Evaluating an alliance-focused treatment for personality disorders.

Abstract

This paper presents a study with the aim of evaluating the relative efficacy of an alliance-focused treatment, brief relational therapy, in comparison to a short-term dynamic therapy and a cognitive-behavioral therapy on a sample of highly comorbid personality disordered patients. Results indicated that the three treatments were equally effective on standard statistical analyses of change, including those conducted on repeated measures and residual gain scores. Some significant differences were indicated regarding clinically significant change and reliable change, favoring the brief relational and cognitive-behavioral models. There was also a significant difference regarding dropout rates, favoring brief relational therapy.

The development of the therapeutic alliance and the emergence of alliance ruptures. [El desarrollo de la alianza terapéutica y la aparición de rupturas en la alianza]

“…The fact that Axis II patients started therapy with lower WAI scores and higher confrontation and withdrawal scores is consistent with previous theoretical and empirical evidence showing that there is a high likelihood of ruptures with such clients (Benjamin & Karpiak, 2001;Muran, Segal, Samstag, & Crawford, 1994), and personality disordered patients benefit the most from therapeutic interventions focused on alliance negotiation (Muran, Safran, Samstag, & Winston, 2005). In a qualitative study in which we explored the experience of rupture episodes of therapists and their patients with personality disorders we found that unresolved ruptures had a strong negative impact on the alliance and on the client.…”

“…Tryon and Kane (1995) also found that weakened alliances were associated with dropped cases. In addition, Muran, Safran, Samstag, and Winston (2005) found that patients in brief relational therapy (BRT), which focuses on the repair of alliance ruptures, had significantly lower dropout rates as compared to patients who received CBT. It is important to note that because we did not evaluate therapist interventions or therapist contributions to detected ruptures, we cannot confirm this possibility that the therapists were unable to resolve ruptures in unsuccessful and dropped cases.…”

“…Personality disordered patients constitute a group of patients in which the emergence of alliance ruptures is not only more likely to occur (Benjamin & Karpiak, 2001;Muran, Segal, Samstag, & Crawford, 1994), but also more beneficial to the treatment process, when they are efficiently resolved (Muran, Safran, Samstag, & Winston, 2005). On the contrary as a previous study has shown, when not adequately addressed, ruptures may lead to the repetition in the therapeutic interaction of the patient's typical dysfunctional interpersonal cycle (Coutinho, Ribeiro, Hill, & Safran, 2011).…”

Avaliação de resultados da psicoterapia psicanalítica

“…Através de um rastreamento do número de sessões utilizado em pesquisas de tratamentos psicodinâmicos de curta duração realizadas a partir do ano 2000 [28][29][30][31][32][33][34][35][36][37][38][39] e que apontam um amplo espectro de uma a 63 sessões, foi possível chegar ao número mínimo de 18 sessões, e cinco pacientes foram incluídos com essa freqüência.…”

Do personality problems improve during psychodynamic supportive–expressive psychotherapy? Secondary outcome results from a randomized controlled trial for psychiatric outpatients with personality disorders.

“…Few of these studies included measures assessing core PD pathology. For example, interpersonal problems, often considered a major aspect of PD pathology, were assessed in only two psychodynamic studies (Bateman & Fonagy, 2001Muran, Safran, Samstag, & Winston, 2005). Furthermore, measures theoretically relevant to the goals of psychodynamic psychotherapy (e.g., reflective functioning and levels or forms of attachment) have surprisingly rarely been used (for an exception see Levy et al, 2006).…”