Specialized interventions like dialectical behaviour therapy for borderline personality disorder (BPD) strongly emphasize target changes in behaviours and symptoms. But is symptom reduction the totality of what patients with BPD want from therapy? There is a growing emphasis in mental health care on patient-centred care and personalizing treatment. One approach is to focus on goals generated by patients, based on their target complaints at the start of therapy. In this study, Ng and colleagues examined the personally meaningful treatment goals of patients with BPD. The authors interviewed 102 patients seeking treatment for BPD who met strict diagnostic criteria. The patients were asked to provide, in their own words, the most important problems that they wanted to change by coming for treatment. They were prompted to provide up to 3 goals and to rate the severity of these problems. Almost all participants reported 3 individual goals. The researchers then conducted a qualitative analysis of the content of these patients’ statements and grouped the individual goals into four major themes representing the patients' overarching goals. The first major theme, reducing symptoms, was mentioned by 86.3% of the patients. This included reducing suicidality, self-harm, and depressive and anxiety symptoms. The second theme, improving well-being, was indicated by 62.7% of patients. This included better coping and managing emotions to improve quality of life, achieving a better financial situation, engaging in paid work or education, and participating more in society. The third theme, better interpersonal relationships, was endorsed by 52.9% of patients. This major goal included better connections with others, improved interpersonal skills, better communication, a deeper understanding of others, greater assertiveness, and a capacity for trust. The fourth theme, a greater sense of self, was indicated by 39.2% of patients. This included improving attitudes towards self, increasing personal awareness, developing a meaningful life direction, shifting away from a “victim persona”, and improving self-esteem and self-worth.
Practice Implications
Although symptom reduction was the most frequently cited goal among patients with BPD, the majority also had more broadly defined goals related to well-being, relationships, and a sense of self. Reducing symptoms may affect other goals, but patients generally desire a broader range of outcomes than those defined by treatment manuals for BPD. Therapists would do well to discuss treatment goals with patients and be open to patient-defined outcomes. This will improve the therapeutic alliance (agreement on the goals of therapy) and patients’ willingness to collaborate in the more demanding aspects of psychotherapy.
Ng, F. Y. Y., Carter, P. E., Bourke, M. E., & Grenyer, B. F. S. (2019). What do individuals with borderline personality disorder want from treatment? A study of self-generated treatment and recovery goals. Journal of Psychiatric Practice, 25(2), 148–155. https://doi.org/10.1097/PRA.0000000000000369.
The director of the Psychotherapy Practice Research Network (PPRNet) is Dr. Giorgio Tasca. Dr. Tasca is an Associate Professor with the School of Psychology, in the Faculty of Social Sciences at the University of Ottawa. His research is centered around psychotherapy process, mechanisms of change, and outcomes, as well as eating disorders.
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PPRNet Clinical summary: What Do Individuals With Borderline Personalities Want From Treatment?
Specialized interventions like dialectical behaviour therapy for borderline personality disorder (BPD) strongly emphasize target changes in behaviours and symptoms. But is symptom reduction the totality of what patients with BPD want from therapy? There is a growing emphasis in mental health care on patient-centred care and personalizing treatment. One approach is to focus on goals generated by patients, based on their target complaints at the start of therapy. In this study, Ng and colleagues examined the personally meaningful treatment goals of patients with BPD. The authors interviewed 102 patients seeking treatment for BPD who met strict diagnostic criteria. The patients were asked to provide, in their own words, the most important problems that they wanted to change by coming for treatment. They were prompted to provide up to 3 goals and to rate the severity of these problems. Almost all participants reported 3 individual goals. The researchers then conducted a qualitative analysis of the content of these patients’ statements and grouped the individual goals into four major themes representing the patients' overarching goals. The first major theme, reducing symptoms, was mentioned by 86.3% of the patients. This included reducing suicidality, self-harm, and depressive and anxiety symptoms. The second theme, improving well-being, was indicated by 62.7% of patients. This included better coping and managing emotions to improve quality of life, achieving a better financial situation, engaging in paid work or education, and participating more in society. The third theme, better interpersonal relationships, was endorsed by 52.9% of patients. This major goal included better connections with others, improved interpersonal skills, better communication, a deeper understanding of others, greater assertiveness, and a capacity for trust. The fourth theme, a greater sense of self, was indicated by 39.2% of patients. This included improving attitudes towards self, increasing personal awareness, developing a meaningful life direction, shifting away from a “victim persona”, and improving self-esteem and self-worth.
Practice Implications
Although symptom reduction was the most frequently cited goal among patients with BPD, the majority also had more broadly defined goals related to well-being, relationships, and a sense of self. Reducing symptoms may affect other goals, but patients generally desire a broader range of outcomes than those defined by treatment manuals for BPD. Therapists would do well to discuss treatment goals with patients and be open to patient-defined outcomes. This will improve the therapeutic alliance (agreement on the goals of therapy) and patients’ willingness to collaborate in the more demanding aspects of psychotherapy.
By Dr. Giorgio Tasca
The director of the Psychotherapy Practice Research Network (PPRNet) is Dr. Giorgio Tasca. Dr. Tasca is an Associate Professor with the School of Psychology, in the Faculty of Social Sciences at the University of Ottawa. His research is centered around psychotherapy process, mechanisms of change, and outcomes, as well as eating disorders.Also Read