Dialectical behaviour therapy : factors relating to dropout and experiences of completion

• Main Author: McCormack, Moninne
• Published: University of Liverpool 2015
• Subjects: 616.89; BF Psychology
• Online Access: http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.677544

This thesis focuses on non-completion of dialectical behaviour therapy (DBT) for people with some features of personality difficulties (FPD) and termination of DBT for people with borderline features (BF). It contains two distinct journal papers; a systematic literature review and an empirical paper. The findings from the systematic review are outlined in chapter one. The aim of this review is to summarise the findings from studies that explore what is known about why participants do not complete DBT programmes for FPD and their characteristics. Using a systematic strategy the databases PsycINFO, PubMed, CINAHL, Web of Science, Medline and Scopus were searched for English-language only papers but with no restrictions in relation to date of publication. Papers were selected that included data in relation to dropout of adult participants from DBT for FPD. Eleven papers were included, nine observational studies and two controlled trials. The results are separated into four broad categories; personal characteristics, co-morbidity and distress, environmental and relational factors, and motivation. The results highlight the complexity of factors involved in non-completion of DBT for FPD. Further research using qualitative methods to explore participants’ reasons for non-completion is required to fill a gap in the literature. Chapter two is an empirical study exploring participants' experiences of completing DBT. Little is known about termination experiences of DBT for individuals with borderline features from their own perspectives. This study aimed to explore participants’ experiences of ending a DBT programme and how this experience has influenced their perception of previous endings and management of future endings. Six women were interviewed and their transcripts analysed using Interpretative Phenomenological Analysis. Four key themes were found: (1) fear arising from the powerful influence of previous experiences of ending, (2) engagement with the therapeutic structure of DBT to manage the ending, (3) experiencing the ending of DBT as a reparative process and (4) personal growth during the DBT programme resulting in an awareness of enhanced resilience for the future. Clinical implications highlight the importance of services and therapists to provide an experiential reparative process of therapy termination for service users.