Shari E. Goldstein, Fielding's School of Psychology
The goal of improving therapy experiences for individuals diagnosed with borderline personality disorder (BPD) requires that the relationships between this patient population and the clinicians who treat them be better understood (Clearly, Siegfried, & Walter, 2002; Commons-Treloar, 2009; Westen, 1990). Though studies suggest that the therapy relationships of BPD-diagnosed patients are unusually fraught with miscommunications and mutual feelings of frustration and dissatisfaction (Clearly, Siegfried, & Walter, 2002; Fallon, 2003; Muller & Poggenpoel, 1996; Nehls, 1999), little is known about how these tensions develop, particularly from the viewpoint of the patients. The purpose of this qualitative study was to explore the interpersonal therapy experiences of seven female participants previously diagnosed with BPD using participants’ narratives as the primary data source. An additional purpose was to consider the impact of participants’ object relations patterns on their therapy relationship experiences. Prominent interpersonal patterns were identified from three sources--participants’ narratives, results from the Core Conflictual Relationship Theme-Relationship Anecdotes Paradigm (CCRT-RAP) interview (Luborsky, 1990), and my interpersonal reactions to each participant. The results were analyzed by participant and by group. Identified object relations patterns contributed significantly to each participant’s interpersonal therapy experiences, including experiences of alliance ruptures and outcomes. Sustainability of therapy relationships was closely linked to participant reports of how their therapists responded to interpersonal tensions. As a group, the seven participants desired therapists who demonstrated caring and kindness and who joined them in their experiences through a deep form of listening and validation. These conditions were necessary but not adequate for the development of a healing alliance. Participants also desired clinicians who were confident, skilled, knowledgeable about BPD, and who maintained a collaborative approach, balancing strength with flexibility. Therapist neutrality, withholding, and inactivity were experienced as aversive and participants expressed a desire for explicit evidence of clinician humanity. Though participants were aware of the stigma associated with BPD, especially within the mental health community, they experienced relief and hope in receiving a diagnosis. The results support further investigation into how identified object relations patterns can assist clinicians in developing more intricate conceptualizations of client interpersonal experiences and how these may serve to moderate counter-therapeutic experiences. The significance of therapist contributions to what develops in the interpersonal context is also highlighted.
Key words: borderline personality disorder, therapy relationships, narrative research, object relations, intersubjectivity, reflexivity