2005, Number 1
Compílanse with group psychoterapeutic treatment in patients with borderline personality disorder. Pilot study in patients 18 to 24 years old.
Biagini AM, Torruco SM, Carrasco FB
Full text
Language: Spanish
References: 30
Page: 52-60
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ABSTRACT
The treatment of election for patients with Borderline Personality Disorder (BPD), consists on the combination of psychotherapy and pharmacotherapy. Concerning a psychoanalitic and individual focuse, there has been found, that in spite of the differences in orientations and the therapists experience, the manifestations of the disorder tend to decrease. First of all, a decrease in the impulsivity and an increase in the affective stability is seen, whether the identity alterations modify poorly with treatments of a duration of up to two years.Traditionally, patients with BPD have not been considered apt for group therapy, because their disruptive behavior interferes with the development of the groupal cohesion; however, this characteristics are the ones that can be rapidly treated in the group, when putting a slight pressure on the patient so he can modify this maladaptive behavior.
The objectives of group therapy, are consistent with the ones in individual therapy. They include stability for patients, management of impulsivity and other symptoms, and management of the reactions in the transference and countertransference. The presence of other patients helps to establish limits between the participants and it also generates an altruistic interaction, in which they can consolidate their changes in the process of helping others.
Group therapists suggest that individual therapy can be accelerated if the patient participates in the group in which the primitive fantasies are stimulated and where the group structure provides a support that helps personal growth.
One of the most difficult tasks in any therapy is the desertion of the patients. Specially, the group is vulnerable to desertion, in its initial stage, since it has been recorded that there is a 13 to 63% of desertions.
The purpose of the present study was to determine the psychological and psychopathological variables in patients with BPD, that influence the compliance in a group therapy.
All the candidates in this investigation were patients with a probable diagnose of BPD, that had been sent to the Psychotherapy Department of National Institute of Psychiatry, aged between 18 to 24 years. This diagnose was corroborated with the SCID II.
A descriptive study was made with the characteristics of the patients in some different areas: character and temperament, self esteem, quality of life, psychosocial functioning, interpersonal problems, ego strength, and psychiatric symptoms.
A total of 24 weekly sessions with a duration of an hour and a half, were conducted under the direction of two psychotherapists and a non active observer.
A Spearman correlation was used to correlate the psychological variables with the number of assisted sessions. We included 16 female patients, with an age mean of 20.43 years; the mean of assistance to the group was of 4.5 sessions.
None of the subjects assisted to all the 24 sessions and 56% of the patients deserted the group as well as the pharmacological treatment.
The findings of the correlations between the number of assisted sessions and the psychological variables, suggested first of all, a positive relation between the persistence scale of the ITC and a negative association with the subscales 1 (preoccupation vs optimism) and 4 (fatigability vs energy).
Other findings suggested negative correlations between the psychosis scale of the SCL 90 and the evitative scale. The rest of the scales did not have a significative correlation with the number of assisted sessions.
The items mentioned during the sessions by the patients consisted in the extreme dependency to the external criticism, that came from significative figures. The patients also talked about some of the common symptoms of BPD, like frustration, intolerance, suicide, lack of affective stability, self mutilations, rage, ambivalence, poor self concept, feelings of inferiority, and low self esteem.
The percentage of desertion in this study was a lot higher than expected, assuming that in a regular group basis, there is 30% to 40% of desertion. It also came to our attention, that groupal phenomena, were not observed. Specially identifications and groupal cohesion, were not developed in this case.
The patients collaborated exclusively with the therapists; they did not give any devolutions to other patients. They all waited for their turn, changing the theme, in a way that satisfied their own conflicts.
The universality of the experience phenomenon was no seen, since the patients, did not feel that the others had the same problems, conflicts emotions or ideas, feeling supported or relieved by it.
In conclusion, the patients with BPD, in our institution have a bad compliance in a group therapy, in which only personality disorders are admitted.
These patients did not blend within the environment, because the groupal phenomena that produce the changes were not seen at all. This is probably associated with the intrinsic characteristics of the disorder, and this is why the probable changes in the patients should be evaluated and this technique questioned, as a reliable treatment method for personality disorders. A comparison of this technique with others, such as individual therapy and the combination of both, should be also considered.
The Psychobiologic model of Cloninger, used in other investigations to predict the efficacy of pharmacotherapy, can be used to make a prediction of the compliance of BPD with groupal therapy. This data should be considered in the previous evaluation of the patients, with the goal of establishing different strategies, and an adequate treatment, for subjects with these characteristics.
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