Search

Introduction: The aim of this proof-of-concept multimethod exploratory single case study is to increase knowledge of the underlying mechanisms of alliance ruptures and repairs in Borderline Personality Disorder treatment across and within the psychotherapeutic treatment process. Method: The multimethod includes outcome assessment of patient self-reporting questionnaires (the Affect Integration Inventory, the Hopkins Symptom Checklist), observation-based ratings of sessions with the Rupture Resolution Rating System, quantitative analysis of heart rate variability using recurrence quantification analysis, and a qualitative multimodal interaction analysis of within-session dynamics. Result: Results reveal how patterns of heart rate synchrony between patient and therapist reflect periodical patterns of emotional interaction corresponding to key therapeutic alliance processes throughout the treatment process. Particularly, heart rate synchronization and desynchronization correspond with increasing rupture resolution ratings and positive outcome measures in the last part of the therapy process, indicating increased productivity, affectivity, and positive change. The qualitative microanalysis highlights context sensitivity to alliance management within sessions. Physiological arousal is found to underlie important alliance processes, including emotion regulation, relatedness, security, empathic responding, sense-making, and validation in correspondence with different therapist verbal and non-verbal markerbs. Discussion: Clinical implications and study limitations are discussed. Recommendations are made for future directions in relation to applying multimethod approaches when studying rupture and repair processes in psychotherapy. [ABSTRACT FROM AUTHOR]

Objectives: Treatments for borderline personality disorder (BPD) and post‐traumatic stress disorder (PTSD) are less effective for patients with co‐occurring symptoms of both disorders, who are considered to have complex PTSD (cPTSD), compared with patients with either condition alone. Evidence suggests that co‐occurrence of symptoms indicates greater impairment in mentalizing. This study examines evidence for targeting mentalizing when treating individuals with co‐occurring symptoms, irrespective of their exposure to developmental trauma and, for the first time, investigates the mediational role of mentalizing in the associations between BPD symptomatology and cPTSD. Design: We identified in a routine clinical service a group of patients with BPD, with or without co‐occurring symptoms of PTSD. We hypothesized that patients with co‐occurring symptoms and a history of childhood maltreatment will show more severe clinical profiles and greater mentalizing problems, which in turn lead to symptoms consistent with cPTSD. Method: Clinical profiles of 72 patients with BPD (43 with and 29 without co‐occurring symptoms of PTSD; mean age in both groups 28 years, 79% and 83% female, respectively) were identified using the Structured Clinical Interview for DSM‐IV Axis II Disorders. Patients completed self‐report measures of BPD and PTSD symptoms, well‐being, dissociation and reflective functioning. Childhood trauma histories were evaluated. Results: Compared with patients with BPD‐only, those with co‐occurring BPD and PTSD showed greater severity in terms of BPD and dissociative symptoms, met a broader range of BPD diagnostic criteria, had a greater sense of personal worthlessness and self‐evaluated their well‐being as considerably diminished. This group was also more inclined to recall increased instances of childhood sexual abuse. In a mediation analysis, mentalizing acted as a partial mediator for the relationship between BPD severity and cPTSD, as well as between dissociative symptoms and cPTSD. Interestingly, mentalizing did not mediate the relationship between childhood sexual abuse and cPTSD. Conclusions: Overall, the correlational findings are consistent with an intended focus on mentalizing to treat cPTSD symptoms in individuals who also meet criteria for a diagnosis of BPD. [ABSTRACT FROM AUTHOR]

Trauma-Focused mentalization-based treatment (MBT-TF) is an adaptation of mentalization-based treatment (MBT) specifically developed for patients suffering from attachment or complex trauma, with the possibility of co- occurring borderline personality pathology. The creation of MBT-TF was driven by previous research and observations that interventions centered on mentalizing could be significantly improved by directly addressing the impact of trauma. MBT-TF aims to mitigate symptoms that arise post-trauma, such as hyperarousal, hypervigilance, intrusions, flashbacks, avoidance behaviors, dissociative experiences, negative perceptions of self and others, and ensuing relational difficulties. Implemented as a group intervention, MBT-TF typically spans 6-12 months. From a mentalizing perspective, trauma, particularly attachment trauma, leads to a failure in processing the effects of trauma through and with others. Stress and attachment behavioral systems are disrupted, which undermines the capacity for epistemic trust, and impairs mentalizing abilities. This paper offers a concise summary of the reasoning for MBT-TF's creation, its theoretical underpinnings, and its clinical strategy for addressing the adverse impacts of trauma. It further details the treatment phases, their main goals, and their interventions, supplemented by clinical case examples that underscore MBT-TF's distinctive attributes and frequent clinical hurdles. [ABSTRACT FROM AUTHOR]