1
|
Debrot A, Berthoud L, Caspar F, Berger T, Pomini V. Tailoring Guidance in Internet-Based Interventions With Motive-Oriented Therapeutic Relationship. Front Digit Health 2022; 4:842487. [PMID: 35419558 PMCID: PMC8995493 DOI: 10.3389/fdgth.2022.842487] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 03/04/2022] [Indexed: 12/18/2022] Open
Affiliation(s)
- Anik Debrot
- Institute of Psychology, Faculty of Social and Political Sciences, University of Lausanne, Lausanne, Switzerland
- *Correspondence: Anik Debrot
| | - Laurent Berthoud
- Institute of Psychology, Faculty of Social and Political Sciences, University of Lausanne, Lausanne, Switzerland
| | - Franz Caspar
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Thomas Berger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Valentino Pomini
- Institute of Psychology, Faculty of Social and Political Sciences, University of Lausanne, Lausanne, Switzerland
| |
Collapse
|
2
|
Grandjean L, Hummel J, Wyer D, Beuchat H, Caspar F, Sachse R, Berger T, Kramer U. Psychotherapeutic case formulation: Plan analysis for narcissistic personality disorder. Personal Ment Health 2021; 15:309-316. [PMID: 34145790 PMCID: PMC9285548 DOI: 10.1002/pmh.1521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/30/2021] [Accepted: 05/16/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND One of the relevant case formulation methods for personality difficulties is plan analysis. The present study aimed at delivering a prototypical plan analysis for clients presenting with a diagnosis of narcissistic personality disorder (NPD). The sample consisted of 14 participants diagnosed with an NPD. Based on audio clinical material, we developed 14 individual plan analyses that we then merged into a single prototypical plan analysis. For explorative purposes, we ran an ordinary least squares regression model to predict the narcissistic symptoms severity (NAR) measured on a scale of 1-7 of the 14 clients by the presence (respectively absence) of certain plans in their individual plan analysis. The synthesis revealed that clients with pathological narcissism share common basic motives. Results of the regression model reveal that the presence of the plan 'be strong' reduces the NAR scale by 1.52 points (p = 0.011). DISCUSSION In the treatment of psychological disorders, precise case formulations allow therapists for making clinically appropriate decision, personalizing the intervention and gaining insight into the client's subjective experience. In the prototypical plan structure we developed for NPD, clients strive to strengthen their self-esteem and avoid loss of control, criticism and confrontation as well as to get support, understanding and solidarity. When beginning psychotherapy with a client presenting with NPD, the therapist can use these plans as valuable information to help writing tailored, and therefore more efficient, case formulations for their patients presenting with an NPD.
Collapse
Affiliation(s)
- Loris Grandjean
- Institute of Psychotherapy, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Human Sciences, University of Bern, Bern, Switzerland
| | - Jana Hummel
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Human Sciences, University of Bern, Bern, Switzerland
| | - Dominik Wyer
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Human Sciences, University of Bern, Bern, Switzerland
| | - Hélène Beuchat
- Institute of Psychotherapy, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Franz Caspar
- Institute of Psychotherapy, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Rainer Sachse
- Institut für Psychologische Psychotherapie, Bochum, Germany
| | - Thomas Berger
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Human Sciences, University of Bern, Bern, Switzerland
| | - Ueli Kramer
- Institute of Psychotherapy, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,General Psychiatry Service, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,Department of Psychology, University of Windsor, Windsor, Ontario, Canada
| |
Collapse
|
3
|
Maillard P, Dimaggio G, Berthoud L, de Roten Y, Despland JN, Kramer U. Metacognitive improvement and symptom change in a 3-month treatment for borderline personality disorder. Psychol Psychother 2020; 93:309-325. [PMID: 30712326 DOI: 10.1111/papt.12219] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 12/21/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Recognizing and reflecting on one's own and other people's mental states represent a major difficulty for patients with borderline personality disorder (BPD). Only recently have studies begun exploring whether these capacities increase with successful therapies and if such an improvement is linked with outcome. The present study investigated whether metacognition would improve and if its improvement was related with symptom change in BPD patients. DESIGN The transcripts from the first and the penultimate session of a ten-session version of good psychiatric management were analysed with the MAS-R scale in a N = 37 BPD sample. Patients, selected from a previously published RCT (Kramer et al., 2014), were assigned either to the good psychiatric management treatment or to the same treatment with the addition of the Motive-Oriented Therapeutic Relationship (Caspar, 2007), a form of therapeutic relationship based on an individualized case formulation. Symptoms were assessed with the OQ-45. RESULTS Findings partially support the hypotheses. First, improvement in capacities to understand others' mind, to take a critical distance from one's own rigid and maladaptive beliefs, and to use behavioural and attentional strategies to face adversities is found in both treatment groups. Controlling for marital status, only the ability to differentiate between reality and representations remains significant. Second, no link between metacognitive change and symptom change during treatment is found. However, a link is observed between the increase in metacognition and symptom reduction at 6-month follow-up. CONCLUSIONS Results invite to further investigate the role of metacognition in therapy change through different modalities and in longer-term treatments. PRACTITIONER POINTS The development of metacognitive processes and their links with symptom change were examined during a short-term treatment in 37 borderline patients Improvement was found in capacities to understand others' mind, to take a critical distance from own rigid and maladaptive beliefs, and to use behavioural and attentional strategies even in a short-term treatment Controlling for marital status, only the ability to take a critical distance from representations remained significant A link was observed between increase in metacognition and symptom reduction at 6-month follow-up Understanding and tailoring interventions to specific metacognitive difficulties could be associated with symptom change during treatment for BPD patients.
Collapse
Affiliation(s)
- Pauline Maillard
- Institute of Psychotherapy-University Hospital Center, University of Lausanne, Switzerland
| | | | - Laurent Berthoud
- Institute of Psychotherapy-University Hospital Center, University of Lausanne, Switzerland
| | - Yves de Roten
- Institute of Psychotherapy-University Hospital Center, University of Lausanne, Switzerland
| | - Jean-Nicolas Despland
- Institute of Psychotherapy-University Hospital Center, University of Lausanne, Switzerland
| | - Ueli Kramer
- Institute of Psychotherapy-University Hospital Center, University of Lausanne, Switzerland.,University of Windsor, Canada
| |
Collapse
|
4
|
Westermann S, Gantenbein V, Caspar F, Cavelti M. Maintaining Delusional Beliefs to Satisfy and Protect Psychological Needs. ZEITSCHRIFT FUR PSYCHOLOGIE-JOURNAL OF PSYCHOLOGY 2018. [DOI: 10.1027/2151-2604/a000337] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Abstract. Affiliation, control, and self-esteem are psychological needs that human beings attempt to satisfy and protect ( Epstein, 2003 ; Grawe, 2004 ). From a motivational perspective, behaviors, attentional and cognitive biases as well as symptoms can have an instrumental function for need satisfaction and protection ( Caspar, 2011 ). In this opinion paper, we elaborate the idea that the maintenance of delusions could be a motivated process. This approach helps to view the maintenance of delusional beliefs as a purposeful, yet mostly nonconscious, and not completely adaptive attempt to satisfy and protect psychological needs. Conclusions for case formulations, therapy planning, and therapeutic relationship building are drawn within the framework of cognitive-behavioral therapy for psychosis. In addition, limitations of the approach and future research avenues are discussed.
Collapse
Affiliation(s)
- Stefan Westermann
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Bern, Switzerland
| | - Vivien Gantenbein
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Bern, Switzerland
| | - Franz Caspar
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Bern, Switzerland
| | - Marialuisa Cavelti
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland
| |
Collapse
|
5
|
Berthoud L, Pascual-Leone A, Caspar F, Tissot H, Keller S, Rohde KB, de Roten Y, Despland JN, Kramer U. Leaving Distress Behind: A Randomized Controlled Study on Change in Emotional Processing in Borderline Personality Disorder. Psychiatry 2017; 80:139-154. [PMID: 28767333 DOI: 10.1080/00332747.2016.1220230] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The marked impulsivity and instability of clients suffering from borderline personality disorder (BPD) greatly challenge therapists' understanding and responsiveness. This may hinder the development of a constructive therapeutic relationship despite it being of particular importance in their treatment. Recent studies have shown that using motive-oriented therapeutic relationship (MOTR), a possible operationalization of appropriate therapist responsiveness, can enhance treatment outcome for BPD. The overall objective of this study is to examine change in emotional processing in BPD clients following the therapist's use of MOTR. METHOD The present paper focuses on N = 50 cases, n = 25 taken from each of two conditions of a randomized controlled add-on effectiveness design. Clients were either allocated to a manual-based psychiatric-psychodynamic 10-session version of general psychiatric management (GPM), a borderline-specific treatment, or to a 10-session version of GPM augmented with MOTR. Emotional states were assessed using the Classification of Affective-Meaning States (Pascual-Leone & Greenberg, 2005) at intake, midtreatment, and in the penultimate session. RESULTS Across treatment, early expressions of distress, especially the emotion state of global distress, were shown to significantly decrease (p = .00), and adaptive emotions were found to emerge (p < .05). Between-condition differences of change were found, including a significant increase in emotional variability and stronger outcome predictors in the MOTR condition. CONCLUSIONS The findings indicate initial emotional change in BPD clients in a relatively short time frame and suggest the addition of MOTR to psychotherapeutic treatments as promising. Clinical implications are discussed.
Collapse
|
6
|
Are Suicide Attempters Wired Differently?: A Comparison With Nonsuicidal Depressed Individuals Using Plan Analysis. J Nerv Ment Dis 2015; 203:514-21. [PMID: 26057773 DOI: 10.1097/nmd.0000000000000321] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Limited research exists on internal risk processes in suicide attempters and factors that distinguish them from nonsuicidal depressive individuals. In this qualitative study, we investigated Plans, motives, and underlying self-regulatory processes of the two groups and conducted a comparative analysis. We analyzed narrative interviews of 17 suicide attempters and intake interviews of 17 nonsuicidal depressive patients using Plan Analysis. Then, we developed a prototypical Plan structure for both groups. Suicidal behavior serves various Plans found only in suicide attempters. Plans of this group are especially related to social perfectionism and withdrawal to protect their self-esteem. Depressive patients use several interpersonal control and coping strategies, which might help prevent suicidal behavior. The prototypical Plan structure of suicide attempters may be a valuable tool for clinicians to detect critical Plans and motives in their interaction with patients, which are related to suicide risk.
Collapse
|
7
|
Kramer U, Kolly S, Berthoud L, Keller S, Preisig M, Caspar F, Berger T, de Roten Y, Marquet P, Despland JN. Effects of motive-oriented therapeutic relationship in a ten-session general psychiatric treatment of borderline personality disorder: a randomized controlled trial. PSYCHOTHERAPY AND PSYCHOSOMATICS 2014; 83:176-86. [PMID: 24752034 DOI: 10.1159/000358528] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Accepted: 01/11/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Motive-oriented therapeutic relationship (MOTR) was postulated to be a particularly helpful therapeutic ingredient in the early treatment phase of patients with personality disorders, in particular with borderline personality disorder (BPD). The present randomized controlled study using an add-on design is the first study to test this assumption in a 10-session general psychiatric treatment with patients presenting with BPD on symptom reduction and therapeutic alliance. METHODS A total of 85 patients were randomized. They were either allocated to a manual-based short variant of the general psychiatric management (GPM) treatment (in 10 sessions) or to the same treatment where MOTR was deliberately added to the treatment. Treatment attrition and integrity analyses yielded satisfactory results. RESULTS The results of the intent-to-treat analyses suggested a global efficacy of MOTR, in the sense of an additional reduction of general problems, i.e. symptoms, interpersonal and social problems (F1, 73 = 7.25, p < 0.05). However, they also showed that MOTR did not yield an additional reduction of specific borderline symptoms. It was also shown that a stronger therapeutic alliance, as assessed by the therapist, developed in MOTR treatments compared to GPM (Z55 = 0.99, p < 0.04). CONCLUSIONS These results suggest that adding MOTR to psychiatric and psychotherapeutic treatments of BPD is promising. Moreover, the findings shed additional light on the perspective of shortening treatments for patients presenting with BPD.
Collapse
Affiliation(s)
- Ueli Kramer
- Institute of Psychotherapy, CHUV, University of Lausanne, Lausanne, Switzerland
| | | | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Kramer U, Caspar F, Drapeau M. Change in biased thinking in a 10-session treatment for borderline personality disorder: Further evidence of the motive-oriented therapeutic relationship. Psychother Res 2013; 23:633-45. [DOI: 10.1080/10503307.2013.791404] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
|
9
|
Kramer U, Sachse R. Early clarification processes in clients presenting with borderline personality disorder: Relations with symptom level and change. PERSON-CENTERED & EXPERIENTIAL PSYCHOTHERAPIES 2013. [DOI: 10.1080/14779757.2013.804647] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|