A Novel Approach to Examining Working Alliance Instability During Psychotherapy for Borderline Personality Disorder

Area of Science:

• Psychology
• Psychotherapy Research
• Clinical Psychology

Background:

• The working alliance is crucial in psychotherapy, but its dynamic instability and relationship with client self-esteem remain underexplored.
• Quantifying process variables like alliance instability requires advanced analytical techniques.

Purpose of the Study:

• To quantify psychotherapy process variable instability using a novel data-analytic approach.
• To explore the instability of the working alliance over 10 treatment sessions.
• To examine the relationship between alliance instability and self-esteem in borderline personality disorder treatment.

Main Methods:

• Utilized data from a randomized controlled trial for borderline personality disorder (BPD).
• Employed square successive differences to calculate alliance instability from client and therapist ratings.
• Applied multilevel models to assess within- and between-person associations with self-esteem.

Main Results:

• Preliminary analyses indicated a link between a more stable alliance and higher initial self-esteem.
• The working alliance did not demonstrate increased stability over the 10 treatment sessions.
• Alliance instability was not significantly associated with self-esteem at either the within- or between-person level.

Conclusions:

• The study highlights the utility and challenges of applying square successive differences in psychotherapy research.
• Findings suggest the working alliance evolves in complex, non-linear ways.
• Emphasizes the need for innovative methods to capture dynamic therapeutic processes.