Background and objectives

In Schema Therapy (ST) for Borderline Personality Disorder (BPD) patients the empty chair technique (EC) is often used to diminish the ‘punitive parent mode’ (PP). The present study is a first attempt to assess whether EC is more effective in reducing the PP than a standard Cognitive Behavioral Therapy technique (CT).

Methods

We utilized a counterbalanced, crossover design comparing one EC session to one CT session in twenty patients with a primary BPD diagnosis who had started ST. Before and after each intervention we assessed credibility, power, and valence of the PP-associated core belief and how much power patients felt over this core belief (dominance). Patients also completed a working alliance inventory. An interview was conducted to explore subjective views regarding the interventions.

Results

Both techniques reduced power and credibility of the PP-associated core belief and increased dominance. CT reduced credibility more strongly than EC. Still, patients preferred EC as they felt it was better able to elicit feelings during the session and believed it would be more effective than CT when administered repeatedly.

Limitations

A complex technique was tested early in treatment and only once, effects might be different later in treatment and when applied repeatedly. Moreover, only short-term effects were assessed in a rather small sample.

Conclusion

Both EC and CT help combat the PP in BPD patients, with CT being more effective in reducing credibility after one session. However, patients preferred EC and suggest multiple sessions might be needed to truly elucidate differences between both techniques.

中文翻译：

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解决边缘型人格障碍图式治疗中的惩罚性父母模式：与认知挑战相比，空椅子技术的短期影响。

背景和目标

在边缘型人格障碍 (BPD) 患者的图式治疗 (ST) 中，通常使用空椅子技术 (EC) 来减少“惩罚性父母模式”(PP)。本研究首次尝试评估 EC 在降低 PP 方面是否比标准认知行为治疗技术 (CT) 更有效。

方法

我们采用了一种平衡的交叉设计，比较了 20 名原发性 BPD 诊断并开始 ST 的患者的一次 EC 疗程和一次 CT 疗程。在每次干预之前和之后，我们评估了 PP 相关核心信念的可信度、权力和效价，以及患者对这一核心信念（主导地位）的感受程度。患者还完成了工作联盟清单。进行了一次访谈，以探讨对干预措施的主观看法。

结果

这两种技术都降低了与 PP 相关的核心信念的力量和可信度，并增加了支配地位。CT 比 EC 更强烈地降低可信度。尽管如此，患者还是更喜欢 EC，因为他们认为它在治疗期间能够更好地引发感觉，并且相信在反复给药时它会比 CT 更有效。

限制

一项复杂的技术在治疗早期进行了一次测试，但在治疗后期和重复应用时效果可能会有所不同。此外，仅在相当小的样本中评估了短期影响。

结论

EC 和 CT 都有助于对抗 BPD 患者的 PP，CT 在一次治疗后更有效地降低可信度。然而，患者更喜欢 EC，并建议可能需要多次治疗才能真正阐明两种技术之间的差异。