Review Article Open Access

The Approach of Metacognitive Interpersonal Therapy to Supervision of Therapists Treating Borderline Personality Disorder: The Key Role of Partial Counter Transferential Patterns

Abstract

We are physiologically multiple, swinging among different self-states according to different circumstances; but we generally possess a superordinate point of view capable of monitoring our different self-aspects and integrating them into a coherent and complex sense of identity. Patients suffering from Borderline Personality Disorder (BPD) display a pathological self-multiplicity. They show multiple self-states which are dissociated or compartmentalized-each with idiosyncratic patterns of ideas, affects, regulatory strategies and representations of self and others - and have a limited capacity to form a coherent sense of identity; that is significantly correlated with high levels of emotional suffering, internal chaos and psychiatric symptoms. In the psychotherapeutic relationship, the patient’s compartmentalized self-states have a strong tendency to elicit the therapist’s non-integrated, difficult to regulate, self-states, giving rise to what we refer to as Partial Countertransferential Patterns (PCPs). PCPs hinder the therapeutic effort to promote an integration of the patient’s identity and the therapeutic progress. In order to review a good clinical outcome with patients suffering from BPD, Metacognitive Interpersonal Therapy (MIT) emphasizes the role of a systematic supervisory process aimed to help therapists to face ones self discontinuity experienced with BPD patients. The main elements of MIT approach to supervision are: 1) Supervisory relationship; 2) Promoting therapists’ metacognitive abilities; 3) Case conceptualization and 4) Experiential techniques to unlock therapists’ initiative. In this paper, we first describe how MIT conceptualizes and treats BPD, then describe PCPs and finally focus on how MIT supervision deals with the problem. Some implications for future research are discussed.

Gianpaolo Salvatore1,2*, Omar Gelo3,4, Luisa Buonocore2, Maria Conza2, Tania Di Somma2, Nadia Di Sturco2, Gerardina Fimiani2, Nicoletta Manfredi2, Raffaella Marciano2, Antonella Pallotta2, Maria Grazia Proto2, Anna Sateriale2

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