Doctor of Philosophy
School of Psychology
Bourke, Marianne, Therapist’s emotional, cognitive and linguistic responses to patients with borderline personality disorder in psychotherapy, Doctor of Philosophy thesis, School of Psychology, University of Wollongong, 2013. https://ro.uow.edu.au/theses/3884
Clinical and theoretical literature frequently report that mental health professionals experience interpersonal challenges and emotional distress in providing treatment for patients with Borderline Personality Disorder (BPD). This thesis involved a series of four studies which compared therapists’ (N = 20), responses to patients with BPD (N = 40) to patients with Major Depressive Disorder (MDD; N = 40). Study 1 aimed to investigate therapists’ Core Conflictual Relationship Themes (CCRT; Luborsky, 1998a), elicited in narratives using the Relationship Anecdotes Paradigm (Luborsky, 1998b) interview method. Results from multilevel modelling analysis indicated that therapists differentially experienced patients, with negative valence scores on all CCRT components significantly related to patients with BPD. Study 2 aimed to investigate relational patterns expressed by patients towards their therapist using the Psychotherapy Relationship Questionnaire (PRQ; Westen, 2000). Dominant concepts and themes in therapists’ verbal descriptions were examined using a content analytic approach, Leximancer (Smith & Humphreys, 2006). Results revealed that therapists perceived patients with BPD as presenting with higher hostile, narcissistic, compliant, anxious, and sexualized dimensions of interpersonal responses compared to patients with depression. Therapists reported greater emotional distress and an increased need for supportive supervision when working with patients with BPD. Study 3 further extended these findings through an examination of therapist’s linguistic styles using the Linguistic Inquiry and Word Count (LIWC) content-analytic approach (Pennebaker, Chung, Ireland, Gonzales, & Booth, 2007). Results suggest that psychotherapeutic process with BPD patients induced in therapists a self-focused emotionally intense linguistic style, with disturbed reflective functioning and metacognitive processing. Words denoting negative emotions, anxiety, anger and sadness, first person singular pronouns and adverbs were used frequently, together with fewer words suggestive of cognitive processes, insight and causation when discussing patients with BPD. Study 4 was a pilot study investigating one session with a patient with BPD and a patient with MDD. The observer rated coding system, Psychotherapy Process Q-set (PQS; E. E. Jones, 2000), was utilised to code a wide range of patient and therapist attitudes and behaviours, as well as therapist-patient interactions. In addition, the Therapeutic Cycles Model (TCM; Mergenthaler, 2008) provided framework in which to compare therapist and patient emotional tone and conceptual language. Results from this study indicated that the therapist intervened most to facilitate psychological change with patients with BPD, yet they gained less change in emotion-abstraction patterns. Taken together, findings from these four studies articulate specific ways therapists are challenged in their clinical treatment. The severity of interpersonal difficulties experienced by patients with BPD transfer in particular ways that disrupt the cognitive processing of therapists. Deficits were found in therapists’ language fluency and emotional processing consistent with “countertransference” problems often discussed in clinical theory. This has utility in providing guidance for therapists in training and supervision.