Integrative dynamic treatment for comorbid depression and borderline conditions.

Hilsenroth, Mark J.; Slavin, Jenelle M.

doi:10.1037/a0014317

Cited by 13 publications

(11 citation statements)

References 84 publications

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“…Like Gabbard and Horowitz (2009), we believe that such prohibition represents a false dichotomy of practice that appears inconsistent with the available data on the optimal use of techniques exploring the patient–therapist relationship. Consistent with the findings presented here, this appears to be a low to moderate number (1–4) of interventions per session examining the patient–therapist relationship, in the context of a strong therapeutic alliance, within a larger treatment that allows for an optimal responsiveness of both supportive and expressive technical components (see Bateman & Fonagy, ; Hilsenroth & Slavin, ; Høglend & Gabbard, in press; McMain et al, 2009; Ryum et al, ; Schut et al, ).…”

Section: Discussionsupporting

confidence: 76%

Exploring In‐Session Focus on the Patient–Therapist Relationship: Patient Characteristics, Process and Outcome

Kuutmann

Hilsenroth

2011

Clin Psychology and Psychoth

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This study explored the amount of in-session focus on the patient-therapist relationship during early treatment with patient pre-treatment interpersonal style, personality pathology, patient ratings of session process and outcome. The sample consisted of 76 outpatients engaged in short-term psychodynamic psychotherapy. Results showed that higher levels of pre-treatment personality pathology and interpersonal problems were positively related to a greater focus on the patient-therapist relationship early in treatment. This was especially true for patients with a cold/distant interpersonal style and low self-esteem. Moreover, these two patient pre-treatment characteristics demonstrated a significant change over the course of therapy. These post-treatment changes also demonstrated a significant relationship with greater early treatment focus on the patient-therapist relationship. In addition, we found an interaction effect between quality of object relations (i.e., higher levels of object relations) and greater early treatment focus on the patient-therapist relationship with subsequent changes in patient cold/distant interpersonal problems. Greater in-session focus on the therapeutic relationship was not significantly related to patient ratings of session process. Implications for clinical practice and future research are discussed.

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Section: Discussionsupporting

confidence: 76%

Exploring In‐Session Focus on the Patient–Therapist Relationship: Patient Characteristics, Process and Outcome

Kuutmann

Hilsenroth

2011

Clin Psychology and Psychoth

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“…Interestingly, learning principles or mechanisms underlying the prescription of homework in CBT, such as exposure and the acquisition of social skills, have also been retained and emphasized by integrative oriented psychodynamic therapists (e.g., McCullough et al, 2003;Wachtel, 1977). For example, drawing on a treatment approach that yielded clinically significant improvement in a small sample of patients with comorbid depressive disorders and borderline pathology, Hilsenroth and colleagues (Hilsenroth & Slavin, 2008) proposed an assimilative psychodynamic approach that integrates more active CBT interventions such as homework assignments, as well as experiential strategies such as exploring patients' affective experience by focusing on their bodily sensations. A recent study has also provided preliminary evidence that the systematic integration of homework in psychodynamic therapy for depression is not only feasible, but shows potential to improve its efficacy (Nelson & Castonguay, 2012).…”

Section: Psychotherapy Research 369mentioning

confidence: 99%

Research on psychotherapy integration: Building on the past, looking to the future

Castonguay

Eubanks

Goldfried

et al. 2015

Psychotherapy Research

130

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Integration has become an important and influential movement within psychotherapy practice, reflected by the fact that many treatment providers now identify as integrative. However, integration has not had as great an influence on psychotherapy research. The goal of this paper is to highlight the growing body of research on psychotherapy integration, and to identify future directions for research that may strengthen the integration movement as well as the field of psychotherapy as a whole. We first summarize the past 25 years of research on integration, with a focus on four approaches to integration: theoretical integration, technical eclectic, common factors, and assimilative integration. Next, we identify directions of research within these four areas that could strengthen and support integrative practice. We then propose ways in which the perspective of integrationists could contribute to psychotherapy research in the critical areas of harmful effects, therapist effects, practice-oriented research, and training. We end this paper by suggesting that a greater collaboration between integrationists and psychotherapy researchers will help to create a unified landscape of knowledge and action that will benefit all participants and advance the field.

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“…Stone emphasizes the importance of tailoring the treatment to each patient by considering what treatment modalities would work best with the patients’ characteristics (Stone, 1990; 2017). An integrative dynamic approach might include structuring sessions, assigning homework between sessions, actively focusing on treatment, providing support while exploring difficult topics, and assessing relational patterns (Hilsenroth & Slavin, 2008).…”

Section: Methodsmentioning

confidence: 99%

How are expert therapists similar, different, and integrative in the treatment of borderline personality disorder?

Groth¹,

Hilsenroth²,

McMillen³

et al. 2021

Psychotherapy

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This study examined the use of therapeutic skills by different, well-known experts in psychology who have published extensively on the treatment of borderline personality disorder to ascertain areas of technique similarity, difference, and integration. Initial videotaped sessions from these expert therapists working with the same patient were independently rated, using an established measure, on cognitivebehavioral and psychodynamic-interpersonal techniques by 6 trained clinicians. These raters also independently identified what they believed were the most clinically significant segments of each session. The 6 raters demonstrated excellent levels of reliability. Results of this empirically based comparative process analysis suggest significant similarity, integration, and common focus across these 7 expert therapists in the specific techniques they used and in the themes and issues explored during the most clinically significant segments. All therapists took an active stance in exploring areas of clinical focus and initiating topics of discussion in this first meeting. Therapists tended to focus on the patient's pattern of romantic relationships ending abruptly and his lack of understanding why they ended, or his role in them ending. Almost all these segments included the therapist providing the patient with an alternative way to understand his experiences not previously recognized. Moreover, several of the therapists tended to both explore his irrational thoughts (e.g., all-or-nothing thinking, being incomplete without a partner) and relate perceptions of these relationships (e.g., being a victim, minimizing his anger/violence) to his interpersonal difficulties. Likewise, therapists often used the information gained from this process to provide psychoeducation regarding treatment approach and rationale. Finally, therapists would often return to key specific themes and issues that were clinically significant within the session in order to further explore and work through their meaning with the patient. Clinical Impact StatementQuestion: How do expert therapists from various theoretical orientations approach treatment of borderline personality disorder? What are the differences and commonalities, and are they integrative? Findings: Several techniques may be helpful in the treatment of borderline personality disorder, such as taking an active stance and initiating clinical focus as well as offering alternative perspectives to understand experiences not previously recognized and exploring irrational thoughts. Meaning: Across the various theoretical orientations, there were many similarities across the work of the expert therapists, suggesting the clinical utility of integration when treating borderline personality disorder. Next Steps: Future steps include examining how integrative and traditional therapies differ at the level of technique with various types of patients at different points across the treatment process.

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Integrative dynamic treatment for comorbid depression and borderline conditions.

Cited by 13 publications

References 84 publications

Exploring In‐Session Focus on the Patient–Therapist Relationship: Patient Characteristics, Process and Outcome

Exploring In‐Session Focus on the Patient–Therapist Relationship: Patient Characteristics, Process and Outcome

Research on psychotherapy integration: Building on the past, looking to the future

How are expert therapists similar, different, and integrative in the treatment of borderline personality disorder?

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