Borderline patients in group psychotherapy studies in process and outcome

Sammanfattning: Group psychotherapy with borderline patients is an activity that is fraught with ominous apprehension and it is perhaps for this reason that little research has been done in the field. The aim of the present studies was to map out the area and to test some basic hypotheses about patient and therapist behaviour during the therapy process. Two therapy groups of carefully diagnosed clinical borderline patients were studied by means of video-technique during a therapy process of 20 months. Special technical arrangements and ethical agreements were elaborated for the research. Outcome data was collected concerning the patients’ self-image, symptom-level and personality structure. A follow-up was done 2-3 years after therapy on functional level, capacity for work, medication and need of further treatment.As expected a high drop-out rate occurred. Within a year 40% of the patients had left, and within 20 months 60%. Drop-out was not found possible to predict before the period of therapy commenced but early drop-outs were generally younger and in a more acute state of distress than late drop-outs. In order to study the therapy process two major perspectives were elaborated and operationalized: 1) classification of focus and depth of therapists’ interventions and 2) relational capacity of the patient (Borderline Relatedness). In contrast to remainers, late drop-outs were found most sensitive to disturbances in the frame of therapy (group instability) and were considered prone to interact malignantly with the therapists, eventually leading to drop-out.As to outcome and follow-up, late drop-outs were characterized by the poorest outcome all over, while early drop-outs and remainers were generally more stabilized although the early drop-outs seemed more dependent on medication for their functioning. By means of a principal components analysis the large amount of outcome data was condensed to two important factors: 1) symptom and functional level and 2) direction of anger. Thus, it was found that an important feature of a positive outcome was the ability to function at work and in social life and to direct anger outwards, not just towards oneself, thus protecting and idealizing important others, as was often the case with these patients before treatment.Taken together, the results point to the need for more precise and sensitive diagnostic methods and outcome criteria both to predict and to evaluate therapeutic outcome. To minimize drop-out and negative therapeutic reaction the research speaks in favor of further studying the therapist-patient interaction during the group therapy process and to evaluate the relative importance of therapist interventions and non-specific curative factors.