The alliance-outcome association in borderline and obsessive-compulsive personality disorder

Abstract

Personality disorders are considered a possible factor affecting the relationship between therapeutic alliance and therapy outcome. The present study investigated the alliance-outcome effect in patient groups with borderline personality disorder (BPD) and obsessive-compulsive personality disorder (OCPD). Data derived from a sample of n = 66 patients, treated in a day care hospital setting with a dialectical-behavioral and schema therapeutic treatment concept. Patients rated their symptom severity at admission, early alliance after 4–6 therapy sessions and symptom severity as well as alliance at discharge. Results showed no significant differences between BPD and OCPD patients regarding symptom severity and alliance. Multiple regression analyses indicated that the alliance was a significant predictor of symptom reduction, however only in the OCPD group. Our results showed an exceptionally strong alliance-outcome relationship in OCPD patients, suggesting that focusing on building a strong alliance and measuring it early in therapy may be especially beneficial for this patient group. For patients with BPD, a more regular screening of the therapeutic alliance might be helpful.

Personality disorder type only sometimes matters: An exploration of patient's personality disorder as a source of variance in early therapeutic alliance

“…Although the literature indicates that patient's personality disorder strongly differentiates the therapeutic alliance (Beiling et al, 2023; Lingiardi et al, 2005), the current results support this thesis to a small extent only, showing that it applies to BPD patients. In their case, the study yielded the lowest early alliance ratings, significantly different from other groups, both for global alliance and for its dimensions.…”

“…one cluster. Relational dynamics in the professional alliance are most often investigated among BPD (Culina et al, 2023) and OCPD patients (Beiling et al, 2023), while systematic studies of NPD patients are few . The issues raised have not been unambiguously resolved.…”

“…Knowledge about the presence or absence of such differences will allow psychotherapists to refine interventions addressing patients' therapeutic needs (including alliance optimization), facilitate their commitment and anticipate the subsequent trajectories of alliance development (Beiling et al, 2023). After all, the treatment of personality disorders requires balance between treating symptoms and maintaining an appropriate interpersonal relationship with the patient.…”

“…BPD and OCPD patients seem particularly appropriate for this differential analysis of alliance. Representing different DSM-5 clusters, their personality disorders are the most frequent ones in clinical samples and in outpatients (Zimmerman et al, 2005), which makes them important in everyday clinical practice (Beiling et al, 2023).…”

“…Psychotherapy discontinuation rates are higher among personality disorder patients than in other groups (Swift & Greenberg, 2012). It has been observed that particularly dysfunctional interpersonal skills interfere with building a helpful and stable therapeutic relationship, but not in all personality disorders (Beiling et al, 2023). Although the presence of personality pathology strongly predicts weak early cooperation (Sharpless et al, 2010), the dynamics of alliance development may vary depending on personality disorder type.…”