Published online Dec 19, 2021. doi: 10.5498/wjp.v11.i12.1328
Peer-review started: February 23, 2021
First decision: July 15, 2021
Revised: July 19, 2021
Accepted: November 20, 2021
Article in press: November 20, 2021
Published online: December 19, 2021
Emotional reactivity in patients with borderline personality disorder (BPD) due to dysfunctional processes is still a concept being developed. Specifically designed psychotherapies for BPD have significant, modest benefits over TAU. The effects of psychotherapy on BPD are still insufficiently understood. Substantial heterogeneity of processes and populations studied contributes to varying research results when investigating the effects of different treatment methods, and whether they differ from each other.
The question was whether similarities and differences between psychoanalysis (PSA) and psychodynamic psychotherapy (PDT) in BPD would be detectable, especially in terms of emotional reactivity in the patient-therapist interaction.
We aimed to study repetitive interaction patterns in patients with BPD undergoing either psychoanalysis or psychodynamic therapy.
Within a retrospective study framework, we compared matched PSA (n = 10) and PDT (n = 10) BPD patients’ treatment sessions. Five consecutive sessions were recorded and analyzed, with evaluation of effects compared to baseline over three years. Patient characteristics (including affect regulation and personality traits), quality of object relations, as well as related therapeutic actions, were analyzed (micro-process analysis).
Differences between PSA and PDT were significant when analyzing the “mean change” in the Shedler-Westen Assessment Procedure Borderline variable after one year of therapy (P = 0.024). Variance of observed change was higher in PSA than in PDT (SDPSA ± 9.29 vs SDPDT ± 7.94). Transference interpretations are followed closely by affective changes in the patient, and were useful modes of interaction.
PSA and PDT were both effective in BPD. Interactional aspects differed between the two treatments.
As BPD patients are a very heterogeneous population, further research should focus on investigating optimal matching of BPD patients to specific modes of affect regulation, as well as which specific level of personality functioning would benefit from a given therapy modality.