The use of borderline personality disorder severity index-iv feedback in adjusting borderline personality disorder treatment: therapists and patients perspectives

Background: Previous research has emphasized the importance of therapists giving Routine Outcome Monitoring (ROM) feedback to their patients. It has been shown that several factors influence therapists’ tendency to provide ROM feedback to their patients. 

Methods: In this qualitative study, using a semi-structured interview followed by thematic analysis using Atlas.ti, we focused on experiences of therapists and patients with a disorder specific ROM instrument: the Borderline Personality Disorder Severity Index-IV (BPDSI-IV). Ten patients with a borderline personality disorder who had been in Mentalization Based Treatment (MBT) and ten MBT-therapists treating patients with a borderline personality disorder were interviewed. 

Results: Qualitative analysis revealed that patients experienced benefits of ROM using the BPDSI-IV. Patients gained more insight in and recognition of their borderline personality disorder symptoms. They also felt more understood by the therapist because they got an opportunity to explain their symptoms in a different way than in a regular therapy session. Therapists shared they didn’t always use all the ROM outcomes as serious feedback for adjusting treatment. They preferred to use the BPDSI-IV over the other ROM instruments, because the BPDSI-IV is disorder specific, which gives insight into the treatment course of the patient. 

Conclusions: Experiences of both patients and therapists with the BPDSI-IV were positive. It seems to be valuable and promising for healthcare institutions to evaluate treatment with a disorder specific ROM instrument.