| This study examined the presence of an affective communication created between patient and therapist that allows for a dyadic process of symbolization in psychotherapy. The expression of affect is one of many channels by which patients communicate their internal world to the therapist, and due to impairments in object representations patients with borderline personality disorder (BPD) may unconsciously communicate their internal experience through affect. This "affective communication" allows the therapist to use his/her own internal structures to give organization and meaning to the unsymbolized affect and give it back to the patient in a more symbolic form. The present study is part of a recent randomized controlled trial comparing Transference Focused Psychotherapy (TFP) to a psychodynamic supportive psychotherapy (SPT) and dialectic behavioral therapy (DBT) for patients with BPD. Therapists from the three treatments completed questionnaires focusing on the therapist's experience of an affective communication in the treatment. It was demonstrated (1) that the construct of affective communication can be reliably assessed by therapists of various treatment modalities, (2) that the construct of affective communication relates in predicted ways to similar constructs, and (3) that the affective communication created between therapist and patients with BPD in the initial stages of treatment predicted aspects of the course and outcome of a twelve month treatment. Specifically, it was found that patients stayed in treatment longer when therapists experienced their patients and themselves as enlivened and emotionally-present in the treatment. Overall, the relationship between affective communication and symptom change during treatment was not strong, with decreased negative affect predicting some indicators of symptom change. However, this construct may have a greater impact on structural change within the patient; affective communication variables were found to predict change in reflective function (RF) in patients treated in TFP but not SPT or DBT, with findings indicating that there is an optimal level of engagement and affect within which change in RF occurs. Affective communication is hypothesized to be of particular relevance to TFP due to that treatment's explicit effort to promote mentalization in the context of heightened affect in the attachment relationship with the therapist. |
