Background: Motive-oriented therapeutic relationship (MOTR) was postulated to be a particularly helpful therapeutic ingredient in the early treatment phase of patients with personality disorders, in particular with borderline personality disorder (BPD). The present randomized controlled study using an add-on design is the first study to test this assumption in a 10-session general psychiatric treatment with patients presenting with BPD on symptom reduction and therapeutic alliance. Methods: A total of 85 patients were randomized. They were either allocated to a manual-based short variant of the general psychiatric management (GPM) treatment (in 10 sessions) or to the same treatment where MOTR was deliberately added to the treatment. Treatment attrition and integrity analyses yielded satisfactory results. Results: The results of the intent-to-treat analyses suggested a global efficacy of MOTR, in the sense of an additional reduction of general problems, i.e. symptoms, interpersonal and social problems (F_{1, 73} = 7.25, p < 0.05). However, they also showed that MOTR did not yield an additional reduction of specific borderline symptoms. It was also shown that a stronger therapeutic alliance, as assessed by the therapist, developed in MOTR treatments compared to GPM (Z₅₅ = 0.99, p < 0.04). Conclusions: These results suggest that adding MOTR to psychiatric and psychotherapeutic treatments of BPD is promising. Moreover, the findings shed additional light on the perspective of shortening treatments for patients presenting with BPD.

Following prescription of weight gain-inducing psychotropic drugs, a 5% threshold for weight gain after 1 month should raise clinician concerns about weight-controlling strategies.

A 20-session dialectical behaviour therapy (DBT)-informed skills training is a promising adjunct intervention for patients with borderline personality disorder, in particular for reducing problems related to social role. Increases in assertive anger mediate the effects of DBT-informed skills training, whereas rejecting anger remains unchanged over the course of treatment. Short-term objectives for intervention might involve the specific increase of assertive anger in BPD, by using DBT-informed skills training; long-term objectives for intervention might involve a specific decrease of rejecting anger in BPD.

Nicolas; de Roten, Yves (2014). Unpacking the effects of therapist responsiveness in borderline personality disorder: motive-oriented therapeutic relationship, patient in-session experience, and the therapeutic alliance. Psychotherapy and Psychosomatics, 83(6):386-387. DOI: https://doi.org/10.1159/000365400 E-Mail karger@karger.com Letter to the Editor ter 10 sessions) in treatments based on the MOTR for BPD. We hypothesized that, compared to a short version of general psychiatric management (GPM) [6] , the MOTR produced more positive in-session experiences and significant links between the patient's in-session experience, the therapeutic alliance, and the outcome. We assumed that patient indices of good process, i.e. early therapeutic alliance and in-session experience, predicted the outcomes.In the present process-outcome study, we included the intentto-treat sample analyzed by Kramer et al. [5] which involved, due to missing responses to the self-reported questionnaires, 60 individuals (GPM, n = 28; MOTR, n = 32). In addition to the questionnaires used in the parent study, the present study used a 24-item short version of the Bern Post-Session Report 2000 (BPSR) [7] , measuring the patient's in-session experience, administered after each session. It comprises 7 dimensions: (1) control experiences, (2) self-esteem experiences, (3) contentment, (4) therapeutic relationship, (5) problem actuation, (6) experience of mastery of problems, and (7) experience of clarification.A preliminary analysis of the links between MOTR scores and related session experiences on the BPRS revealed a mean correlation of r = 0.27 (range between 0.17 and 0.41). Therefore, the therapist responsiveness was moderately appropriate from the patient's perspective. A between-group comparison showed that MOTR produced on average better self-esteem experiences in patients [t(1, 27) = 1.80; p = 0.05; d = 0.46] compared to GPM treatments. The hierarchical linear modeling model confirmed this result for the slope, using 2-level and 3-level modeling (time nested within patient within therapist; detailed results are obtainable from the first author). When examining the links between the patient's experience of self-esteem session by session, the alliance, and the outcome, we found that the patient's experience of selfesteem correlated with the outcome only for session 8 in the case of the MOTR (r = 0.39; table 1 ). When comparing correlations according to therapy conditions, process-outcome correlations tended to be greater in the case of MOTR compared to GPM (see also the grand means). Patient alliance ratings correlated highest (positively; on average r = 0.36) with outcome in the case of MOTR (GPM: r = 0.11). Therapist alliance ratings correlated highest (negatively; on average r = -0.31) with outcome in the case of MOTR (GPM: r = -0.05). In a final hierarchical regression analysis, taking both groups together (n = 48), we found that the patient's experience of self-esteem rated after session 8 predicted outcomes in the most parsimonious model...

Motive-oriented therapeutic relationship (MOTR, also called complementary therapeutic relationship) was postulated to be a particularly helpful therapeutic ingredient in the early-phase treatment of patients with personality disorders, in particular borderline personality disorder (BPD). The present pilot study of randomized controlled trial using an add-on design aims to investigate the effects of MOTR in early-phase treatment (up to session 10), with BPD patients on therapeutic alliance, session impact, and outcome. In total, N = 25 patients participated in the study. BPD patients were randomly allocated to a manual-based investigation process in 10 sessions or to the same investigation process infused with MOTR. Adherence ratings were performed and yielded satisfactory results. The results suggested a specific effectiveness of MOTR on the interpersonal problem area, on the quality of the therapeutic alliance and the quality of the therapeutic relationship, as rated by the patient. These results may have important clinical implications for the early-phase treatment of patients presenting with BPD.