment. Regardless of CPTSD’s recognition as a formal diagnosis, education about the construct is widely recommended for therapists.

People with Borderline Personality Disorder (BPD) have a particular difficulty in forming and maintaining close relationships. The Relational Affective Model (Mizen, 2014) proposes that intimate relationships activate claustro-agoraphobic anxieties as the person alternately seeks and flees emotional closeness. The therapeutic relationship is a specialised kind of intimate relationship in which claustro-agoraphobic anxieties are likely to be activated in a process which psychoanalysis understands as transference. The understanding and working through of this transference is the mutative factor proposed in psychodynamic therapies. This study explored participants' mental representation of the internal psychic space of the other. Ten people with a diagnosis of BPD were asked to describe themselves and significant others, including their therapist in order to understand more about (1) their mental representations of the internal space of the other; (2) their relationship with their therapist with reference to internal space. and (3) the implications for the Relational Affective Model and clinical understanding of BPD. Using a mixed qualitative methodology four broad but distinct ways of describing internal space states emerged: positive, negative, nondescript and merged, which I have termed Alpha, Omega, Non-Alpha and Merged. Case study analyses for the four participants who provided interviews at the beginning and end of their treatment were conducted to attempt to highlight any changes in the internal space states identified. A thematic analysis of therapist descriptions indicated participants were positively engaged with their therapist. Negative internal space (Omega) descriptions of self and mother did not transfer to the relationship with the therapist in the early stages of therapy. The implications for the Relational Affective Model are considered.

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Esta dissertação nasce da constatação de que é necessário conjugar a tradição clínica com a investigação empírica para ampliar o entendimento da desorganização aguda vivenciada por pacientes com transtorno de personalidade borderline em tratamento psicoterápico de orientação psicanalítica e estabelecer diretrizes para o seu manejo pelo psicoterapeuta. É uma dissertação de mestrado organizada em dois artigos empíricos. O primeiro, em formato de ensaio, trata da aparente dissociação entre a prática clínica e a pesquisa empírica e discute as possibilidades de uma aproximação entre estes dois campos a partir da conjugação de métodos clínicos e empíricos para a compreensão do processo psicoterápico e das mudanças observadas na psicoterapia psicanalítica. O caso de uma paciente borderline é utilizado para ilustrar como instrumentos empíricos e anotações clínicas feitas pelo psicoterapeuta podem se complementar e oferecer subsídios para a compreensão do processo de mudança em psicoterapia. São feitas considerações sobre o potencial deste tipo de perspectiva contribuir para a diminuição da brecha existente entre pesquisa e prática clínica. O segundo artigo é um estudo empírico que buscou aprofundar e contribuir para o aumento do conhecimento dos aspectos subjacentes às crises borderline e o seu manejo pelo psicoterapeuta de orientação psicanalítica, visto que elas são esperadas, recorrentes, mas alvo de poucos estudos. O caso é de uma paciente borderline em psicoterapia psicanalítica há aproximadamente três anos. A análise se concentrou num período de aproximadamente três meses, perto do final do primeiro ano de tratamento, no qual houve uma desorganização aguda que culminou numa tentativa de suicídio da paciente, seguida por uma internação psiquiátrica e reorganização psíquica após a mesma. A psicoterapia não foi interrompida neste período, que compreendeu 12 sessões. Estas foram analisadas, em profundidade, por meio das anotações clínicas da terapeuta, de uma medida empírica do processo terapêutico, o Psychotherapy Process Q-set (PQS), e de instrumento de avaliação de sintomas. Os achados apontam para a recomendação da não interrupção da psicoterapia na vigência da crise borderline e para a importância da empatia, sensibilidade e flexibilidade dos terapeutas para adaptar suas técnicas às necessidades destes pacientes. De modo geral, a dissertação demostra a necessidade do envolvimento de psicoterapeutas com a leitura e co-construção do conhecimento empírico para auxiliá-los a nortear suas práticas, tornando-as mais efetivas. Pacientes borderline podem apresentar crises intensas, vivenciadas dentro do setting, o que constitui desafio técnico para terapeutas psicanalíticos. A adoção de perspectivas integradas de investigação, que contemplem métodos empíricos e a perspectiva clínica do psicoterapeuta, é fortemente recomendada.
This paper is born from the realization that it is necessary to combine the clinical tradition and empirical research to increase the understanding of acute disorganization experienced by patients with borderline personality disorder in psychoanalytic psychotherapy and establish guidelines for their management by the psychotherapist. It is a dissertation arranged on two empirical articles. The first, in assay format, deals with the apparent dissociation between clinical practice and empirical research and discusses the possibilities of a closer relationship between these two fields from the combination of clinical and empirical methods for understanding the psychotherapeutic process and observed changes in psychoanalytic psychotherapy. The case of a borderline patient is used to illustrate how empirical tools and clinical notes made by the psychotherapist can complement each other and offer subsidies for understanding the psychotherapy change process. Considerations about the potential of this kind of perspective contribute to reducing the gap between research and clinical practice. The second article is an empirical study that aimed to deepen and contribute to increase knowledge of the underlying aspects of the borderline crises and their management by the psychoanalytic psychotherapist, as they are expected, applicants, but subject to few studies. The case is a borderline patient in psychoanalytic psychotherapy for about three years. The analysis focused on a period of approximately three months near the end of the first year of treatment, in which there was an acute disorganization that culminated in an attempt to patient suicide, followed by a psychiatric hospitalization and psychological reorganization after. Psychotherapy was not interrupted during this period, which included 12 sessions. These were analyzed in depth through clinical notes from the therapist, an empirical measure of the therapeutic process, the Psychotherapy Process Q-Set (PQS), and symptom evaluation tool. The findings point to the recommendation to not interrupt the psychotherapy in the presence of borderline crisis and the importance of empathy, sensitivity and flexibility of therapists to adapt their techniques to the needs of these patients. Overall, the dissertation demonstrates the need for the involvement of psychotherapists with reading and co-construction of empirical knowledge to help them guide their practices, making them more effective. Borderline patients may present experienced intense crises inside the setting, which is technical challenge for psychoanalytic therapists. The adoption of integrated perspectives of research that include empirical and clinical perspective from the psychotherapist, is strongly recommended.

In recent years, research of borderline personality disorder (BPD) has intensified and a specialized treatment, Dialectical Behavior Therapy, has been developed by Marsha Linehan to treat this disorder. Proponents of the biosocial theory, the foundation for this treatment model, contend that BPD is the result of a series of transactions over time between the individual's biological disposition and his or her “invalidating environment.” This theory is based on clinical experience and has not been studied. The present study provides an in depth examination of the life experiences in the family of origin of individuals with the diagnosis of borderline personality disorder (BPD) and compared their experiences to those of individuals diagnosed with major depressive disorder (MDD) in order to elucidate the patterns of emotional communication in the families of individuals with BPD. Drawing on the biosocial theory of BPD described by Linehan (1993a, 1993b) this study explores the social underpinnings of the development of borderline personality disorder in order to increase awareness of the social factors contributing to its development. Ten women (six diagnosed with BPD and four diagnosed with MDD) were recruited from a private not-for-profit community mental health clinic to participate in the study. Participants were interviewed using the Meta-emotion Interview, a semi-structured interview developed by Katz and Gottman (1986) which explores the philosophy toward emotions in each individual's family of origin during childhood and in the present day. Using the concepts of meta-emotion and meta-emotion philosophy (Gottman, Katz, & Hooven, 1996; Katz, Wilson, & Gottman, 1999) interviews were coded to identify themes to describe experiences in the family of origin of each participant as well as her approach toward emotions in the present day. Experiences of borderline women were compared to those of women with major depressive disorder. Women in both groups described experiences in their family of origin representative of Gottman's description of emotion dismissing families. However, borderline women more commonly described parents who were punitive and physically abusive in response to the expression of emotions. These experiences of borderline women are consistent with what Linehan terms the “invalidating environment.” In contrast to the depressed women, the borderline women appear to perpetuate their experiences in childhood by dismissing their own emotions in adulthood.

This paper explores Transference Focused Psychotherapy, developed by Otto F. Kernberg, and Role Method in Drama Therapy, developed by Robert J. Landy, as treatment modalities for Borderline Personality Disorder. This paper is divided into four sections. The first section traces the origins of the Borderline Personality Disorder psychopathology. The second section presents Kernberg's Object Relations theory and Transference Focused Psychotherapy based on that theory. The third section is a demonstration of Landy's Role Theory and the Role Method as a treatment technique in Drama Therapy. The last section in this paper provides a trial linkage of Object Relations Theory concepts and Role Theory concepts. It describes the pathology of Borderline Personality Disorder and highlights the potential of Role Method in Drama Therapy as a treatment method for Borderline Personality Disorder. Additionally, it connects the techniques of Role Method with those of Transference Focused Psychotherapy.

In this dissertation, the author provides an account of his therapeutic interaction and experience, as an intern clinical psychologist, in working with a patient in psychotherapy who was eventually diagnosed with a “factitious disorder”. This study descriptively addresses how the therapeutic interaction impacted upon the therapist’s thinking of the process both diagnostically and in terms of therapeutic goals. This study consists of a single case, qualitative research design. It concerns the interactions and experiences of the therapist with a specific patient (diagnosed with a factitious disorder) in the context of a multidisciplinary academic hospital setting. The study aims to be predominantly descriptive of this therapy, and as such employs the psychological phenomenological method of Giorgi (1985) in order to provide a specific description of the situated structure of the therapy. As such, this study is able to contribute to the sparse psychological and therapeutic information available on factitious disorders. There are few detailed accounts of actual therapeutic interactions – specifically from a psychological perspective – for patients diagnosed with factitious disorders. The specific description of the situated structure of the therapy is also compared to the available literature on factitious disorders. Although the aim of this study was not evaluative in nature, the author does provide some tentative comments on the aetiology and therapeutic considerations for factitious disorders – with regards to this particular case. The author suggests a strong link to personality and character deficits underlying factitious behaviour. The author further suggests the importance of acknowledging the “sick role”; allowing for “face-saving” strategies; providing consistency (on behalf of the therapist); and the setting of rigid, overt, therapeutic boundaries in the psychotherapeutic treatment of factitious disorders.
Dissertation (MA (Clinical Psychology))--University of Pretoria, 2005.
Psychology
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