Affect regulation in psychoanalytic treatments of patients with a borderline personality disorder–psychoanalysis and psychodynamic psychotherapy–a comparison

Table 1 Descriptive analysis of the patients in the therapy groups psychoanalysis and psychodynamic psychotherapy

	PSA (n = 10)	PDT (n = 9)	P value1
Mean age (yr)	30.4 ± 7.5	31.9 ± 10.2	0.719
Sex	8 f, 2 m	7 f, 2 m	0.912
Therapeutic dose (mean)	390 sessions	124 sessions	0.001
DSM IV axis II diagnosis	Borderline personality disorder
Structural diagnosis	Borderline personality organization
SWAP diagnosis
Paranoid	49.37	48.85	0.871
Schizoid	49.65	54.79	0.201
Schizotypal	51.27	53.72	0.475
Antisocial	49.22	45.62	0.132
Borderline	52.97	48.62	0.289
Histrionic	53.92	46.37	0.127
Narcissistic	50.86	46.56	0.249
Avoidant	47.78	54.18	0.037
Dependent	49.29	52.01	0.233
Obsessive-compulsive	47.65	52.51	0.245

¹P value calculated using ANOVA. PSA: Psychoanalysis; PDT: Psychodynamic psychotherapy (i.e., psychoanalytically oriented psychotherapy); SWAP: Shedler-Westen Assessment Procedure.

Table 2 Items from the psychotherapy process Q-sort–that were applied to assess therapeutic action in the present study

Item	Description
2	Therapist draws attention to patient’s non-verbal behavior, e.g., body posture, gestures
22	Therapist focuses on patient’s feelings of guilt
28	Therapist accurately perceives the therapeutic process
36	Therapist points out patient’s use of defensive maneuvers, e.g., undoing, denial
40	Therapist makes interpretations referring to actual people in the patient’s life
50	Therapist draws attention to feelings regarded by the patient as unacceptable (e.g., anger, envy, excitement)
62	Therapist identifies a recurrent theme in the patient’s experience or conduct
65	Therapist clarifies, restates, or rephrases patient’s communication
67	Therapist interprets warded-off or unconscious wishes, feelings, or ideas
79	Therapist comments on changes in patient’s mood or affect
80	Therapist presents an experience or event in a different perspective
82	The patient’s behavior during the hour is reformulated by the therapist in a way not explicitly recognized previously
93	Therapist is neutral
98	The therapy relationship is a focus of discussion
100	Therapist draws connections between the therapeutic relationship and other relationships

Table 3 Differences in the variable “Shedler-Westen Assessment Procedure Borderline” measured at baseline (t1), after 1 yr of therapy (t3) and after 3 yr of therapy (t7) (mean ± SD)

		n (%)			Min	Max	P value1	dt32	dt72
Baseline (t1)	PSA	10	52.97	8.73	42.69	71.88		0.79	0.88
	PDT	9	48.62	8.56	40.23	67.63		|0.40|	0.04
	Total	19	50.90	8.70	40.23	71.88	0.289	0.24	0.45
After 1 yr of therapy (t3)	PSA	10	46.26	8.21	29.99	60.21			0.04
	PDT	9	51.80	7.49	40.26	65.30			0.33
	Total	19	48.88	8.17	29.99	65.30	0.145		0.20
After 3 yr of therapy (t7)	PSA	7	45.96	6.75	37.63	56.78
	PDT	5	49.01	10.20	38.90	61.33
	Total	12	47.23	8.07	37.63	61.33	0.545

¹P value calculated using ANOVA.

²d = Cohen’s. d: Represents effect size measured after 1 yr (t3) and after 3 yr (t7) of therapy.

PSA: Psychoanalysis; PDT: Psychodynamic psychotherapy; SWAP: Shedler-Westen Assessment Procedure; SWAP-borderline: SWAP personality syndrome “dysregulated/borderline”.

Table 4 Changes in patient characteristics, borderline pathology, and object relations after one year of therapy (mean ± SD)

				Min	Max	P value
SWAP Borderline	PSA	6.71	9.29	-1.58	29.58	0.024a
	PDT	-3.18	7.94	-10.61	15.22
	Total	2.02	9.85	-10.61	29.58
AREQ positive affect	PSA	-0.11	0.98	-1.57	1.86	0.513
	PDT	0.19	0.86	-0.94	1.43
	Total	0.03	0.91	-1.57	1.86
QORS total score	PSA	-0.20	0.73	-1.60	0.90	0.726
	PDT	-0.34	0.75	-1.70	0.50
	Total	-0.26	0.72	-1.70	0.90
PRQ positive working alliance	PSA	0.15	0.35	-0.33	0.50	0.339
	PDT	-0.27	0.73	-1.08	0.50
	Total	-0.08	0.60	-1.08	0.50
PQS therapeutic action	PSA	-0.00	0.60	-0.73	1.00	0.318
	PDT	-0.28	0.45	-1.07	0.47
	Total	-0.14	0.53	-1.07	1.00

^aP < 0.05. Mean differences (“mean”) regarding the mean scores of the relevant variables (“Shedler-Westen Assessment Procedure-borderline”, “Affect experience and affect regulation Q-sort-positive affect”, “Quality of object relations scale total score”, “Psychotherapy relationship questionnaire-positive working alliance”, “Psychotherapy process Q-sort therapeutic action”) between the score at baseline vs the score after the first year of therapy (t1 minus t3, where t1 represents measurements taken at baseline and t3 after 1 yr of therapy). PSA: Psychoanalysis; PDT: Psychodynamic psychotherapy; SWAP: Shedler-Westen Assessment Procedure; AREQ: Affect experience and affect regulation Q-sort; QORS: Quality of object relations scale; PRQ: Psychotherapy relationship questionnaire; PQS: Psychotherapy process Q-sort.

Table 5 Univariate analysis of the variable “Shedler-Westen Assessment Procedure Borderline” (mean ± SD)

Patient characteristics	Estimate		T value	P value
PDT group	4.07	1.86	2.19	0.042a
Sex of patient	2.89	5.18	0.56	0.584
Sex of therapist	7.15	4.24	1.68	0.109
Education: Apprenticeship	12.21	10.49	1.16	0.261
Education: Vocational school	3.15	8.29	0.38	0.709
Education: High school	-2.80	5.78	-0.48	0.635
Married	-1.03	7.19	-0.14	0.888
Divorced	-0.39	9.90	-0.04	0.969
Age	0.41	0.22	1.81	0.087

^aP < 0.05. SWAP-borderline: Shedler-Westen Assessment Procedure personality syndrome “dysregulated/borderline”; PDT: Psychodynamic psychotheray.