Thesis (Ph.D.)--Drexel University, 2008. / Includes abstract and vita. Includes bibliographical references (leaves 70-82).

Thesis (Ph. D.)--University of Washington, 1990. / Vita. Includes bibliographical references (leaves [115]-123).

Thesis (J.C.L.)--Catholic University of America, 1991. / Includes bibliographical references (leaves 54-56).

Thesis (Ph. D.)--University of Washington, 2004. / Vita. Includes bibliographical references (leaves 105-120).

Thesis (Ph. D.)--UCLA, 2009. / Vita. Description based on print version record. Includes bibliographical references (leaves 169-195).

Thesis (Psy. D.)--Wheaton College, 2005. / Abstract. Includes bibliographical references (leaves 33-37).

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.