The Effect of Therapist Interventions on the Therapeutic Alliance with Borderline Patients

Abstract

The authors draw attention to the problems of establishing and maintaining a therapeutic alliance in the psychotherapy of the borderline patient. They elaborate an extensive methodology designed to study the manner in which shifts in collaboration occur in response to therapist interventions. This report demonstrates how one particular borderline patient increased his ability to collaborate with the therapist in response to a transference focus in the psychotherapy. Methodological problems are noted as are directions for future research. Only a series of patients studied with this or with similar methodology will allow for a sophisticated and empirical rationale for choosing a particular form of psychotherapy for a particular kind of borderline patient.

Psychodynamic psychotherapy of borderline personality disorder: A contemporary approach

“…While Kernberg (1975), for example, has advocated early interpretation of transference, others, such as Zetzel (1971), have argued for a supportive ego-building approach at lower frequency. To study these different viewpoints, the Menninger Treatment Interventions Project (TRIP) studied process material from three cases of extended psychoanalytic psychotherapy of borderline patients at The Menninger Clinic (Gabbard et al, 1988Horwitz et al, 1996). Two sets of investigators worked from typed transcripts of randomly selected psychotherapy hours that were audiotaped.…”

The Relationship Between Agreeableness and the Development of the Working Alliance in Patients with Borderline Personality Disorder

“…Despite the importance of the alliance with BPD patients, there are a number of challenges inherent in establishing such a relationship. In particular, the relational instability associated with BPD diagnosis can have a negative impact on the development and maintenance of a working alliance between patient and therapist (Frieswyk et al, 1986;Gabbard et al, 1988;Taft, Murphy, Musser, & Remington, 2004). Nonetheless, patients with BPD who develop an effective alliance are more likely to see positive treatment outcomes as a result of therapeutic interventions (Marziali, Munroe-Blum, & McCleary, 1999;Yeomans et al, 1994).…”

Relational Mental Health: Beyond Evidence-Based Interventions

“…Gabbard et al (1988) tried to make this conception compatible with the psychoanalytical viewpoint, and compared the self-directedness factor with the self-esteem factor; self-coherence with representations of the self and ego functions; cooperation with internal relations of the externalised object in interpersonal relationships; and self-transcendence with sublimation and altruism.…”