Abstract

Objective: Mentalization-based treatment (MBT) is an evidence-based long-term treatment for borderline personality disorder (BPD). Alliance is central for effective psychotherapies. Few studies have addressed aspects of working alliance in BPD evidence-based treatments. This study aimed to investigate alliance development in MBT therapies with different clinical outcomes. Method: The sample included 155 patients in an MBT programme. Clinical outcomes were based on Global Assessment of Functioning (GAF). The sample was divided in two subgroups according to GAF levels at the end of treatment (cut-off = 60). Working alliance was assessed by patient report (Working Alliance Inventory, subscales, Goals, Bonds and Tasks) and assessed repeatedly over 36 months. The method for statistical analyses was linear mixed models. Results: Initial levels of Goals, Bonds, and Tasks did not differ by subgroup, but change over time differed significantly by subgroup. In the good outcome subgroup, ratings of Goals, Bonds, and especially Tasks increased significantly over time. In the poor outcome subgroup, paranoid PD was associated with poorer alliance development over time. Conclusions: Good outcome therapies were characterized by a process where the working alliance grew over time. Results encourage an explicit focus on tasks in therapy particularly for patients with high levels of mistrust.

摘要

目的：基于心理的治疗（MBT）是针对边缘性人格障碍（BPD）的基于证据的长期治疗。联盟对于有效的心理治疗至关重要。很少有研究涉及基于BPD循证治疗的工作联盟方面。这项研究旨在调查具有不同临床结局的MBT治疗中的联盟发展。方法：该样本包括MBT计划中的155名患者。临床结果基于全球功能评估（GAF）。在治疗结束时，根据GAF水平将样品分为两个亚组（临界值= 60）。通过患者报告（工作联盟清单，分量表，目标，保证金和任务）评估工作联盟，并在36个月内反复评估。统计分析的方法是线性混合模型。结果：子组的目标，联系和任务的初始水平没有差异，但子组随时间的变化差异很大。在良好结果子组中，目标，保证金，尤其是任务的评级随着时间的推移而显着提高。在结局较差的亚组中，随着时间的推移，偏执型PD与较差的联盟发展相关。结论：良好结果疗法的特点是，随着时间的推移，工作联盟不断发展。结果鼓励明确将注意力集中在治疗任务上，尤其是对于高度不信任的患者。