Examining challenging behaviors of clients with borderline personality disorder

• Published in: Behaviour research and therapy 2015-12, Vol.75, p.11-19
• Main Authors: Chalker, Samantha A., Carmel, Adam, Atkins, David C., Landes, Sara J., Kerbrat, Amanda H., Comtois, Katherine Anne
• Format: Article
• Language: English
• Subjects: Adult; Aggression; Avoidance behavior; Avoidance Learning; Behavior modification; Behavior problems; Behavior therapy; Behavior Therapy - methods; Borderline personality disorder; Borderline Personality Disorder - psychology; Borderline Personality Disorder - therapy; Challenging behaviors; Client satisfaction; Coaching; Dialectical behavior therapy; Disengagement; Dropping out; Emotional regulation; Emotions; Evidence based; Evidence-based medicine; Female; Humans; Male; Middle Aged; Patient Satisfaction; Personality; Personality disorders; Psychological problems; Psychotherapy; Randomized Controlled Trials as Topic; Severity; Suicide; Therapists; Therapy-interfering behaviors; Treatment Outcome; Violence; Women
• ISSN: 0005-7967; 1873-622X
• DOI: 10.1016/j.brat.2015.10.003

Few studies have examined effects of challenging behaviors of clients with borderline personality disorder (BPD) on psychotherapy outcomes. Dialectical behavior therapy (DBT) is an evidence-based treatment designed to treat chronic suicidality, self-directed violence (SDV), and emotion dysregulation, while targeting challenging behaviors. DBT has been shown to be effective with clients with BPD. We evaluated whether therapist reported challenging behaviors, such as high volume phone contacts or violating the therapist's limits, during DBT would be associated with dropping out of DBT, severity and frequency of SDV, emotion regulation deficits, psychological symptom severity and client's and therapist's satisfaction of treatment. The current study examined challenging behaviors reported by therapists in a sample of 63 psychiatrically disabled outpatient DBT clients diagnosed with BPD (73% women, average age 37 years). More frequent phone contacts were associated with a decrease in dropout and psychological symptoms, and an increase in client and therapist satisfaction. More avoidance/disengagement behavior was associated with more than twice the risk of SDV and a decrease in therapist satisfaction. Findings suggest that the phone coaching might serve to maximize client satisfaction and reduce the likelihood of dropout. •Frequent phone contacts were associated with a decrease in dropout.•Frequent phone contacts were associated with an increase in client satisfaction.•Frequent phone contacts were associated with an increase in therapist satisfaction.•Avoidance behavior was associated with a higher risk of SDV.•Avoidance behavior was associated with a decrease in therapist satisfaction.