Gersh Elon, Hulbert Carol A, McKechnie Ben, Ramadan Reem, Worotniuk Tamara, Chanen Andrew M
Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Victoria, Australia.
Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia.
Psychol Psychother. 2017 Mar;90(1):84-104. doi: 10.1111/papt.12097. Epub 2016 May 30.
This study aimed to investigate alliance rupture and repair processes in psychotherapy for youth with borderline personality disorder. It sought to examine whether alliance processes differ between treatments, across the phases of therapy, and what associations these processes might have with therapeutic outcomes.
The study involves repeated measurement of both process and outcome measures. Hypotheses were addressed using within- and between-subjects analyses.
Forty-four people, aged 15-24, with a diagnosis of BPD were randomized to receive either 16 sessions of Cognitive Analytic Therapy (CAT) or a supportive treatment known as Befriending. In addition to pre-post outcome assessments, alliance processes were rated using the observer-based Rupture Resolution Rating Scale.
Results indicated that CAT and Befriending did not differ in terms of number of ruptures, although CAT was associated with more stages of rupture resolution. Examination of alliance processes across time pointed to increasing ruptures, more frequent confrontation ruptures and increasing rupture resolution, suggesting increased volatility, directness and productivity in the therapeutic process across time. Contrary to hypotheses, there was no consistent link between alliance processes and outcome. However, two specific phases were significant. Early treatment ruptures were associated with poor outcome whereas greater late treatment resolution was associated with better outcomes.
This study suggests that alliance processes can differ across treatments and the phases of therapy in psychotherapy for youth with BPD. Alliance ruptures are more likely to be problematic early in therapy but later in therapy, they appear to be opportunities for therapeutic growth.
Alliance ruptures are more likely than not to occur in any given session with a young person with Borderline Personality Disorder. Early in therapy, withdrawal type ruptures are more frequent, whereas late in therapy, confrontation ruptures are more frequent. Late in therapy, alliance ruptures should be viewed as opportunities for therapeutic change, rather than barriers to good outcomes.
本研究旨在调查边缘型人格障碍青少年心理治疗中的联盟破裂与修复过程。研究试图检验不同治疗方法之间、治疗各阶段的联盟过程是否存在差异，以及这些过程与治疗结果可能存在何种关联。
该研究涉及对过程和结果指标的重复测量。通过组内和组间分析来验证假设。
44名年龄在15 - 24岁、被诊断为边缘型人格障碍的患者被随机分为两组，分别接受16节认知分析疗法（CAT）或一种名为交友的支持性治疗。除了治疗前后的结果评估外，联盟过程使用基于观察者的破裂解决评定量表进行评分。
结果表明，认知分析疗法和交友疗法在破裂次数方面没有差异，尽管认知分析疗法与更多的破裂解决阶段相关。对不同时间点联盟过程的检查显示，破裂次数增加、对抗性破裂更频繁以及破裂解决增加，这表明治疗过程随着时间推移波动性、直接性和有效性增加。与假设相反，联盟过程与结果之间没有一致的联系。然而，有两个特定阶段具有显著意义。治疗早期的破裂与不良结果相关，而后期治疗中更大程度的破裂解决与更好的结果相关。
本研究表明，在边缘型人格障碍青少年的心理治疗中，联盟过程在不同治疗方法和治疗阶段可能存在差异。联盟破裂在治疗早期更可能出现问题，但在治疗后期，它们似乎是治疗成长的机会。
在与边缘型人格障碍青少年的任何特定治疗环节中，联盟破裂都很可能发生。在治疗早期，退缩型破裂更为频繁，而在治疗后期，对抗性破裂更为频繁。在治疗后期，联盟破裂应被视为治疗改变的机会，而非良好结果的障碍。
