This study found that significant events in therapy were characterized by high levels of both emotional and cognitive language, and alliance strengthening. Linguistic analysis methods provide important data on psychotherapeutic processes which can be useful in guiding clinicians and improving treatment outcomes.

Background No known recent studies have investigated service provision for personality disorder in Australia, despite international studies suggesting provision of such services is sub-optimal. Aims This study aimed to gain insight into psychotherapy provided for personality disorders, treatments considered optimal by clinicians and opinions of clinicians on the current levels of care. Methods The views of 60 experienced clinicians working with personality disorders were sampled. Results Data showed significant gaps between current practices for the treatment of personality disorders provided by clinicians compared to their perceptions of optimal treatment practice. Conclusions This study highlights the evidence-practice gap and the need for more training for clinicians in the treatment of personality disorders and service improvements to implement optimal care strategies.

Psychodynamic change is understood to occur in part through the unique therapeutic relationship developed between therapist and patient, and the subtle cycles of their conversation from relaxed connection to intense experiencing. The Therapeutic Cycles Model (TCM) (Mergenthaler, 1996 ) and Heidelberg Structural Change Scale (HSCS) (OPD Task Force, 2008 ) were used to investigate therapist-patient dynamic processes across 16 sessions of psychotherapy. The TCM identified interventions of the therapist instigating change in emotion-abstraction patterns. Structural personality change was higher in TCM cycles, and differed according to emotion-abstraction patterns. The interventions of the therapist promoted dynamic structural change in the patient. The findings demonstrate for the first time the interconnection between specific types of therapist and patient dialogue that promote deep changes.