Therapeutic relationship in cognitive behaviour therapy: Challenges and possibilities with a borderline patient

Abstract

While the traditional model emphasises conceptual and rational processing, this study highlights experiential processes in the practice of cognitive behaviour therapy. The study aims to identify therapeutic opportunities in impasses during a difficult treatment. A qualitative case study method examines the treatment of a 38 year old, female client with Borderline Personality Disorder (BPD). Three vignettes illustrate specific challenges: (1) flight and avoidance patterns hinder Socratic questioning; (2) logical disputation does not convince the client on an emotional level; and (3) interpersonal problems inherent in the disorder interfere in the therapist‑‑client relationship. The analysis of the therapist‑client relationship aids in overcoming gridlocks that are frequent with borderline clients, and allows the integration of more experiential strategies in the therapeutic process. As a suggestion for practice, a stronger emphasis on emotional and interpersonal work is due, besides the traditionally emphasized cognitive interventions.