An integrative complexity analysis of cognitive behaviour therapy sessions for borderline personality disorder.
OBJECTIVE
Integrative complexity (IC), a measure of cognitive style, was used to analyse discourse in Cognitive Behaviour Therapy (CBT) sessions from patients with borderline personality disorder treated in the BOSCOT trial. It was predicted that patients' level of integrative complexity would be positively associated with the outcome of therapy. That is, an increase in patients' level of integrative complexity would be associated with good outcome. We also predicted that therapists would also show an increase in the level of complexity associated with their patient's increase in integrative complexity and good outcome.


METHODS
Ten patients who received CBT were categorized according to the outcome, good (N=5) and poor (N=5), using an algorithm that incorporated the number of suicide attempts and magnitude of change in severity of depression during therapy.


METHODS
For each patient and their therapist, an early and a late therapy session were transcribed and coded for integrative complexity (IC) (N=20 sessions transcribed). IC scores for patients and therapists were compared across early and late therapy sessions and for good and poor outcomes of therapy.


RESULTS
The majority of discourse was at the lower levels of IC. Higher levels of IC at baseline were related to depression and anxiety. Good outcome was not associated with a change in the level of IC between earlier and later CBT sessions. Therapists, however, showed an increase in IC when patient's outcome was poor. In addition, an increase in patient's IC was associated with improvement in social functioning.


CONCLUSIONS
Therapists may overcompensate for patient's poor outcome by giving more complex explanations to patients. Higher complexity does not necessarily lead to better outcomes.
Davidson
Kate
K
Department of Psychological Medicine, University of Glasgow, UK. k.davidson@clinmed.gla.ac.uk
Livingstone
Steven
S
McArthur
Katherine
K
Dickson
Lindsay
L
Gumley
Andrew
A
D000328:Adult; D001883:Borderline Personality Disorder / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003142:Communication; D003866:Depressive Disorder / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D030141:Feedback, Psychological; D005260:Female; D006801:Humans; D008297:Male; D008606:Mental Processes; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010552:Personality Assessment; D011369:Professional-Patient Relations; D011599:Psychopathology; D013406:Suicide, Attempted / Q000517:prevention & control / Q000523:psychology