Citation

Bittencourt AA, de Barcellos ED, Serralta FB. J. Clin. Psychol. (Hoboken) 2019; 75(5): 846-858.

Affiliation

Department of Psychology, Universidade do Vale do Rio dos Sinos (UNISINOS), São Leopoldo, Brazil.

Copyright

(Copyright © 2019, John Wiley and Sons)

DOI

10.1002/jclp.22761

PMID

30817004

Abstract

The core characteristics of patients with a borderline personality disorder (BPD) affect the therapeutic relationship and frequently lead psychodynamic therapists to adapt interventions to manage crises. This study aims to increase knowledge of how such crises affect the therapeutic process. Using her therapist's notes, combined with the Psychotherapy Process Q-Set, we studied the therapeutic process of the first 44 therapy sessions of a female BPD patient with many depressive-like symptoms, including a disruptive period that included hospitalization. We found marked differences between different phases of therapy (before a crisis, acute disorganization, hospitalization, and back to the consulting room). The analysis suggests that a crisis and hospitalization may occur without necessarily damaging the therapeutic process. The therapist's ability to tolerate aggression, to explore and contain suicide wishes and behaviors, and to flexibly adapt techniques to patient needs, are among the therapeutic attitudes and behaviors that can help restore an effective psychodynamic process.

© 2019 Wiley Periodicals, Inc.

Language: en

Keywords

crisis intervention; personality disorder; psychodynamic therapy; psychotherapeutic process