Therapeutic Alliance Ruptures and Resolution in Cognitive Behaviour Therapy with Patients with Borderline Personality Disorder

Abstract

Abstract

This research thesis consists of three sections; a literature review, the research report, and appendices.

Literature Review: Aims: 1) to investigate, beyond recent reviews of the literature, the theoretical developments for how ruptures in the therapeutic alliance are resolved; 2) to identify whether there is empirical evidence supporting these ideas.

Research Report: Aims: 1) to investigate how therapists deal with alliance ruptures in cognitive behaviour therapy (CBT) with good outcome clients with borderline personality disorder (BPD); 2) to identify whether a CBT model of rupture resolution (Aspland, Llewelyn, Hardy, Barkham & Stiles, 2008) could be validated with BPD clients. This study focused on data collected from participants in the Sheffield Personality Disorders (SPeDi) Trial who had received CBT. A rupture and repair session for two good outcome clients (totalling four sessions) were the focus of qualitative task analysis. Systematic analysis of 41 rupture resolution attempts suggested progress toward resolution took place when therapists changed their approach to explore the salient issue for the client. The final rupture resolution model shared similarities with Aspland et al. (2008). However, additional components included the ‘external observer’, which encompassed bringing the client’s attention back to salient issues, therapists’ acknowledgement of their own limitations, and therapist emotional self-disclosure. Focus on affective experience appeared to be important for rupture resolution in BPD clients, and is suggested as a future research area. Clinical implications of results are discussed.

Appendices: Relevant documentary evidence for the study is presented and additional data supplementing the research report provided.