Doctoral dissertation

Summary

This thesis covers a wide range of topics and is recommended for clinicians, researchers, and readers interested in the cultural aspects of borderline personality disorder (BPD). The introduction and discussion provide valuable insights and are particularly worth reading for those interested in the therapeutic alliance and common factors in the treatment of BPD.

The main objective of this research was to examine the role of the therapeutic alliance in the treatment of borderline personality disorder (BPD), a severe mental health condition that is traditionally difficult to treat and characterized by both self and relational pathology. The therapeutic alliance is a central issue in therapy and a key factor in the treatment of BPD patients. However, there is limited research on the therapeutic alliance in this population, and the impact of the alliance on patients with personality disorders (PDs) has been shown to be six times higher than for other patient groups. The research also aimed to establish reliable integrity measures for mentalization-based treatment (MBT), an evidence-based treatment for BPD. The study used a variety of methods, including generalizability theory, purposeful sampling, and linear mixed models, to examine the reliability and effectiveness of MBT and the development of the therapeutic alliance over time in MBT for BPD patients. The results showed that MBT is a reliable and effective treatment for BPD, and that the therapeutic alliance is a key factor in the success of MBT for BPD patients. The study also found that aspects of the therapeutic alliance, such as goals, tasks, and bonds, develop over time in MBT and that these changes are associated with clinical outcomes. Overall, the research suggests that the therapeutic alliance is a crucial factor in the treatment of BPD and that it is important to consider the role of the therapeutic alliance in the development and implementation of evidence-based treatments for BPD.

The thesis discusses the importance of the therapeutic alliance and epistemic trust in the treatment of BPD using MBT. Epistemic trust refers to the ability to trust someone else's knowledge about the world, which is an essential part of the "strong alliance" in therapy. The text suggests that in order to foster epistemic trust, therapists should provide new and corrective experiences and offer direct feedback to their clients. MBT emphasizes the teaching aspect of therapy and focuses on fostering a not-knowing exploration, in which the patient learns how to learn and trusts their new knowledge at a deeper level. The text also discusses the role of countertransference in the therapeutic relationship, and how the therapist's own feelings and reactions can impact the alliance. It is suggested that therapists should be able to tolerate the patient's negative emotions and thoughts, and be able to withhold their own opinions and solutions in order to allow the patient to understand and change. Overall, the text emphasizes the importance of the therapeutic alliance and epistemic trust in the treatment of BPD and suggests that incorporating pedagogy and strategies to foster these elements can be effective in improving outcomes for BPD patients.

This dissertation discusses the importance of providing a sense of understanding and agency in the treatment of BPD. It suggests that helping patients feel understood and having a sense of agency is a powerful and essential part of psychotherapy, and can lead to the restoration of feelings of selfhood. The text also emphasizes the importance of the therapist adopting a not-knowing or inquisitive stance, in which they listen to the patient and communicate a sense of respect and interest in what the patient has to say. This can help enhance the patient's sense of being understood. The text also discusses the importance of the therapist having a greater understanding of the patient's problem, in order to be able to guide them towards a more accurate understanding of reality and help them find the path from error to truth. Overall, the thesis emphasizes the importance of providing a sense of understanding and agency in the treatment of BPD and suggests that adopting a not-knowing stance and having a deeper understanding of the patient's problem can be effective in improving outcomes for BPD patients.

One strength of the research is that it used a variety of methods, including generalizability theory and linear mixed models, to examine the reliability and effectiveness of MBT and the development of the therapeutic alliance over time in MBT for BPD patients. However, there are several limitations to the generalizability of the findings. For example, the study only rated a small number of treatment sessions per therapist, which could artificially increase inter-rater conformity. Additionally, the raters were not blinded to the treatment modality, so the observed differences between therapies cannot be exclusively interpreted as reflecting the discriminant validity of the scale. There are also limitations to the study's use of the Working Alliance Inventory (WAI), as two different versions of the WAI were used, which may have affected the alliance ratings. Finally, the study was conducted in a specialized clinic, which may limit the generalizability of the findings to other treatment settings. Despite these limitations, the research suggests that the therapeutic alliance is a crucial factor in the treatment of BPD and that it is important to consider the role of the therapeutic alliance in the development and implementation of evidence-based treatments for BPD.

My doctoral dissertation can be downloaded here:

Measuring MBT – A marriage of the common and specific psychotherapy factors