Abstract
Objective: To examine conformity to prototypical therapeutic principles and its relation with change in reflective functioning in 3 treatments for borderline personality disorder (BPD). Method: Early phase videotaped sessions from a randomized-controlled trial of year-long transference-focused psychotherapy (TFP; n = 27), dialectical behavior therapy (DBT; n = 26), and supportive psychodynamic therapy (SPT; n = 29) were coded using the Psychotherapy Q-sort (Jones, 1985). Ratings were compared to experts’ ratings of ideal TFP, DBT, and mentalizing-enhancing principles to quantify conformity to ideal treatments. Reflective functioning was assessed at pre- and posttreatment. Differences among treatments in conformity and its relation with change in reflective functioning were examined. Results: Conformity to TFP and mentalizing-enhancing principles was highest in TFP (ps <.01) while conformity to DBT principles was high in DBT and SPT (DBT vs. SPT: p >.40), but lower in TFP (ps <.01). Larger improvements in reflective functioning were predicted by higher conformity to TFP principles during TFP (p =.04) and higher conformity to mentalizing-enhancing principles during SPT (p =.02). Conclusions: Treatments for BPD differ in conformity to unique principles of specific modalities. Treatments also differ in the processes that predict increase in reflective functioning. The findings point to specificity and multiple pathways in increasing reflective functioning in the treatment of BPD.
| Original language | English |
|---|---|
| Pages (from-to) | 975-988 |
| Number of pages | 14 |
| Journal | Journal of Consulting and Clinical Psychology |
| Volume | 87 |
| Issue number | 11 |
| DOIs | |
| State | Published - Nov 2019 |
| Externally published | Yes |
Bibliographical note
Publisher Copyright:© 2019. American Psychological Association.
Funding
John F. Clarkin receives royalties from a book published by American Psychiatric Publishing. All other authors report no conflicting interests. This research was supported by grants from the National Institute of Mental Health, International Psychoanalytic Association, the American Psychoanalytic Association, the Research and Graduate Studies Office (RGSO) in the College of the Liberal Arts at the Pennsylvania State University and the Kohler Fund of Munich awarded to Kenneth N. Levy, and a grant from the Borderline Personality Disorder Research Foundation (BPDRF) awarded to Otto F. Kernberg. Preparation of this article was also supported by grants from the Fulbright program (PI: Yogev Kivity), The American Psychoanalytic Association (PI: Yogev Kivity), The International Psychoanalytic Association (PI: Yogev Kivity, co-PIs: Kenneth N. Levy & John F. Clarkin), and The American Psychological Association, Division 29 (PI: Yogev Kivity, co-PIs: Kenneth N. Levy & John F.
| Funders | Funder number |
|---|---|
| Borderline Personality Disorder Research Foundation | |
| Fulbright Program | |
| Kohler Fund of Munich | |
| National Institute of Mental Health | |
| American Psychoanalytic Association | |
| American Psychological Association | |
| Pennsylvania State University | |
| International Psychoanalytical Association |
Keywords
- Borderline personality disorder
- Dialectical behavior therapy
- Psychotherapy Q-sort
- Supportive psychodynamic therapy
- Transference-focused psychotherapy
