Effects of Motive-Oriented Therapeutic Relationship in a Ten-Session General Psychiatric Treatment of Borderline Personality Disorder: A Randomized Controlled Trial

Abstract

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.

Unpacking the Effects of Therapist Responsiveness in Borderline Personality Disorder: Motive-Oriented Therapeutic Relationship, Patient In-Session Experience, and the Therapeutic Alliance

“…There are 2 hypotheses for this unexpected result: (1) the MOTR therapists might have assessed the already difficult collaboration in a more mindful and 'realistic' fashion, as a correlate of the individualized PA understanding of the case, and might actually have rated the alliance overly negatively, inversely proportional to the actual subsequent patient change; (2) alternatively, as a correlate of the PA case formulation and MOTR heuristics, the therapists may have overestimated the positive relationship. The moderate-to-low therapist mean ratings of the alliance [5] would speak in favor of the first hypothesis. The MOTR may have a specific impact on the therapist's awareness and interaction style, which produces in the patient an additional symptom relief.…”

“…Among several ways of operationalizing appropriate therapist responsiveness, in the present letter we will focus on one specific method of conceptualization, i.e. Plan analysis (PA), and the motive-oriented therapeutic relationship (MOTR) [3,4] .In patients with BPD, a randomized controlled trial [5] showed that the MOTR as an operationalization of how therapists can explicitly be responsive -based on the individualized case formulation related to the PA -had an effect on the global outcome and progression of the therapeutic alliance, rated by the therapist, over the course of 10 sessions of therapy. However, it is unclear what the exact patient change processes are in treatments based on appropriate responsiveness.…”

“…However, it is unclear what the exact patient change processes are in treatments based on appropriate responsiveness. The objective of the present processoutcome study, as a reanalysis of a larger data set [5] , is to examine the potential predictive role of the patient's in-session experience and the therapeutic alliance for outcome (i.e. symptom change af-…”

“…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.…”

Are Suicide Attempters Wired Differently?

“…Evidence for the effectiveness of MOTHER can be provided by a pilot study conducted by Kramer et al (2011), in which a reduction of interpersonal problems and a stronger therapeutic alliance was found in the early-phase treatment of patients with borderline personality disorder. In a recent study by Kramer et al (2014), these findings could be replicated and extended in a larger ten-session randomized controlled trial (RCT). The present study also has a number of limitations that might have influenced some of the results.…”