The shorter the better? A follow-up analysis of 10-session psychiatric treatment including the motive-oriented therapeutic relationship for borderline personality disorder

Kramer, Uëli; Stulz, Niklaus; Berthoud, Laurent; Caspar, Franz; Marquet, Pierre; Kolly, Stéphane; Roten, Yves de; Despland, Jean‐Nicolas

doi:10.1080/10503307.2015.1110635

Cited by 17 publications

(9 citation statements)

References 25 publications

(36 reference statements)

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“…Finally, Pearson's partial correlations were conducted between delta MAS‐R and symptom change during the 6‐month follow‐up (OQ‐45 score at 6‐month follow‐up – OQ‐45 score at discharge), controlling for MAS‐R score at intake and OQ‐45 score at discharge. Analyses were made on n = 20 participants (eight were part of the GPM group and 12 of the GPM + MOTR group), due to missing values at follow‐up (Kramer, Stulz, et al ., ). A negative correlation was found between delta MAS‐R and delta OQ‐45: r = −.403, p = .049, suggesting that the greater the MAS‐R improvement during treatment, the greater the symptom reduction during follow‐up.…”

Section: Resultsmentioning

confidence: 97%

“…The present study represents a secondary process‐outcome analysis based on a RCT (Kramer et al ., , N = 85), using a subsample of a process‐outcome mediation analysis (Kramer, Stulz, et al ., ; N = 57). The study was offered to each adult (between 18 and 65 years of age) addressed to a specialized centre for borderline personality disorder ( BPD ), which was part of an outpatient university psychiatric clinic.…”

Section: Methodsmentioning

confidence: 97%

“…Twenty participants from the Kramer, Stulz, et al . () study were excluded because either the tape‐recorded session was a structured assessment (diagnosis, suicidal risk, addiction) or for other exclusion criteria (presence of a translator or of comorbid head injury).…”

Section: Methodsmentioning

confidence: 99%

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Metacognitive improvement and symptom change in a 3‐month treatment for borderline personality disorder

et al. 2019

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Objectives. Recognizing and reflecting on one's own and other people's mental states represent a major difficulty for patients with borderline personality disorder (BPD). Only recently have studies begun exploring whether these capacities increase with successful therapies and if such an improvement is linked with outcome. The present study investigated whether metacognition would improve and if its improvement was related with symptom change in BPD patients.Design. The transcripts from the first and the penultimate session of a ten-session version of good psychiatric management were analysed with the MAS-R scale in a N = 37 BPD sample. Patients, selected from a previously published RCT (Kramer et al., 2014), were assigned either to the good psychiatric management treatment or to the same treatment with the addition of the Motive-Oriented Therapeutic Relationship (Caspar, 2007), a form of therapeutic relationship based on an individualized case formulation. Symptoms were assessed with the OQ-45.Results. Findings partially support the hypotheses. First, improvement in capacities to understand others' mind, to take a critical distance from one's own rigid and maladaptive beliefs, and to use behavioural and attentional strategies to face adversities is found in both treatment groups. Controlling for marital status, only the ability to differentiate between reality and representations remains significant. Second, no link between metacognitive change and symptom change during treatment is found. However, a link is observed between the increase in metacognition and symptom reduction at 6-month follow-up.Conclusions. Results invite to further investigate the role of metacognition in therapy change through different modalities and in longer-term treatments. Practitioner pointsThe development of metacognitive processes and their links with symptom change were examined during a short-term treatment in 37 borderline patients

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Section: Resultsmentioning

confidence: 97%

Section: Methodsmentioning

confidence: 97%

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Metacognitive improvement and symptom change in a 3‐month treatment for borderline personality disorder

et al. 2019

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“…The treatment followed a manual (Kolly, Kramer, Herrera, Follonier, Maksutaj, Schopfer et al, 2010) which was adapted from the Good Psychiatric Management (GPM; Gunderson & Links, 2014). GPM has shown in earlier studies to be an effective generalist treatment, both for the long-term treatment (McMain, Links, Gnam, Guimond, Cardish, Korman et al, 2009) and in the short-term treatment within a stepped-care approach (Kramer, Kolly, Berthoud, Keller, Preisig, Caspar et al, 2014;Kramer, Stulz, Berthoud, Caspar, Marquet, Kolly et al, 2017). The treatment encompassed the establishment of a psychiatric diagnosis, the development of a treatment focus and discussion of major symptoms and interpersonally relevant situations.…”

Section: Participantsmentioning

confidence: 99%

Change in Emotional and Theory of Mind Processing in Borderline Personality Disorder

Kramer¹,

Kolly

Maillard³

et al. 2018

J Nerv Ment Dis

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Changes in emotion processing (EP) and in theory of mind (TOM) are central across treatment approaches for patients with borderline personality disorder (BPD). Whilst the assessment of EP relies on the observation patient's self-criticism in a two-chair dialogue, individual's TOM assessments is made based on responses to humorous stimuli based on false beliefs. For this pilot study, we assessed eight patients with BPD before and after a three-month long psychiatric treatment, using functional magnetic resonance imaging (fMRI) and behavioral tasks. We observed arousal increase within session of the two-chair dialogue (d = 0.36), paralleled by arousal decrease between sessions (d = 0.80). We found treatment associated trends for neural activity reduction in brain areas central for EP and TOM. Our exploratory findings using an integrative assessment procedure of changes in EP and TOM point towards evidence for treatment effects at the brain systems level related to behavioral modulation.

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“…MOTR is not a distinct treatment form, but a set of therapeutic principles, which determine how to best build a therapeutic relationship and conduct therapeutic interventions, and can be added to any (pharmacological or psychosocial) treatment form . While MOTR has been a demonstrated utility in the treatment of affective disorders (Caspar, Grossmann, Unmuessig, & Schramm, 2005;Kramer, Berger, & Caspar, 2009;Kramer, Rosciano, et al, 2011), post-traumatic stress disorder (Kramer, 2009), and personality disorders (Caspar & Ecker, 2008;Kramer, Berger, et al, 2011;Kramer, Caspar, & Drapeau, 2013;Kramer, Fluckiger, et al, 2014;Kramer et al, 2015), it has not been examined in the treatment of psychosis so far.…”

Section: Introductionmentioning

confidence: 99%

Therapeutic relationship and concordance of client- and clinician-rated motivational goals in treatment of people with psychosis: an exploratory study

et al. 2018

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Addressing motives determining behaviour and experiences of people in treatment for psychosis could improve the therapeutic relationship. This pilot study explored the association between the concordance of clients and clinicians ratings of clients' motivational goals and the therapeutic relationship in the treatment of psychosis. Twenty in-and outpatients with a psychotic disorder in a general psychiatric setting answered measures addressing motivational goals and the therapeutic relationship. Fifteen clinicians rated their clients' motivational goals and psychopathology. The concordance between clients' and clinicians' ratings of approach goals was not associated with clients' ratings of the therapeutic relationship. However, a higher concordance in avoidance goals ratings was significantly correlated with less satisfaction with the therapeutic relationship. This finding might be understood in light of explicit (i.e., conscious) and implicit (i.e., non-conscious) avoidance goals: The more difficulties clinicians had in recognizing their clients' implicit goals, the more they may have only rated and considered the clients' explicit goals. This could have resulted in both a higher concordance rating between clients and clinicians, and less clients' satisfaction with the therapeutic relationship (because of unintended threats for implicit avoidance goals). Future studies with larger samples are needed that separately examine explicit and implicit motivational goals of people in treatment for psychosis.

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The shorter the better? A follow-up analysis of 10-session psychiatric treatment including the motive-oriented therapeutic relationship for borderline personality disorder

Abstract: These results are overall consistent with earlier studies on short-term treatments for BPD and underline the importance of individualizing interventions, by using case formulations that rely on idiographic methods and integrative concepts.

Cited by 17 publications

References 25 publications

Metacognitive improvement and symptom change in a 3‐month treatment for borderline personality disorder

Metacognitive improvement and symptom change in a 3‐month treatment for borderline personality disorder

Change in Emotional and Theory of Mind Processing in Borderline Personality Disorder

Therapeutic relationship and concordance of client- and clinician-rated motivational goals in treatment of people with psychosis: an exploratory study

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