a Department of Psychiatry , Institute of Psychotherapy and General Psychiatry, University of Lausanne , Lausanne , Switzerland.
b Department of Psychology , University of Windsor , Windsor , Canada.
Psychother Res. 2019 Apr;29(3):324-336. doi: 10.1080/10503307.2017.1377358. Epub 2017 Sep 25.
The present paper elaborates a process perspective of change in psychotherapy for personality disorders (PDs). Firstly, the paper reviews the literature of mechanisms of change in treatments of PD, with the main focus on emotional processing and socio-cognitive processing. Secondly, it proposes an illustrative case-series analysis of eight cases, drawn from a mediation analysis conducted within the context of a randomized controlled trial for borderline personality disorder (BPD).
As such, cases with good and poor outcomes are compared, as are cases with poor and good intake features and cases with poor and good process markers across treatment.
The results illustrate possible pathways to healthy change over the course of four months of treatment, and possible pathways of the absence of change.
These results are discussed with regard to three main research perspectives: the combination of qualitative and quantitative methodology in psychotherapy research may be applied to case study research, a neurobehavioral perspective on change may incorporate the individualized experience in the laboratory and therapist responsiveness to patient characteristics may be a core feature of fostering change. Clinical or methodological significance of this article: The present paper illustrates individual pathways to change in personality disorders. It illustrates how coping capacities influence the process of psychotherapy and outcome in personality disorders. It demonstrates the relevance of individualizing treatments for personality disorders. It demonstrates several integrative features of psychotherapy research, in particular the use of neurobehavioral paradigms and the integration of single-case research within randomized controlled trials.
本文阐述了心理治疗人格障碍（PD）变化的过程视角。首先，本文回顾了 PD 治疗中变化机制的文献，主要关注情绪处理和社会认知处理。其次，它提出了一个例证性的病例系列分析，该分析来自于一项针对边缘型人格障碍（BPD）的随机对照试验中的中介分析。
因此，将比较治疗中预后良好和预后不良的病例、纳入特征差和纳入特征好的病例以及治疗中过程指标差和过程指标好的病例。
结果说明了在四个月的治疗过程中可能出现的健康变化途径，以及可能出现的无变化途径。
本文从三个主要研究视角讨论了这些结果：心理治疗研究中定性和定量方法的结合可应用于病例研究，变化的神经行为视角可将个体在实验室中的体验纳入其中，治疗师对患者特征的反应能力可能是促进变化的核心特征。
本文说明了人格障碍变化的个体途径。它说明了应对能力如何影响人格障碍的心理治疗过程和结果。它证明了针对人格障碍个体化治疗的相关性。它展示了心理治疗研究的几个综合特征，特别是神经行为范式的使用以及在随机对照试验中整合单病例研究。
