Examining challenging behaviors of clients with borderline personality disorder

Abstract

Few studies have examined effects of challenging behaviors of clients with borderline personality disorder (BPD) on psychotherapy outcomes. Dialectical behavior therapy (DBT) is an evidence-based treatment designed to treat chronic suicidality, self-directed violence (SDV), and emotion dysregulation, while targeting challenging behaviors. DBT has been shown to be effective with clients with BPD. We evaluated whether therapist reported challenging behaviors, such as high volume phone contacts or violating the therapist’s limits, during DBT would be associated with dropping out of DBT, severity and frequency of SDV, emotion regulation deficits, and client’s and therapist’s satisfaction of treatment. The current study examined challenging behaviors reported by therapists in a sample of 63 psychiatrically disabled outpatient DBT clients diagnosed with BPD (73% women, average age 37 years). More frequent phone contacts were associated with a decrease in dropout and psychological symptoms, and an increase in client and therapist satisfaction. More avoidance/disengagement behavior was associated with more than twice the risk of SDV and a decrease in therapist satisfaction. Findings suggest that the phone coaching might serve to maximize client satisfaction and reduce the likelihood of dropout.

Barriers, facilitators, and benefits of implementation of dialectical behavior therapy in routine care: results from a national program evaluation survey in the Veterans Health Administration

“…Instructional guidance is available to assist therapists in providing phone coaching [28][29][30] and yet, limited research on both the effectiveness and implementation of phone coaching is available. One study [31] found that more frequent calls were associated with a reduction in psychological symptoms and an increase in client and therapist satisfaction in a full DBT program with clients with BPD.…”

Evaluating the national multisite implementation of dialectical behaviour therapy in a community setting: a mixed methods approach

“…Participants expressed concern about holding clinical responsibility for a DBT client in the context of phone coaching when heretofore; clients would have been encouraged to attend out-of-hours emergency services if in emotional distress. Phone coaching is an essential element of DBT with evidence to suggest that more frequent phone contact is associated with a decrease in dropout and psychological symptoms, and an increase in client and therapist satisfaction [47]. While the NDBTPI coordinating team encouraged therapists to work with local management and use supervision to guide practice, the coordinating team did not have the authority to mandate change for individuals or systems in their practice.…”

El síndrome de Burnout en supervisados en Terapia Dialéctica Conductual: Una revisión de literatura

“…Al igual que en terapia, la supervisión parte de la premisa que la/el terapeuta trabaja con una población en la que la intervención se torna retante. Estas conductas retantes conllevan, pero no se limitan, a: 1) la evitación y abandono del proceso, que reduce la satisfacción de la/el terapeuta; 2) cruzar los límites terapéuticos, que incentiva actitudes negativas y miedo en la/el terapeuta; y 3) desregulación conductual, que debilita la alianza terapéutica (Chalker, et al, 2015). Estas conductas características de las personas que viven con TPL, y diagnósticos comórbidos, promueve que las/ los terapeutas evalúen a la población como retante y la estigmaticen (Morse et al, 2012).…”

“…Según Waltz et al (1998) (Field, 2016), mientras la supervisión grupal brinda apoyo y ayuda en torno a encontrar la dialéctica en el proceso terapéutico (Waltz et al, 1998). El modelo de supervisión parte de la idea que la naturaleza del trabajo terapéutico es retante debido a su población, por lo cual trabaja en conjunto con la/el terapeuta de distintas formas para maximizar la calidad de la terapia (Chalker et al, 2015;Waltz et al, 1998). (Haynos et al, 2016;Landes et al, 2016).…”