Rupture resolution in cognitive analytic therapy for adolescents with borderline personality disorder

Abstract

Background: Ruptures are potential change events in therapy that might result in positive or negative consequences for the therapeutic alliance and outcome. Alliance ruptures and premature drop-out are common with clients diagnosed with borderline personality disorder, limiting treatment effectiveness.

Objective: To test a nine stage model of rupture resolution in cognitive analytic therapy (CAT) with adolescents.

Method: The validation phase of task analysis was employed to test the rupture resolution model and to relate handling of ruptures to outcome using quantitative and qualitative analysis of transcripts. Eighteen ruptures and resolution attempts were intensively examined across three good and two poor outcome sessions, as rated by clients. The number of model stages employed by therapists was related to outcome.

Results: Sessions evaluated as poor or good by clients could be distinguished according to the extent to which therapists used model stages. Treatment outcome was significantly associated with number of model stages included by therapists.

Conclusion: Competent resolution of ruptures in CAT is dependent on therapists' inclusion of stages of the model, providing validation for the model, and demonstrating that effective rupture resolution might be related to treatment outcome. Ruptures and their resolution are likely to be key events in psychotherapy process.