Cited by 88Psychotherapy Techniques and ApplicationsPersonality Disorders and PsychopathologyPsychoanalysis and Psychopathology Research

The therapeutic alliance as a predictor of outcome in dialectical behavior therapy versus nonbehavioral psychotherapy by experts for borderline personality disorder.

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Bedics, Jamie D., Atkins, David C., Harned, Melanie S., Linehan, Marsha M.·2015·Psychotherapy

Abstract

The purpose of the present study was to explore facets of the client- and therapist-rated therapeutic alliance as predictors of suicide attempts, nonsuicidal self-injury, depression, and introject during the course of 2 psychosocial treatments for borderline personality disorder. A total of 101 women meeting Diagnostic and Statistical Manual of Mental Disorders-IV DSM-IV criteria for borderline personality disorder participated in a randomized controlled trial of dialectical behavior therapy (DBT) versus community treatment by experts. Clients and therapists rated the therapeutic alliance at 4 time points during 1 year of treatment. Multilevel models showed no significant differences in client ratings of the alliance by treatment condition. DBT therapists reported greater working strategy consensus early in treatment and an overall greater alliance during treatment. Client ratings of commitment and working capacity were associated with fewer suicide attempts in DBT. Client ratings of commitment were also associated with reduced nonsuicidal self-injury in DBT only. Therapist ratings of the alliance were predictive of reduced suicide attempts in both treatments. Therapist ratings of the alliance in community treatment by experts were predictive of increased nonsuicidal self-injury. Client and therapist ratings of the alliance were not significantly associated with changes in depression or introject across both treatments. The study supported theoretically predicted relationships between facets of the therapeutic alliance in DBT and suicidal behavior. Results are discussed in the context of recommendations for developing the therapeutic alliance in DBT.

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Crossref · 10.1037/a0038457

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Authors
Bedics, J. D., Atkins, D. C., Harned, M. S., & Linehan, M. M.
Affiliations
University of Washington (US)
Venue
Psychotherapy
Published
2015-03
Volume
52
Issue
1
Pages
67-77
ISSN
  • 0033-3204 (ISSN-L)
  • 1939-1536
OpenAlex
W2332592400
Cited by
88
References
26
Citations by year
2026: 7 · 2025: 5 · 2024: 4 · 2023: 5 · 2022: 9 · 2021: 14 · 2020: 15 · 2019: 6 · 2018: 8 · 2017: 9 · 2016: 6
FWCI
9.52
Type
journal article
Language
en
Open access
Locations
  • Psychotherapy (publishedVersion, other-oa)
  • PubMed (publishedVersion)
Funders
National Institute of Mental Health (MH34486)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
  • Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
  • Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
Keywords
therapeutic relationship, dialectical behavior therapy, borderline personality disorder, suicide attempts, non-suicidal self-injury, depression, introjects, customer commitment, work capacity
MeSH terms
Adolescent, Adult, Behavior Therapy, Borderline Personality Disorder, Female, Humans, Middle Aged, Professional-Patient Relations, Psychotherapy, Treatment Outcome, Young Adult

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