Psychopathological factors in the psychotherapeutic process in patients with borderline personality disorder and other personality disorders

State-of-the-art empirical psychotherapy research is moving away from the focus of efficacy and effectiveness studies and increasingly focusing on individual factors of unfavorable psychotherapy courses. Due to the challenging psychotherapy courses in patients with personality disorders, and especially with borderline personality disorder, process research is of high relevance for the clinical practice of this patient group. This cumulative dissertation consists of five studies from the research project BION Basel of the Psychiatric University Hospital Basel, Switzerland. The clinical samples (N = 152) of the studies come from a twelve- week, structured, disorder-specific, and inpatient treatment program, and include patients with borderline personality disorder or other personality disorders. In this naturalistic treatment setting, associations between disorder-relevant patient variables and various variables of the course of treatment were examined (study 1 - 3). Further, the naturalistic treatment setting was combined with an experimental setting (study 4) and in the experimental setting, neuronal correlates were measured (study 5). The results showed that (1) the patient's interpersonal functioning and the therapeutic alliance from the therapist's perspective in individual therapy significantly predicted the risk of treatment dropout (study 1). (2) Impulsiveness at the beginning of treatment was a significant predictor of the course of symptoms after the end of treatment (study 2) and (3) vulnerable narcissism was a significant predictor of the course of the therapeutic alliance in individual therapy during treatment (study 3). (4) The threat to basic psychological needs during experimentally simulated social exclusion showed a significant predictive value for the therapeutic alliances in group therapy at the beginning of treatment (study 4). (5) Prefrontal brain activations during experimentally simulated social exclusion were significantly associated with negative affectivity (study 5). The results provide evidence that the individual characteristics of patient variables that have been shown to be relevant to the course of treatment in research should be included in treatment planning at an early stage in order to support a favorable course of treatment. This approach is intended to contribute to the development of more patient-oriented psychotherapy.