Determining the Effectiveness of Transference-focused Psychotherapy on Emotional Regulation in patients with Borderline Personality Disorder

Borderline personality disorder (BPD) is one of the most common personality disorders in psychiatric situations. Emotional regulation plays a significant role in these patients. Emotion regulation refers to a person's ability to understand and accept his emotional experiences and behave in a healthy strategy to control unpleasant emotions when necessary. As one of the components of emotion regulation, the reappraisal strategy is a prediction–oriented strategy by which people change the emotional effect of that situation in a similar situation. Also, the expressive suppression component of emotion regulation is a response–oriented strategy used entirely in suppressing the expression of emotion. Many researchers were always trying to prove how different psychotherapies affect the reduction of BPD symptoms. Transference–focused psychotherapy (TFP) is one of the most effective treatments for borderline personality disorder. The present study aimed to determine the effectiveness of transference–focused psychotherapy on emotional regulation in patients with borderline personality disorder.

This study was a semi–experimental, single–subject A–B–A design. Among the clients with BPD who referred to the Sirjan psychotherapy and counseling clinic (Hadi) in the latter part of 2020 and early part of 2021, three persons (qualified volunteers) were selected by available sampling through a clinical interview, performing Millon Clinical Multiaxial Inventory (MCMI–III) (Million, 1994) and the Personality Organization Questionnaire (Kernberg, 2002). Three qualified volunteers diagnosed with borderline personality disorder were selected as subjects. After they met the research conditions, individuals entered the treatment process for twelve months and a four–month follow–up period. Inclusion criteria were: having the diagnostic criteria of borderline personality disorder; Willingness to cooperate to receive counseling intervention and agreeing to the goals and conditions of the treatment; Obtaining written consent from the subject to participate in the research; Having third middle school; Placement in the age range between 18 and 50 years; having cognitive ability appropriate to the treatment; not receiving psychotherapy services at least in the last two months; Not using psychiatric drugs and not abusing or depending on substances for at least three months before entering the study. Data were collected using the Emotion Regulation Questionnaire (Gross & John, 2003) in three stages baseline, treatment and follow–up in 16 months. Statistical analysis of the data was done using indexes of visual analysis, recovery percentage, effect size and reliable change.

The results of the recovery percentage index in the treatment and follow–up stages, were respectively, for expressive suppression strategy in the first client (23.99 and 49.32), the second client (25.00 and 49.30) and the third client (32.72 and 55.88) and were for reappraisal strategy in the first client (74.32 and 143.24), the second client (58.72 and 119.77) and the third client (50.00 and 92.45). This indicated an increase in the recovery percentage index during treatment and follow–up. All results of the reliable change index in the treatment and follow–up stages were greater than 1.96, and Cohen's effect size was above the average, indicating the treatment's effectiveness and maintenance.

According to the results, the twelve months of transference–focused psychotherapy could effectively increase the reappraisal strategy and decrease the expressive suppression strategy in borderline personality disorder patients. In order to achieve a more comprehensive understanding of treatment, it is imperative to conduct further research and delve deeper into its various dimensions.