Therapists' accounts of psychotherapy process associated with treating patients with borderline personality disorder

Abstract

Frequent reports in the clinical literature indicate that mental health professionals experience interpersonal challenges and emotional distress when providing treatment for patients with borderline personality disorder (BPD). The present study aimed to empirically investigate the clinical experience of therapists (N = 20) treating patients with BPD (N = 40) compared to treating patients with major depressive disorder (MDD; N = 40). Prominent concepts and themes in therapists' verbal descriptions of therapeutic process were examined using content analysis software. The Psychotherapy Relationship Questionnaire (PRQ) indexed therapists' perceptions of patients' relational patterns. Results revealed that therapists expressed greater emotional distress and an increased need for supportive supervision in their clinical work with patients with BPD. Therapists perceived patients with BPD as presenting with higher hostile, narcissistic, compliant, anxious, and sexualized dimensions of interpersonal responses than patients with MDD. Using structured research tools, the authors were able to elaborate and validate the interpersonal challenges and clinical stress experienced by therapists working with patients with BPD.