Thesis (Ph.D.) - University of Queensland, 2004. / Includes bibliography.

Thesis (M.A.) University of Missouri-Columbia, 2006. / The entire dissertation/thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file (which also appears in the research.pdf); a non-technical general description, or public abstract, appears in the public.pdf file. Title from title screen of research.pdf file (viewed on August 28, 2007) Includes bibliographical references.

This thesis presents an in-depth exploration of psychotherapists’ lived experience of working with borderline personality (BPD) disorder in psychodynamic psychotherapy, using interpretative phenomenological analysis (IPA). The existing research literature suggests that working with borderline patients is very difficult, as they can evoke negative counter transference experiences in therapists and thus make the working alliance difficult to maintain. The stigmatising and negative attitude towards BPD, which is found amongst mental health professionals, can cause many therapists to avoid working with this patient population, leaving many patients without the necessary help for treatment. Some literature also suggests that psychodynamic therapy may not be helpful for the treatment of BPD in its traditional form, because of the neutrality of the model and borderline patients’ ‘reduced capacity to mentalise’. Instead, empathy and the therapeutic relationship have been reported to be significant factors. This qualitative study aimed to provide a rich and detailed examination of the experiences, which psychodynamic psychotherapists and counselling psychologists might have in their work with BPD patients. Five psychodynamic psychotherapists were interviewed twice in one unstructured and one semi-structured interview, and IPA was used to analyse the data. The five master-themes (Negative countertransference feelings; “Sitting in the dark together”; Hindrance in therapeutic work; Therapist omnipotence; Labelling as problematic) found in this study suggested that borderline patients could benefit from a modified version of psychodynamic 1 Note that the ‘psychodynamic’ and ‘psychoanalytic’ terms will be interchangeably used in this study. 2 The researcher, as a trainee-counselling psychologist, is in favour of using the word ‘client’. However, psychodynamic practitioners talk about their ‘patients’ rather than ‘clients’, and as this study focuses on psychodynamic therapists’ experiences, the researcher will use these two terms interchangeably. Thus, the word ‘patient’ here is applied in the psychodynamic and not in the medical sense. 9 psychotherapy with a focus on empathy and a bond between therapist and patient. Furthermore, the therapists’ awareness of negative countertransference feelings and emergent obstacles in the therapeutic work, as well as their understanding of BPD as a label and its effects on their borderline patients were crucial. Finally, the therapists’ experienced ‘omnipotent’ feelings, which may have emerged in response to their negative countertransference feelings. While these findings support many of the previous publications and accounts reported in the literature, they also shed new light on therapists’ experiences, which might have implications for the approach that psychotherapists and counselling psychologists take towards working with borderline individuals within the psychodynamic modality.

D.Litt. et Phil. / The aim of this study was to evaluate a feasible rating scale to measure the adherence of therapists carrying out Dialectical Behavior Therapy (DBT) with Borderline Personality Disorder (BPD) clients. Adherence referred to therapists carrying out DBT and how frequently and thoroughly they executed the specific targets and strategies of the therapy, which included taking the context into account. DBT is very specific in its treatment targets and in their hierarchical order of importance. The 97 item adherence scale was rated on a 7 point (0-6) scale. Some 86 items, that corresponded with the therapist ethological scale, were selected and then compared to the therapist and client ethological scales from an earlier study. These ethogram scales were process coding instruments which rated minute-by-minute, the frequency of specific categories of client and therapist verbal behaviors. The adherence scale was further compared to client self-report diary card measures. The diary card measures were also compared to the therapist and client ethological scales. Randomly selected client-therapist dyads (N = 10) were used, meeting criteria for BPD. All clients were women and between the ages of 18-45. The clients were seen by a total of 7 DBT trained therapists. Random sessions (N = 6) were selected from the first 16 sessions for each clienttherapist dyad. Some 60 sessions were chosen. 57 tapes were coded as 3 were too inaudible to code. Results indicated that the adherence rating of the respective therapist increased as the negative behaviors of the client increased (p < 0.05). Conversely, the greater the client's positive behavior on the ethological scale, the lower the DBT adherence rating of the therapist (p < 0.05). The problem solving category on both the adherence and therapist ethological scale covaried significantly (p < 0.02). Other therapist strategies (i.e., reciprocal, irreverence, primary targets 1-4, contingencies and validation) between the two scales were not significantly correlated. A test of the validity of the adherence scale to measure DBT fidelity draws its strongest support from two findings: 1) that when a client portrayed positive behaviors the therapist needed not to follow the primary targets so closely, resulting in a decrease in the adherence rating; and 2) the greater the negative behaviors of the client, the more stringently the therapist focused upon the primary targets and a wider array of strategies, which led to an overall increase in the adherence rating. The results of this study confirmed that a rating scale of therapist adherence is possible even with a flexible therapy such as DBT. Further, that minute-by-minute ethological ratings may serve to validate a more holistic adherence scale as tested here. Finally, recommendations are discussed for the further improvement and enhancement of the DBT adherence scale when used as a tool for rating DBT's treatment fidelity.

The aim of this study was to describe the female elf-mutilator's lived experience of cutting herself. A question which would elicit a description of the experience of this phenomenon was formulated. Five self-mutilators were interviewed. The four psychologically richest narratives were chosen for this study. Using the empirical phenomenological method. the four protocols were analysed in detail. Self-mutilation is conceptualized as a cycle wherein the mutilator experiences a diffuse bodily felt-sense that mounts to an unbearable point. She has an irresistible urge to alleviate the distress. She isolates herself and cuts herself with a sharp blade. Upon seeing the blood appear she is overcome with a deep sense of satisfaction. power, and ecstatic pleasure. The blood is perceived to carry the distressing contents out of the body. Concomitantly the self-mutilator recollects a sense of her feelings and her body as belonging to her. Her previously alienated body is felt to be a site of vitality. She also feels removed from further harm. encased in a cocoon of safety that renders her invulnerable to others. However. the cutting can never totally rid the body of distressing feelings. As a result the cycle of cutting wiII be re-enacted. The cutting cycle is conceptualized as a process whereby the self-mutilator suffers from a traumatization of the psyche such that the psychic container is fractured and rendered painfully porous. The act of cutting rids the psyche of unwanted contents such that a sense of going-on-being is restored. The cutting acts to temporarily shore up the rent fabric of the psychic envelope and thereby consolidate a sense of personal boundary. This is a temporary respite from the fracturing of the psychic container in that, once again confronted with interpersonal existence, the self-mutilator begins to feel vulnerable and defenceless. When it seems as if disintegration is again imminent, a cycle of cutting is reconstituted. The findings emergent from the interviews were dialogued with the literature on psychic containers, particularly that which addresses the role of the skin in the formation and functioning of psychic containers.

The longitudinal relationship between borderline personality features, disordered eating behaviour, and the role of impulsivity were examined using a sample of 643 Canadian adolescents from the McMaster Teen Study. Participants were assessed annually, beginning in Grade 7 until Grade 12.Using path analysis, the results suggest that higher symptoms of impulsivity increase an adolescent’s risk of engaging in disordered eating behaviour, as well as developing borderline personality features in later years. Results also showed a bidirectional relationship between these variables, whereby borderline personality features and disordered eating influence one another throughout time. As well, disordered eating appeared as an antecedent for borderline personality features. The findings highlight the importance for clinicians to be aware of the high comorbidity of disordered eating, borderline personality features, and impulsivity, and that early interventions that target impulsivity and problematic eating behaviour may mitigate the risk of future borderline personality features. Clinical implications, limitations, and future directions are discussed.

Borderline personality disorder (BPD) is associated with distress in and dissolution of romantic relationships. BPD is a relational disorder. The complex interaction between BPD and romantic relationships continues to warrant further attention, as decreased BPD symptoms are associated with increased relational effectiveness. The current study was one of the first qualitative studies that used dyadic data to examine the experience and impact of BPD on couples' relationships. Semi-structured conjoint interviews were conducted with couples with a partner with BPD (N = 10) using interpretative phenomenology. This study provides a rich understanding of the experiences of couples with BPD by exploring not only how BPD impacts couples' romantic relationships, but how couples cope with BPD. Although BPD was experienced as a relational stressor, couples utilized resources to buffer against the impact of BPD in their relationship. Three superordinate themes emerged from the data that illustrate the couple experience of navigating BPD: (a) the individual lived experience of BPD, (b) the shared experience of BPD as a relational stressor, and (c) adaptive dyadic coping in the context of BPD. Dyadic coping and shared externalization emerged as key factors in adaptive couple functioning in the context of BPD. The lived experiences of these couples provide therapists and other couples with an increased understanding of the resources and skills that support successful dyadic coping with BPD. / Master of Science / Borderline personality disorder (BPD) imposes significant stress on romantic relationships. BPD is associated with increased distress in and dissolution of romantic relationships. However, individuals in recovery from BPD report high relationship satisfaction. Decreased BPD symptoms are associated with increased relational effectiveness, but it is less clear whether reducing BPD symptoms leads to greater relational effectiveness or if relational effectiveness reduces symptoms of BPD. To better understand the complex relationship between BPD and romantic relationships, conjoint interviews were conducted with couples who were navigating the management of BPD. Ten semi-structured conjoint interviews were analyzed using interpretative phenomenology. Three themes emerged from the data that illustrate the couple experience of navigating BPD: (a) the individual lived experience of BPD, (b) the shared experience of BPD as a relational stressor, and (c) adaptive dyadic coping in the context of BPD. Dyadic coping and shared externalization emerged as key factors in adaptive couple functioning in the context of BPD. Couples navigating BPD benefit from many of the same couple coping strategies that other couples utilize to manage common stressors in life.

No description available.

This thesis presents research aimed at examining rejection sensitivity in adolescent girls with borderline personality disorder (BPD) features. Although rejection sensitivity has been discussed more generally in the literature, few studies have identified how this construct may contribute to psychopathology in adolescence. There is also limited research regarding outcome behaviours that may be associated with high rejection sensitivity as well as factors that contribute to the manifestation of this construct. Here, this thesis aims to further the understanding of rejection sensitivity in adolescence and provide evidence to support the clinical utility of examining and offering treatment for this factor in youth presenting with BPD features. Although research has shown that BPD and high rejection sensitivity are strongly correlated, few studies have investigated the outcomes that may result from having this comorbidity. In the first paper of this thesis, disordered eating was examined as an outcome behaviour in a clinical sample of girls with BPD features. The results showed that girls who met diagnostic criteria for BPD had significantly higher disordered eating behaviour and that rejection sensitivity, operationalized as fears of abandonment, mediated this relationship. In the second paper of this thesis, the relationship between self-esteem, BPD features and perceived peer rejection was investigated in a longitudinal community sample of adolescent girls. We tested the sociometer hypothesis (Leary, 2005) that self-esteem served as a metric to detect the degree of belongingness in a group context. The results indicated that the relationship between BPD features and perceived peer rejection depended on self-esteem over time. Overall, the two studies presented in this thesis contribute to the knowledge regarding rejection sensitivity in adolescents with BPD features and explores correlates and outcomes of this relationship to aid in the identification of novel treatments to target and ameliorate rejection sensitivity in this population. / Thesis / Master of Science (MSc)

no / Background: Self-harm (self poisoning and self-injury) is broadly characterised as any act intended to harm one's own body, without a conscious intent to die. Research indicates that when practitioners encounter self-harm they often remain anxious, fearful, frustrated, and challenged about such individuals, principally because they are constrained to understand and respond to self-harm almost exclusively within a problematised discourse (Walker, 2006). That is, a problem that must be diagnosed and contained. Women who self-harm with a diagnosis of BPD are often portrayed as being risky, chaotic and their identity can be unstable. The aim of this study was to examine and explore the subjective experiences of women who self-harm with a diagnosis of BPD. Participants: Four women who had a history of self-harming behaviour with the diagnosis of BPD volunteered for the study. Method: Face-to-face, in-depth narrative interviews were undertaken and were analysed within a framework which drew upon aspects of the ¿performance¿ (Langellier, 1989; 2001) and ¿narrative thematic¿ approaches (Reissman, 1993). Findings: Two of the participant's accounts illustrate how their self-harming appeared to have affected their selfhood and sense of agency. They discuss how the external signs of self-harm may take over their identity and how others communicate and interact with them. Despite the problematic nature of self-harm implications for practice are highlighted which practitioners may draw upon in their work around self-harm.