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      Chairwork in schema therapy for patients with borderline personality disorder—A qualitative study of patients' perceptions

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          Abstract

          Objective

          Chairwork is one of the core experiential techniques of Schema Therapy (ST) which is used in the treatment of patients with borderline personality disorder (BPD). However, little is known about how people with BPD experience chairwork. The aim of this study was to explore the experiences of patients with BPD with chairwork in ST.

          Method

          Qualitative data were collected through semi-structured interviews with 29 participants with a primary diagnosis of BPD who experienced chairwork as part of their ST treatment. The interview data were analyzed using qualitative content analysis.

          Findings

          Many participants reported initial skepticism, and difficulties with engaging in chairwork. Specific therapist behaviors as well as some external (e.g., restricted facilities, noise) and internal factors (especially feeling ashamed or ridiculous) were named as hindering factors. Participants described several therapist behaviors facilitating chairwork such as providing safety, clear guidance through the process as well as flexible application of the technique according to their needs, and sufficient time for debriefing. Participants experienced emotional pain and exhaustion as short-term effects of the technique. All participants reported positive long-term effects including an improved understanding of their mode model as well as positive mode changes (e.g., less Punitive Parent and more Healthy Adult Mode), greater self-acceptance, improvements in coping with emotions and needs as well as improvements in interpersonal relationships.

          Conclusions

          Chairwork is experienced as an emotionally demanding but valuable technique. Based on the participants' statements, the delivery of chairwork can be optimized which can help to improve treatment outcome.

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          Most cited references37

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          A Coefficient of Agreement for Nominal Scales

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            Journal article reporting standards for qualitative primary, qualitative meta-analytic, and mixed methods research in psychology: The APA Publications and Communications Board task force report.

            Heidi Levitt, Michael Bamberg, John Creswell … (2018)
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              Alliance in individual psychotherapy.

              Adam O. Horvath, A Del Re, Christoph Flückiger … (2011)
              This article reports on a research synthesis of the relation between alliance and the outcomes of individual psychotherapy. Included were over 200 research reports based on 190 independent data sources, covering more than 14,000 treatments. Research involving 5 or more adult participants receiving genuine (as opposed to analogue) treatments, where the author(s) referred to one of the independent variables as "alliance," "therapeutic alliance," "helping alliance," or "working alliance" were the inclusion criteria. All analyses were done using the assumptions of a random model. The overall aggregate relation between the alliance and treatment outcome (adjusted for sample size and non independence of outcome measures) was r = .275 (k = 190); the 95% confidence interval for this value was .25-.30. The statistical probability associated with the aggregated relation between alliance and outcome is p < .0001. The data collected for this meta-analysis were quite variable (heterogeneous). Potential variables such as assessment perspectives (client, therapist, observer), publication source, types of assessment methods and time of assessment were explored. (PsycINFO Database Record (c) 2011 APA, all rights reserved).
              Article 0 comments Cited 160 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Journal
                Journal ID (nlm-ta): Front Psychiatry
                Journal ID (iso-abbrev): Front Psychiatry
                Journal ID (publisher-id): Front. Psychiatry
                Title: Frontiers in Psychiatry
                Publisher: Frontiers Media S.A.
                ISSN (Electronic): 1664-0640
                Publication date (Electronic): 02 June 2023
                Publication date Collection: 2023
                Volume: 14
                Electronic Location Identifier: 1180839
                Affiliations
                [1] 1Department of Psychiatry and Psychotherapy, University of Lübeck , Lübeck, Germany
                [2] 2Department of Psychiatry and Psychotherapy, Christian-Albrechts Universität Kiel , Kiel, Germany
                [3] 3Department of Clinical Psychology, University of Amsterdam , Amsterdam, Netherlands
                [4] 4Department of Psychiatry, Psychosomatics and Psychotherapy, University of Lübeck , Lübeck, Germany
                Author notes

                Edited by: David John Arthur Edwards, Rhodes University, South Africa

                Reviewed by: Anna Victoria Oldershaw, Canterbury Christ Church University, United Kingdom; Matthew Pugh, Central and North West London NHS Foundation Trust, United Kingdom

                *Correspondence: Anna Katharina Josek pt-praxis-josek@ 123456posteo.de

                †These authors share first authorship

                ‡Deceased

                Article
                DOI: 10.3389/fpsyt.2023.1180839
                PMC ID: 10272534
                SO-VID: 7cfcfb81-2f3c-4215-af2e-c8389d89f8f4
                Copyright © Copyright © 2023 Josek, Schaich, Braakmann, Assmann, Jauch-Chara, Arntz, Schweiger and Fassbinder.
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                Date received : 06 March 2023
                Date accepted : 12 May 2023
                Page count
                Figures: 0, Tables: 3, Equations: 0, References: 37, Pages: 16, Words: 12585
                Funding
                The Pro *BPD study (including the qualitative studies) was supported by the Else Kröner-Fresenius-Stiftung (2018_A152). EF obtained internal funding from the University of Lübeck (Einzelprojektförderung und Habiliationsförderung für Wissenschaftlerinnen, Sektion Medizin). AS obtained funding from the University of Lübeck (Habilitationsförderung für Wissenschaftlerinnen, Sektion Medizin). Funding bodies played no role in the design of the study, in the collection, analysis and interpretation of data, in the writing of the manuscript and in the decision to submit the manuscript for publication.
                Categories
                Subject: Psychiatry
                Subject: Original Research
                Custom metadata
                section-at-acceptance Psychological Therapy and Psychosomatics

                ScienceOpen disciplines: Clinical Psychology & Psychiatry
                Keywords: borderline personality disorder,chairwork,qualitative research,schema therapy,perspective,experiential techniques,psychotherapy
                Data availability:
                ScienceOpen disciplines: Clinical Psychology & Psychiatry
                Keywords: borderline personality disorder, chairwork, qualitative research, schema therapy, perspective, experiential techniques, psychotherapy

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