Patient-therapist ratings and relationship to progress in dialectical behavior therapy for borderline personality disorder

Abstract

This study investigated the influence of the patient-therapist relationship in reducing suicidal behavior in Dialectical Behavior Therapy (DBT). DBT is a behavioral treatment for borderline women developed by Linehan who demonstrated its effectiveness in two earlier 1-year outcome studies. Subjects were 4 therapist-patient dyads. Patients were parasuicidal women who met criteria for borderline personality disorder; therapists were psychology and nursing graduate students. Weekly patient and therapist relationship ratings were measured over 7 months of initial treatment with a short form of Benjamin's Structural Analysis of Social Behavior (SASB). Four hypotheses encompassing dialectical theory, nonpejorative conceptualization, modeling, and contingency timing predictions were tested for each patient with time series analyses. Combined results of the four patients supported all hypotheses. Dialectical techniques balancing acceptance and change were more effective than pure change or acceptance techniques in reducing suicidal behavior. Therapist ratings consistent with nonpejorative conceptualization were also associated with less suicidal behavior.