Examining Unstable Working Alliance During Treatment for Borderline Personality Disorder
Open Access
- Author:
- Notsu, Haruka
- Graduate Program:
- Psychology
- Degree:
- Master of Science
- Document Type:
- Master Thesis
- Date of Defense:
- August 12, 2020
- Committee Members:
- Kenneth Levy, Thesis Advisor/Co-Advisor
Michael Hallquist, Committee Member
James Marshall Lebreton, Committee Member
Yogev Kivity, Special Signatory
Kristin Ann Buss, Program Head/Chair - Keywords:
- Borderline Personality Disorder
Working Alliance
Psychotherapy
Good Psychiatric Management
Motive-Oriented Therapeutic Relationship - Abstract:
- Borderline personality disorder (BPD) is characterized by instability in interpersonal relationships, identity, and affect. Although these features may pose a challenge to therapists in building strong and stable therapeutic alliance with this group of patients, relatively little is known about the impact of an unstable therapeutic alliance in the treatment of BPD. The aim of the current study are: 1) to examine the change in stability of working alliance during a short, generalist treatment for BPD; 2) to examine the effect of alliance stability on treatment outcome; 3) to examine the effect of an adjunctive person-centered module on these relationships. Data were drawn from a study of a short-term intervention for BPD. Sixty patients diagnosed with BPD were randomized to 10-sessions of Good Psychiatric Management (GPM) or GPM combined with Motive-Oriented Therapeutic Relationship (MOTR), a module tailoring the therapeutic relationship to the needs of specific patients. Patient- and therapist-rated alliance and patient rated self-esteem was assessed after each session. Patient rated general functioning was assessed at pre-, mid- and post treatment. Mean absolute successive difference was used as the measure of instability, and multilevel models were used to test the hypotheses. Results showed that alliance instability did not change over the treatment. Alliance instability did not predict, or was predicted by treatment outcome, neither at within patient level or between patient level. Finally, these relationships were not moderated by the addition of MOTR. Potential implications of the results were discussed.