The principal intention of this study was to explore the heuristic value of the story of the alchemical vessel in understanding borderline conditions and pursuing their psychotherapy. It establishes the pertinence of the case study as a method of exploring the content and process of psychotherapy. The essential nature of story-telling is examined and the hypothesis is made that psychotherapy, borderline conditions, the myth of the alchemical vessel and the case study all reflect instances of story-telling. Towards the end of examining their mutual reflection, and thus heuristic value, elements of Jungian theory, the phenomenology of borderline conditions and case material are examined. Through the examination of certain shared themes which emerge from the story of the alchemical vessel and the material of psychotherapy it is established that there is indeed a metaphoric resonance between the different stories. Furthermore this resonance is useful in that it provides a secure vantage point as well as guidance towards effecting transformation for the client. The validity of the metaphoric resonance is examined and areas of weakness highlighted. Some suggestions are made concerning further research.

Thesis (Ph. D.)--University of Washington, 2004. / Vita. Includes bibliographical references (leaves 101-124).

Thesis (Ph. D.)--University of Washington, 2002. / Vita. Includes bibliographical references (leaves 63-77).

Thesis (Ph. D.)--University of Hawaii at Manoa, 2004. / Includes bibliographical references (leaves 271-279).

Dysfunction in interpersonal relationships is central to Borderline Personality Disorder (BPD) and provides the context in which self-harming behaviour, impulsivity and affective liability manifest (Lazarus et al., 2014). A growing evidence base exists for Mentalisation Based Treatment (MBT) in regard to symptom burden and extent of personality disturbance in BPD (Choi-Kain, Albert, & Gunderson, 2016). Less is known about patients’ experience of MBT, potential moderators or the utility of group only MBT. Method: First, a meta-analysis examining the relationship between attachment organisation and BPD diagnosis was conducted. Second, a mixed method design was employed to assess change in interpersonal problems and symptomatic distress following a group only MBT intervention. Potential moderators were examined and patient narratives were elicited and qualitatively analysed. Results: Across 20 studies including 1,948 participants, we found significant, medium to large effect sizes linking BPD to insecure attachment organisation. The largest effect sizes were found for a negative relationship between BPD diagnosis and attachment security, and a positive relationship between BPD and unresolved, anxious and avoidant attachment. The results of the empirical study revealed a significant reduction in interpersonal problems and psychological distress over the course of the intervention. Pre-treatment level of interpersonal problems did not function as a moderator. Patients found the group to be a challenging but rewarding experience. Conclusion: There is a strong relationship between BPD and insecure and disorganised attachment. Less intensive, group only MBT interventions may be effective in reducing levels of interpersonal problems and psychological distress in adults with a diagnosis of BPD.

Background: Borderline personality disorder (BPD) is a psychiatric diagnosis characterized by emotional and behavioural instability, and impaired ability to maintain relationships. Previous research has demonstrated an association between BPD and insecure attachment style. It has been argued that BPD is a disorder of attachment, with insecure attachment being associated with inadequate capacity to represent mental states, or to “mentalize”. There is evidence that people with BPD are impaired in their capacity to mentalize in the context of attachment relationships. The term “mentalization” encompasses a broad range of processes including metacognition. There is a theoretical basis for metacognitive deficits in BPD. However, there is a lack of empirical evidence regarding the role of metacognition in BPD and its relationship to adult attachment style. Method: Participants with BPD were recruited from Community Mental Health Teams, Clinical Psychology and a Dialectal Behaviour Therapy (DBT) service within NHS Highland. A comparison group of participants without BPD were recruited from the Clinical Psychology service, having been referred for symptoms of depression. Both groups were administered the Relationship Scales Questionnaire (RSQ)(a self-report measure of attachment); and a short version of the Metacognitions Questionnaire (MCQ-30). Severity of clinical symptoms and current mood was assessed using the Clinical Outcomes in Routine Evaluation (CORE) and the Hospital Anxiety and Depression Scale (HADS). Results: Participants with BPD scored significantly higher than those without BPD on the attachment-anxiety and attachment-avoidance dimensions of the RSQ. The BPD group also endorsed MCQ-30 items more than the comparison group. There was a significant difference between the groups on the MCQ-30 total score and four of the five subscale scores. There were significant positive correlations between attachment dimension scores and metacognition subscales. The strongest associations were between attachmentanxiety and “uncontrollability and danger” and “need to control thoughts” subscales of the MCQ-30. Only metacognition was predictive of current mood and distress levels. Conclusions: The results of this study show that people with BPD report high attachment-avoidance and attachment-anxiety in their relationships, relative to a non-BPD, depressed comparison group. These findings are consistent with the existing literature regarding the profile of attachment in BPD. This study also found that people with BPD also have more maladaptive metacognitions than people with symptoms of depression. An association between self-reported adult attachment style and maladaptive metacognitiion was demonstrated in the present study. Maladaptive metacognitive strategies and beliefs potentially contribute to maintenance of depressed and anxious mood, as well as broader symptoms of distress.

Women interpersonal chronic trauma survivors are frequently misdiagnosed with borderline personality disorder (BPD) or post traumatic stress disorder (PTSD), which often results in mistreatment. Neither PTSD nor BPD adequately describes the unique character alterations observed among those exposed to prolonged early childhood trauma.  Researchers suggest survivors of interpersonal and chronic trauma should be subsumed under complex PTSD (CPTSD)(MacLean & Gallop, 2003).  The primary purpose of this study was to test the validity of complex PTSD as a construct. MANOVA, ANOVA, chi- Square, and independent samples t- Tests were utilized to test hypotheses. Results revealed that women who experienced higher frequencies of trauma met more CPTSD criteria and had higher mean base rate scores on the Major Depression, Depressive, Avoidant, Masochistic, Anxiety, PTSD, and Borderline scales of the MCMI- III than women who experienced fewer traumas. Additionally, findings suggest that the Major Depression, Depressive, Anxiety, PTSD, and Borderline scales may highlight differences among women interpersonal trauma survivors who meet five of six CPTSD criteria versus those who meet full CPTSD diagnostic criteria. Lastly, the mean Borderline scale score for women who met full CPTSD diagnostic criteria was below the cutoff for personality traits. Overall, these findings provide evidence and validation for the distinction of CPTSD from BPD and PTSD.

D.Phil. / Please refer to full text to view abstract

Background Borderline Personality Disorder (BPD) is considered to be one of the most debilitating and difficult to treat mental disorders. Traditionally, studies investigating the aetiology and mechanisms associated with the development and exacerbation of BPD have relied on the use of clinical populations. As a consequence, the opportunities to understand vulnerabilities and fundamental processes that may contribute to the development and maintenance of the disorder have been limited. Objectives The aim of this study was to examine the potential interactions and mediating effects of metacognition and emotion regulation on the relationships among different forms of childhood abuse, attachment, and parental bonding with a composite of core BPD features designed to encompass major areas of personality functioning and pathological personality traits (per DSM-5 section III). Method: A non-clinical sample of 695 students in the city of Edinburgh, Scotland took part in an internet survey composed of a battery of self-report measures. This was geared to identify features associated with BPD, emotion regulation difficulties, characteristics of metacognition, adult insecure attachment, fundamental parental bonding styles and signs of childhood maltreatment. Structural Equation Modelling (SEM) was used to analyse the data. Results All variables of interest had a direct effect on the development of features associated with BPD. Metacognition was found to mediate the effects of all three forms of childhood abuse used in the study as well as the effects of adult insecure attachment on the development BPD related traits. Emotion regulation suppression was found to mediate the effects of sexual and physical childhood abuse (but not emotional abuse, adult insecure attachment, parental bonding indifference, or parental bonding overprotection) on the development of borderline features. In addition, the lack of emotion regulation reappraisal was found to mediate the effects of sexual abuse and adult insecure attachment (but not emotional or physical abuse, parental bonding indifference, or parental bonding overprotection) on the development of BPD related traits. Discussion These findings have important clinical and theoretical implications. The results provide support and understanding of the role of mediating mechanisms in the exacerbation and in the development of features associated with BPD. This is important because metacognition and emotion regulation may be more amenable to change than traumatic past experiences and/or deep seeded patterns of attachment. In addition, further development in this area of research has the potential to lead to better and more effective psychotherapeutic treatments for BPD.

Title from PDF of title page (University of Missouri--Columbia, viewed on Feb. 18, 2010). The entire thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file; a non-technical public abstract appears in the public.pdf file. Dr. Stanislav Kolenikov, Thesis Supervisor Includes bibliographical references.