title: Interaction structures formed in the psychodynamic therapy of five patients with borderline personality disorder in crisis.
abstract: OBJECTIVE
  To identify interaction structures (i.e., patterns of reciprocal interaction) that characterize the treatments of patients with borderline personality disorder (BPD) in crisis.
  
  
  METHODS
  A 6-month naturalistic psychotherapy process and outcome study in which interaction structures were correlated with outcome data.
  
  
  METHODS
  Five BPD patients in crisis participated in 6 months of three-times-per-week psychodynamic therapy. Patients completed a measure of psychological distress every week. One hundred and twenty-seven sessions were audiotaped and coded using the Psychotherapy Process Q-Set.
  
  
  RESULTS
  Four interaction structures were identified: (1) collaborative relationship with supportive, reassuring therapist (IS1), (2) therapist empathic attunement (IS2), (3) erotized therapeutic relationship (IS3) and (4) directive therapist with compliant patient (IS4). The magnitude of these four interaction structures varied within and between the five therapist-patient dyads over time. Interaction structures correlations with time were inversely proportional to interaction structures correlations with distress levels. IS2 was correlated with two different outcomes in patient 3's and patient 5's treatments--a positive outcome for patient 3's treatment and a negative outcome for patient 5's treatment.
  
  
  CONCLUSIONS
  An effective treatment model for BPD patients in crisis needs to promote the emergence of empathically attuned interactions as well as supportive and directive interventions as dictated by the patient's individual needs. These treatments require flexibility to accommodate the patient's unique presentation in crisis. The therapeutic dyad senses which interaction structures to increase or decrease over time to reduce the patient's distress.
authors.affiliation: Long Island University, Brookville, New York, USA.
authors.forename: Geoff
authors.initials: G
authors.lastname: Goodman
authors.forename: Keiha
authors.initials: K
authors.lastname: Edwards
authors.forename: Hyewon
authors.initials: H
authors.lastname: Chung
mesh_terms: D000208:Acute Disease; D000328:Adult; D001883:Borderline Personality Disorder / Q000523:psychology / Q000628:therapy*; D003299:Cooperative Behavior; D004645:Empathy; D005260:Female; D006760:Hospitalization; D006801:Humans; D015233:Models, Statistical; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data*; D010349:Patient Compliance; D025341:Principal Component Analysis; D011369:Professional-Patient Relations; D013811:Psychotherapeutic Processes; D064889:Psychotherapy, Psychodynamic / Q000379:methods*; D011779:Q-Sort / Q000706:statistics & numerical data; D012720:Severity of Illness Index; D013315:Stress, Psychological / Q000628:therapy; D013406:Suicide, Attempted / Q000523:psychology; D013997:Time Factors