The therapeutic alliance as a predictor of outcome in dialectical behavior therapy versus nonbehavioral psychotherapy by experts for borderline personality disorder.

Abstract

The purpose of the present study was to explore facets of the client- and therapist-rated therapeutic alliance as predictors of suicide attempts, nonsuicidal self-injury, depression, and introject during the course of 2 psychosocial treatments for borderline personality disorder. A total of 101 women meeting Diagnostic and Statistical Manual of Mental Disorders-IV DSM-IV criteria for borderline personality disorder participated in a randomized controlled trial of dialectical behavior therapy (DBT) versus community treatment by experts. Clients and therapists rated the therapeutic alliance at 4 time points during 1 year of treatment. Multilevel models showed no significant differences in client ratings of the alliance by treatment condition. DBT therapists reported greater working strategy consensus early in treatment and an overall greater alliance during treatment. Client ratings of commitment and working capacity were associated with fewer suicide attempts in DBT. Client ratings of commitment were also associated with reduced nonsuicidal self-injury in DBT only. Therapist ratings of the alliance were predictive of reduced suicide attempts in both treatments. Therapist ratings of the alliance in community treatment by experts were predictive of increased nonsuicidal self-injury. Client and therapist ratings of the alliance were not significantly associated with changes in depression or introject across both treatments. The study supported theoretically predicted relationships between facets of the therapeutic alliance in DBT and suicidal behavior. Results are discussed in the context of recommendations for developing the therapeutic alliance in DBT.

A meta‐analysis of the relation between therapeutic alliance and treatment outcome in eating disorders

“…In the non-ED literature, a study investigating two treatments for borderline personality disorder indicated that alliance was more important for outcome in patients receiving behavioral (i.e., dialectical behavioral therapy) versus nonbehavioral (i.e., community care by experts) treatment (Bedics, Atkins, Harned, & Linehan, 2015). Conversely, one meta-analysis found that alliance was relevant to the outcome of therapy only when that therapy was relatively unstructured (i.e., nonbehavioral) (Crits-Christoph et al, 1991); though other meta-analyses have not replicated this distinction (Horvath et al, 2011).…”

Significados sobre el suicidio en un grupo de psicoterapeutas psicoanalíticos

“…El primer paso en estos tratamientos es el establecimiento de una adecuada alianza terapéutica (Bedics, Atkins, Harned y Linehan, 2015;Briggs et al, 2012;Fukumitsu, 2014;Gabbard, 2002).…”

Tagesklinische dialektisch-behaviorale Therapie: Eine Verlaufsuntersuchung nach Entlassung. Gibt es Prädiktoren für eine Verschlechterung?

“…therapeutische Allianz haben wir jedoch nicht gemessen, auch wenn aufgrund der Zertifizierung und des Bestehens eines tagesklinischen DBT-Angebotes über mehr als 5 Jahre eine hohe Identifizierung mit der DBT im Therapeutenteam zu erwarten ist [Swales et al, 2012] und damit dieses in guter Qualität und Stabilität vorliegen sollte. Adhärenz und therapeutische Allianz sind für weiterführende Studien jedoch zu fordern [Bedics et al, 2015].…”

“…Aber auch in einer randomisierten kontrollierten Studie reduzierten komorbide Dissoziationen während der DBT bei BPS und gleichzeitig vorliegender PTBS deren Therapieerfolg [Kleindienst et al, 2016]. Bedics et al [2015] konnten an 101 Frauen mit einer BPS über eine 1-JahresSpanne zeigen, dass die Stärke der therapeutischen Allianz die Suizidalität beeinflusst und damit auch den Therapieerfolg. Diese Ergebnisse konnten auch Steuwe et al [2017] replizieren.…”