Borderline personality disorder level predicts change in depressiveness after short‐term group psychotherapy: A study in a daily psychiatric clinic

The project examined the comorbidity between depression symptoms and the level of borderline personality organisation among patients admitted for group psychotherapy (Study 1). It also aimed to analyse how the level of borderline personality organisation relates to the reduction in depression symptoms after short‐term psychotherapy (Study 2). The study was conducted in a day clinic where patients were receiving psychotherapy for emotional problems affecting their functioning (N = 57). The study used the Borderline Personality Inventory (BPI) and the Patient Health Questionnaire. The analysis showed that BPI was positively related to depression symptoms. The higher borderline personality organisation patients presented when entering group psychotherapy, the greater was the decrease in depression symptoms after 3 months of psychotherapy. We discuss the results in relation to the notion that the presence of depression could be a positive prognostic indicator for patients with borderline personality.     

Structural models of psychotherapy groups and their effect on inpatients with borderline personality disorders: Patients' perceptions

This research compares the way in which various group structural models affect self-understanding, interpersonal relationships and catharsis in hospitalized patients with borderline personality disorders. Each of the models is characterized by a different combination of group focus and leadership style. Three psychotherapy groups were chosen as paradigms: the dynamic psychotherapy group; the therapeutic games group, and psychodrama group. Sixty three inpatients with borderline personality disorders participated in the study. The one-way ANOVA yielded significant differences between the group models. Results of the post-hoc t-test showed that the dynamic and the games groups were perceived by the patients as more beneficial than psychodrama.     

Some comments on the role of cotherapists in group psychotherapy with borderline patients

This paper points out examples of patients in a psychotherapy group who meet DSM-III criteria for the diagnosis of borderline personality disorder and who are treated by cotherapists utilizing object relations theory. Interpretations of phenomena shown by borderline patients—splitting, projective identification and denial—are illustrated. How cotherapy lends itself to the recognition and management of the problems these patients bring to group psychotherapy is illustrated.Hope Aspell assisted in the editing of this paper.     

Group psychotherapy with borderline patients: Contrasting remainers and dropouts

Borderline patients present major treatment difficulties in almost every treatment modality. The reason borderlines drop out or fail to benefit from therapy are obscure. Some findings points to the important factor of therapist and patient fit. In the present study, two therapy groups with borderline patients were followed for 20 months. In the study, the therapists were found to individualize the process and their interventions were found to be unevenly distributed among future remainers and dropouts especially during periods of group instability. The results were interpreted along with the Pygmalion hypothesis, that is, that the fit and the therapists' perceived trustworthiness were crucial factors for group psychotherapy outcome for borderline patients.     

Combined group and individual treatment for the borderline patient

This article discusses the attenuating mechanisms of group psychotherapy that support and enhance analytic work with borderline patients in combined group and individual psychotherapy. A group case study is presented which addresses the manifestations and management of transference and countertransference in a combined treatment approach. Combined treatment was observed to respond effectively to both the intrapsychic and interpersonal difficulties of borderline patients. A multidimensional model for treating these patients in a community mental health setting is proposed.     

The problem of reinterpretive distortions in group psychotherapy with borderline patients

Group psychotherapy with borderline patients is challenging work. A group in which the core of patients falls within this nosological category is described. The phrase reinterpretive distortion is used to characterize an aspect of these patients' communication style which makes their effective treatment quite difficult. Examples of the phenomenon are offered, as is an explanation of the dynamics which give rise to it and the functions it seems to serve. Effective ways to deal with reinterpretive distortions in the group psychotherapy context are suggested.     

Making room: Developing reflective capacity through group analytic psychotherapy – in the analyst and in the group. Part one

Abstract

This paper is in two parts. This, the first part, traces the inter-related development of trainee group analyst and training group during the first nine months of the group's life. The influence that personal group analytic psychotherapy, supervision and theoretical learning have on the trainee are also considered in relation to the development of the group and its members, many of whom suffer from narcissistic and borderline disorders. The metaphor of ‘making room’ is used to explore the efforts of analyst and group to contain the chaotic, confused and unbounded projective identifications of its members. In this way, amidst the crowded turbulence of the group, a space begins to open up in which, slowly and painfully, the capacity for reflection may emerge.     

Cultural Psychotherapy: A Consideration of Psychosocial Class and Cultural Differences in Group Treatment

Most psychotherapists are aware of the many social issues and cultural factors that influence development throughout each individual life. Human nature, being a social nature, exists within relationships to others, the community, and a culture, sometimes a mixture of cultures. One social parameter, social class, redefined here as psychosocial class, has not received the same attention from psychotherapists as gender issues or ethnicity, two other important sociocultural spheres of influence on everyday life. It is suggested that group therapists are in a unique position to develop a cultural psychotherapy that addresses psychosocial class and cultural aspects of mental health. This paper includes a preliminary model of cultural psychotherapy that highlights the psychology of social class and culture for psychodynamic group psychotherapy.     

The developing ego in group psychotherapy

Analytic group psychotherapy offers the potential for developing ego functions and enhancing identity formation. The nature of the interaction in group psychotherapy forces participants to deal with their perception of reality and revise their perceptions. After a brief review of the literature, focusing on the theoretical basis and ego development in analytic group psychotherapy, the paper discusses the following ego functions and gives an example of each: adaptation to reality, judgment, drive control, object relations (relationships with others), thought process and communication, defenses, affect differentiation, autonomy, mastery-competence, regulation of self-esteem, and frustration tolerance. The paper concludes with an example of assessing ego functions from a clinical vignette taken from one group psychotherapy session.     

The Development,Process, and Evaluation of Group Psychotherapy With Sexually Abused Preschool Girls

The development, process, and evolution of group psychotherapy specifically designed for sexually abused preschool aged females is presented. Utilization of male and female cotherapists, group structure, individual and family dynamics, the role of children's mothers in treatment, and process of treatment are examined. Issues regarding countertransference phenomena, cotherapy relations, in-depth involvement of the children's mothers, and specifics related to structuring of a time-limited group are beyond the initial intent and scope of this paper, and are not discussed here.

The cotherapists conclude that group psychotherapy for children of this age group is both clearly valuable and highly indicated as an adjunct treatment modality. In future group psychotherapy with sexually abused preschool aged children, based upon clinical experience and evaluation, the cotherapists advocate a time-limited approach whereby each session would focus upon specific issues as illustrated in Table 1, and include structured and purposeful involvement of the girls' caretakers.     

Assessing personality change in psychotherapy with the SWAP-200: a case study

Many studies document the efficacy of psychotherapy for acute syndromes such as depression, but less is known about personality change in patients treated for personality pathology. The Shedler-Westen Assessment Procedure (SWAP-200; Westen & Shedler, 1999a, 1999b) is an assessment tool that measures a broad spectrum of personality constructs and is designed to bridge the gap between the clinical and empirical traditions in personality assessment. In this article, we demonstrate the use of the SWAP-200 as a measure of change in a case study of a patient diagnosed with borderline personality disorder. We collected assessment data at the start of treatment and after 2 years of psychotherapy. The findings illustrate the personality processes targeted in intensive psychotherapy for borderline personality.     

The Object Relations Technique by Herbert Phillipson

AIDS has a unique set of characteristics that makes group psychotherapy more complex than with other populations: (1) the threat of an early death, (2) a highly variable course of illness, and (3) stigma related to the illness and to the preexisting lifestyles of most patients. The specific ways in which the three factors seriously interfere with establishing and maintaining group cohesion are discussed, and clinical guidelines are suggested. In addition, a model for understanding and working with these and other issues in group psychotherapy, based on Erik Erikson's interpersonal theory of development, is presented. Finally, particular countertransferential difficulties are discussed in relation to the heightened emotionality common to AIDS psychotherapy groups.     

Symbolization of experience in the process of group development

This paper applies some of the concepts of the theory of experiencing (as developed within the client-centered school of thought) to psychotherapy process in the small group. The ideas of Rogers and Gendlin regarding how change occurs in psychotherapy are applied to the process of development in the group-as-a-whole. The role of perception and symbolization of experience in the process of group development is examined. A case example from group psychotherapy is used to illustrate the process of formation, the change of shared perceptions among the group members, and the importance of these perceptions to the functioning of the group.     

The effect of therapist interventions on the therapeutic alliance with borderline patients

The authors draw attention to the problems of establishing and maintaining a therapeutic alliance in the psychotherapy of the borderline patient. They elaborate an extensive methodology designed to study the manner in which shifts in collaboration occur in response to therapist interventions. This report demonstrates how one particular borderline patient increased his ability to collaborate with the therapist in response to a transference focus in the psychotherapy. Methodological problems are noted as are directions for future research. Only a series of patients studied with this or with similar methodology will allow for a sophisticated and empirical rationale for choosing a particular form of psychotherapy for a particular kind of borderline patient.     

REFLECTIVE BORDERLINE GROUP THERAPY: THE PATIENTS' EXPERIENCE OF BEING BORDERLINE

This paper describes a novel 20-week psycho-educational group therapy for borderline patients. The therapy aims to stabilize the disorganized and chaotic presenting behaviours of the patients when they enter the borderline treatment service by providing a group psycho-educational programme based upon a psychodynamic appreciation of symptoms, causes, defences and affects. We think that borderline patients will only take in such understandings if they feel listened to and understood in a way that may not have been available to them as children. To do this, the therapists need to create a reflective space underpinned by psychodynamic thought and respecting the patient's experience of being borderline. The paper illustrates the difficulties encountered and discusses the importance of containing or modifying the counter-transference stresses felt by the therapists.

The authors also report on some recent outcome data collected from the running of the group programme over the last 4 years. Twenty borderline patients were able to complete the pre- and post-treatment self-report questionnaires. The results indicate some positive signs in extra-punitive symptom control and levels of impulsivity. Significant levels of improvement were noted in the BSI total scores (p=0.048) with particular reduction in interpersonal sensitivity (p=0.007) and the hostility (p=0.008) sub scores. Patients also reported a reduction in ‘feeling like’ scores on the Multi Impulsivity Scale – reflecting an improvement in internal affect triggers that might result in impulsive behaviours.

The authors discuss the potential value of this pragmatic model of care that is underpinned by psychoanalytic thinking, and its application to managing long waiting lists in psychotherapy services for borderline patients.     

Changes of attachment status among women with personality disorders undergoing inpatient treatment

Background: Attachment has increasingly received attention in psychotherapy and has been used as a predictor of process and outcome. Studies investigating changes of attachment styles during psychotherapy are very rare. Method: Forty women with either borderline (BPD) or avoidant personality disorders (AVPD), treated as inpatients, were investigated using an attachment interview (interpersonal relations assessment (IRA)), and questionnaires to determine therapy outcome at the beginning and after seven weeks of therapy. The IRA uses similar questions as the adult attachment interview (AAI) and is used as the basis for the adult attachment prototype rating (AAPR), a procedure to assign individuals to prototypical categories of attachment. Results: The study showed that the therapy in general was effective. In contrast to other studies, we did not find many women classified as secure at the end of their therapy. Comparisons of pre‐post‐ratings revealed instead that clients within both subgroups received higher ratings for the avoidant prototypes at the end of therapy, indicating deactivation of attachment. Changes from ambivalent to avoidant attachment were linked with better outcome among women with borderline personality disorder (BPD). Conclusions: This study adds further evidence to the result that attachment styles do not change dramatically during a time‐limited psychological treatment of personality disorder. Instead, the study showed that features of preoccupied/ambivalent attachment were less significant after seven weeks of therapy. For women with BPD, these changes were linked with a more favourable outcome which might reflect a more structured and deactivated attachment status as a result of inpatient therapy.     

Voices from the Inaudible: The Patients Speak by Theodor Reik

Fifty-one inpatients, hospitalized on average for 21 days, were studied by means of discharge debriefing interviews. An unstructured, mandatory, and functionally heterogeneous psychotherapy group was compared with a structured, voluntary, and functionally homogeneous psychotherapy group. Statistical analysis of the patients' valuation of the group psychotherapy experiences and of their rankings of traditional group psychotherapy curative factors were performed. Results demonstrated that group psychotherapy was a highly valued component of the overall inpatient treatment. Structural modifications aimed at increasing the here and now, and interpersonal focus of the group meetings, such as the use of patient agendas and group rehashes, significantly affected the patients' group experiences. A comparison of both types of inpatient groups with an outpatient group psychotherapy sample suggests certain guidelines for the goal setting and conduct of inpatient group psychotherapy, recognizing the specific and heterogeneous needs and capacities of the patients treated.