S41.01 - The currency makes all the difference! Why the therapeutic relationship should be tailored around the patients’ motives

Abstract

The therapeutic relationship is the factor which has most consistently shown an impact on psychotherapy outcome. While for other disorders, such as circumscribed phobias, the relationship seems to determine a smaller percentage of variance, for the treatment of patients with BPD it is crucial. This is accounted for by disorder specific elements also in manualized treatment (DBT) with the principle of validation. Validation can be conceptualized as criticizing behaviors while accepting motives.

In this paper it will be argued that this principle can be used even more systematically based on the concept of "Plan Analysis" by Grawe and Caspar. It will be shown how the functioning of patients can be analyzed and described in a hierarchical structure of Plans. Such a description serves as a basis for reflections about how to react in a complementary way to problematic patient behavior while avoiding reinforcement of maladaptive behavior.

It will then be elaborated and demonstrated that to the extent to which the individual motives of a patient are met with precision, it becomes realistic to satisfy them and to reduce the motivational basis of problem behavior. In contrast, if attention is given reluctantly and reactive to patient pressure, we have to expect the well known bottomless pit.