Pattern formation, ruptures, and repairs in treatments of personality disorders: an idiographic case series study
BackgroundAny human communication is based on verbal, emotional, and movement patterns that weave within and between conversation partners. Personality disorders (PD), characterized by emotional dysregulation, attachment instability, and impulsivity, present disruptions in the integration of these c...
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Frontiers Media S.A.
2025-07-01
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| Series: | Frontiers in Human Neuroscience |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fnhum.2025.1552895/full |
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| author | Stine S. Høgenhaug Stine S. Høgenhaug Mickey T. Kongerslev Franco Orsucci Franco Orsucci Giovanna Zimatore Sune V. Steffensen Sune V. Steffensen Sune V. Steffensen Andreas Ekberg Andreas Ekberg Matteo Campanella Guenter Schiepek Gry Kjaersdam Telléus Gry Kjaersdam Telléus |
| author_facet | Stine S. Høgenhaug Stine S. Høgenhaug Mickey T. Kongerslev Franco Orsucci Franco Orsucci Giovanna Zimatore Sune V. Steffensen Sune V. Steffensen Sune V. Steffensen Andreas Ekberg Andreas Ekberg Matteo Campanella Guenter Schiepek Gry Kjaersdam Telléus Gry Kjaersdam Telléus |
| author_sort | Stine S. Høgenhaug |
| collection | DOAJ |
| description | BackgroundAny human communication is based on verbal, emotional, and movement patterns that weave within and between conversation partners. Personality disorders (PD), characterized by emotional dysregulation, attachment instability, and impulsivity, present disruptions in the integration of these coordination dynamics influencing alliance formation and outcome. Therapists, regardless of their clinical expertise, often find themselves grappling with the complexities of tailoring PD treatment. The alliance is often challenged by significant tension or breakdowns increasing risk of impaired progress. Thus, this multi-method comparative case series study investigated how four therapists tailored their treatment with four PD patients in a mentalization-based treatment program to identify patterns of interaction that might facilitate or hinder the therapeutic process during sessions characterized by severe disruption.MethodsThe Symptom Checklist (SCL-92) was applied to identify two successful and two unsuccessful PD treatments. The Rupture Resolution Rating System-Revised was used to detect sessions with rupture frequency peaks in each treatment case. Therapist adherence and competence were assessed with the Mentalization-Based Therapy Adherence and Competence Scale. Heart rate patterns were calculated with cross-recurrence quantification analysis to examine synchronization. An interpretative phenomenological analysis examined the therapeutic process, in addition to quantitative measures.ResultsIn sessions with increased rupture frequency, therapists had difficulties managing ruptures and struggled to tailor their treatments no matter the treatment outcome and therapist experience level. Therapists showed high contribution to confrontation ruptures, low adherence and competence ratings, decreased ability to stimulate a mentalizing environment, and inattentiveness to the patients' mental and emotional states during rupture management. Interestingly, more positive heart rate recurrence correlations were identified in sessions from successful treatments showing different regulatory patterns in rupture peak sessions from good vs. poor outcome treatments.DiscussionOur results make a significant contribution to psychotherapy research by offering a multifaceted perspective on how dynamical alliance processes might foster or hinder the therapeutic process. The clinical implications of low adherence, therapist strategic competence, and increased HR synchronization between therapist and patient in rupture intense sessions are discussed. |
| format | Article |
| id | doaj-art-b90ee7c87ae24db2ba414f6163dab990 |
| institution | DOAJ |
| issn | 1662-5161 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Human Neuroscience |
| spelling | doaj-art-b90ee7c87ae24db2ba414f6163dab9902025-08-20T02:50:29ZengFrontiers Media S.A.Frontiers in Human Neuroscience1662-51612025-07-011910.3389/fnhum.2025.15528951552895Pattern formation, ruptures, and repairs in treatments of personality disorders: an idiographic case series studyStine S. Høgenhaug0Stine S. Høgenhaug1Mickey T. Kongerslev2Franco Orsucci3Franco Orsucci4Giovanna Zimatore5Sune V. Steffensen6Sune V. Steffensen7Sune V. Steffensen8Andreas Ekberg9Andreas Ekberg10Matteo Campanella11Guenter Schiepek12Gry Kjaersdam Telléus13Gry Kjaersdam Telléus14Clinic North, Psychiatric Hospital, Brønderslev, DenmarkDepartment of Clinical Medicine, Faculty of Medicine, Aalborg University, Aalborg, DenmarkMental Health Services West, Region Zealand, Slagelse, DenmarkNorfolk and Suffolk NHS Foundation Trust, Research and Development Hub, Norwich, United KingdomCEMHS: Centre for Excellence in Mental Health Sciences, University of Amsterdam, Amsterdam, NetherlandsDepartment of Theoretical and Applied Sciences, eCampus University, Novedrate, ItalyCentre for Human Interactivity, Department of Culture and Language, University of Southern Denmark, Odense, DenmarkDanish Institute for Advanced Study, University of Southern Denmark, Odense, DenmarkCollege of International Studies, Southwest University, Chongqing, China0National Advisory Unit Personality Psychiatry, Division Mental Health and Addiction, Oslo University Hospital, Oslo, Norway1Clinic for Group Therapies and Personality Disorders Nydalen District Psychiatric Center, Oslo University Hospital, Oslo, NorwayDepartment of Theoretical and Applied Sciences, eCampus University, Novedrate, Italy2Institute of Synergetics and Psychotherapy Research, Paracelsus Medical University Salzburg, Salzburg, Austria3Psychiatry, Aalborg University Hospital, Aalborg, Denmark4Psychology, Department of Communication and Psychology, Aalborg University, Aalborg, DenmarkBackgroundAny human communication is based on verbal, emotional, and movement patterns that weave within and between conversation partners. Personality disorders (PD), characterized by emotional dysregulation, attachment instability, and impulsivity, present disruptions in the integration of these coordination dynamics influencing alliance formation and outcome. Therapists, regardless of their clinical expertise, often find themselves grappling with the complexities of tailoring PD treatment. The alliance is often challenged by significant tension or breakdowns increasing risk of impaired progress. Thus, this multi-method comparative case series study investigated how four therapists tailored their treatment with four PD patients in a mentalization-based treatment program to identify patterns of interaction that might facilitate or hinder the therapeutic process during sessions characterized by severe disruption.MethodsThe Symptom Checklist (SCL-92) was applied to identify two successful and two unsuccessful PD treatments. The Rupture Resolution Rating System-Revised was used to detect sessions with rupture frequency peaks in each treatment case. Therapist adherence and competence were assessed with the Mentalization-Based Therapy Adherence and Competence Scale. Heart rate patterns were calculated with cross-recurrence quantification analysis to examine synchronization. An interpretative phenomenological analysis examined the therapeutic process, in addition to quantitative measures.ResultsIn sessions with increased rupture frequency, therapists had difficulties managing ruptures and struggled to tailor their treatments no matter the treatment outcome and therapist experience level. Therapists showed high contribution to confrontation ruptures, low adherence and competence ratings, decreased ability to stimulate a mentalizing environment, and inattentiveness to the patients' mental and emotional states during rupture management. Interestingly, more positive heart rate recurrence correlations were identified in sessions from successful treatments showing different regulatory patterns in rupture peak sessions from good vs. poor outcome treatments.DiscussionOur results make a significant contribution to psychotherapy research by offering a multifaceted perspective on how dynamical alliance processes might foster or hinder the therapeutic process. The clinical implications of low adherence, therapist strategic competence, and increased HR synchronization between therapist and patient in rupture intense sessions are discussed.https://www.frontiersin.org/articles/10.3389/fnhum.2025.1552895/fullinterpersonal physiologyprocess researchrecurrence quantification analysisadherencealliancerupture |
| spellingShingle | Stine S. Høgenhaug Stine S. Høgenhaug Mickey T. Kongerslev Franco Orsucci Franco Orsucci Giovanna Zimatore Sune V. Steffensen Sune V. Steffensen Sune V. Steffensen Andreas Ekberg Andreas Ekberg Matteo Campanella Guenter Schiepek Gry Kjaersdam Telléus Gry Kjaersdam Telléus Pattern formation, ruptures, and repairs in treatments of personality disorders: an idiographic case series study Frontiers in Human Neuroscience interpersonal physiology process research recurrence quantification analysis adherence alliance rupture |
| title | Pattern formation, ruptures, and repairs in treatments of personality disorders: an idiographic case series study |
| title_full | Pattern formation, ruptures, and repairs in treatments of personality disorders: an idiographic case series study |
| title_fullStr | Pattern formation, ruptures, and repairs in treatments of personality disorders: an idiographic case series study |
| title_full_unstemmed | Pattern formation, ruptures, and repairs in treatments of personality disorders: an idiographic case series study |
| title_short | Pattern formation, ruptures, and repairs in treatments of personality disorders: an idiographic case series study |
| title_sort | pattern formation ruptures and repairs in treatments of personality disorders an idiographic case series study |
| topic | interpersonal physiology process research recurrence quantification analysis adherence alliance rupture |
| url | https://www.frontiersin.org/articles/10.3389/fnhum.2025.1552895/full |
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