No abstract

This study explores the relationship between psychotherapists' validation interventions and patients' metacognitive responses at the beginning of treatment of borderline personality disorder (BPD). A model of BPD based on disorganized attachment provides the hypothesis that, before patients' internal working model of attachment has been corrected within the therapeutic relationship, therapist interventions that are likely to activate patients' attachment system are also likely to induce temporary disorganization of patients' metacognitive functions. Any validation intervention implies that therapists openly display an understanding and accepting attitude when they comment on patients' reported experiences and is, therefore, likely to activate the patients' attachment system. Linehan's (1993) manual of dialectic-behavioral therapy (DBT) was used as a guideline to assess validation interventions adopted by therapists. The transcripts of the second individual session in the psychotherapy of 19 consecutive patients were analyzed. Checklists based on the DBT manual were used to identify therapists' validating, supportive, and neutral interventions. The Metacognitive Assessment Scale was used to assess changes in specific aspects of patients' metacognitive processes during therapeutic dialogues. Following validation interventions, patients' responses revealed significantly higher rates of temporary metacognitive failure in comparison to the responses solicited by neutral intervention.

Future research should examine whether clinical techniques aimed at reducing rumination are helpful for reducing aggressive and other dyscontrolled behaviours in treating patients with BPD.

Patients with borderline personality disorders (BPD) show heightened negative affect and maladaptive emotion-regulation strategies. An individual's time perspective towards the past, present, and future as well as the feeling of time passage are strongly related to affect and emotion regulation. We therefore assessed the time perspective (Zimbardo Time Perspective Inventory, ZTPI) and the subjective passage of time for present and past time intervals (Subjective Time Questionnaire, STQ) in 17 patients with BPD between the ages of 18 and 52 and 17 control subjects matched for gender, age and education. Patients with BPD show deviations in nearly all time orientations in the ZTPI: lower scores in the future and the past-positive dimension and higher scores in the present-fatalistic and past-negative dimensions. Patients deviate significantly more than controls from a balanced time perspective (BTP). Regarding the STQ, patients with BPD feel a general expansion of time at present but not for past intervals. Taken together, we show how BPD can be understood as a strong imbalance in individual time orientations and a most likely negatively felt expansion of subjective time in daily life.

Assessing Interpersonal Motivations in Transcripts (AIMIT) is a coding system aiming to systematically detect the activity of interpersonal motivational systems (IMS) in the therapeutic dialogue. An inter- and intra-rater reliability study has been conducted. Sixteen video-recorded psychotherapy sessions were selected and transcribed according to the AIMIT criteria. Sessions relate to 16 patients with an Axis II diagnosis, with a mean Global Assessment of Functioning of 51. For the intra-rater reliability evaluation, five sessions have been selected and assigned to five independent coders who where asked to make a first evaluation, and then a second independent one 14 days later. For the inter-rater reliability study, the sessions coded by the therapist-coder were jointly revised with another coder and finally classified as gold standard. The 16 standard sessions were sent to other evaluators for the independent coding. The agreement (κ) was estimated according to the following parameters for each coding unit: evaluation units supported by the 'codable' activation of one or more IMS; motivational interaction with reference to the ongoing relation between patient and therapist; an interaction between the patient and another person reported/narrated by the patient; detection of specific IMS: attachment (At), caregiving (CG), rank (Ra), sexuality (Se), peer cooperation (PC); and transitions from one IMS to another were also scored. The intra-rater agreement was evaluated through the parameters 'cod', 'At', 'CG', 'Ra', 'Se' and 'PC' described above. A total of 2443 coding units were analysed. For the nine parameters on which the agreement was calculated, eight ['coded (Cod)', 'ongoing relation (Rel)', 'narrated relation (Nar)', 'At', 'CG', 'Ra', 'Se' and 'PC'] have κ values comprised between 0.62 (CG) and 0.81 (Cod) and were therefore satisfactory. The scoring of 'transitions' showed agreement values slightly below desired cut-off (0.56). Intra-rater reliability was very good (κ values for Cod = 0.90; κ for all IMS = 0.78). Data seem to support the validity of the AIMIT method in terms of reliability, and encourage to further implementation of the AIMIT approach.