Personality dimensions and working alliance in subjects with borderline personality disorder.

Background: As yet, the relation between personality traits and working alliance has not been investigated in subjects affected by Borderline Personality Disorder (BPD).

Method: A sample of forty-nine BPD subjects who completed a module of Sequential Brief Adlerian Psychodynamic Psychotherapy (SB-APP) of 40 sessions has been recruited. Before the onset of psychotherapy an assessment was made with Clinical Global Impression (CGI), Global Assessment of Functioning (GAF), Symptom Checklist Revised 90 (SCL-R 90), and with Temperament and Character Inventory (TCI). At the end of their psychotherapy, patients were requested to rate the level of working alliance by means of the Working Alliance Inventory (WAI-S).

Results: Multiple linear regression analysis has identified three variables as independent predictors of WAI-S total score: subjects with lower Harm Avoidance, older patients, and subjects with a higher psychopathology level had a better WAIS total score.

Discussion: These preliminary results showed that the pattern of alliance with the therapist in subjects with BPD could be related not only to weakness of character, but also to a temperamental trait typical of inhibited and avoidant subjects.

Conclusion: These results suggest that an assessment of temperament in subjects affected by BPD at intake could be useful to detect the subjects who have more difficulties in building a good working alliance and in order to improve the technical interventions and settings for psychotherapy of BPD subjects with higher Harm Avoidance.