Examining challenging behaviors of clients with borderline personality disorder.
Few studies have examined effects of challenging behaviors of clients with borderline personality disorder (BPD) on psychotherapy outcomes. Dialectical behavior therapy (DBT) is an evidence-based treatment designed to treat chronic suicidality, self-directed violence (SDV), and emotion dysregulation, while targeting challenging behaviors. DBT has been shown to be effective with clients with BPD. We evaluated whether therapist reported challenging behaviors, such as high volume phone contacts or violating the therapist's limits, during DBT would be associated with dropping out of DBT, severity and frequency of SDV, emotion regulation deficits, psychological symptom severity and client's and therapist's satisfaction of treatment. The current study examined challenging behaviors reported by therapists in a sample of 63 psychiatrically disabled outpatient DBT clients diagnosed with BPD (73% women, average age 37 years). More frequent phone contacts were associated with a decrease in dropout and psychological symptoms, and an increase in client and therapist satisfaction. More avoidance/disengagement behavior was associated with more than twice the risk of SDV and a decrease in therapist satisfaction. Findings suggest that the phone coaching might serve to maximize client satisfaction and reduce the likelihood of dropout.
University of Washington, Harborview Medical Center, 325 9th Ave., Box 359911, Seattle, WA 98104, USA; The Catholic University of America, O'Boyle Hall, Room 339, 620 Michigan Ave NE, Washington, DC 20064, USA. Electronic address: schalker@uw.edu.
Samantha A
SA
Chalker
University of Washington, Harborview Medical Center, 325 9th Ave., Box 359911, Seattle, WA 98104, USA; Harvard Medical School, Massachusetts Mental Health Center, Division of Public Psychiatry, Beth Israel Deaconess Medical Center, 75 Fenwood Road, Boston, MA 02115, USA.
Adam
A
Carmel
University of Washington, Harborview Medical Center, 325 9th Ave., Box 359911, Seattle, WA 98104, USA.
David C
DC
Atkins
University of Washington, Harborview Medical Center, 325 9th Ave., Box 359911, Seattle, WA 98104, USA; National Center for PTSD, VA Palo Alto Health Care System, 795 Willow Road (MPD 334-PTSD), Menlo Park, CA 94025, USA.
Sara J
SJ
Landes
University of Washington, Harborview Medical Center, 325 9th Ave., Box 359911, Seattle, WA 98104, USA.
Amanda H
AH
Kerbrat
University of Washington, Harborview Medical Center, 325 9th Ave., Box 359911, Seattle, WA 98104, USA.
Katherine Anne
KA
Comtois
D000328:Adult; D001362:Avoidance Learning; D001521:Behavior Therapy / Q000379:methods*; D001883:Borderline Personality Disorder / Q000523:psychology* / Q000628:therapy*; D004644:Emotions; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
Borderline personality disorder; Challenging behaviors; Dialectical behavior therapy; Therapy-interfering behaviors