Enhancing Therapists' Recognition and Responsiveness to Alliance Ruptures in Treatments for Borderline Personality Disorder: Protocol for a Pilot Randomised Controlled Trial

ABSTRACT Background The therapeutic alliance in psychotherapy is associated with clinical outcomes in borderline personality disorder (BPD). However, while psychotherapy training programmes vary in their inclusion of experiential components, structured and systematic training in alliance rupture recognition and repair specifically tailored to the relational demands of BPD treatment remains limited. Accordingly, strengthening alliance‐focused skills in BPD‐specific psychotherapy training is essential. Deliberate practice has emerged as a promising approach for enhancing psychotherapy skill acquisition, yet its application to alliance‐focused training in BPD contexts has not been empirically explored. The present study aims to investigate the efficacy of alliance‐focused‐DBT training (AF‐DBTT), a novel therapist training intervention integrating principles from alliance‐focused training (AFT) and dialectical behaviour therapy (DBT) to develop therapists' abilities to recognise and respond to alliance ruptures in BPD treatments. The secondary objective is to compare the effectiveness of deliberate practice versus reflective practice homework on alliance‐focused skills acquisition. A third objective is to explore whether therapist characteristics moderate the relationship between training and outcome. Methods A pilot randomised controlled trial will be conducted with N = 84 trainees randomised to one of two conditions: AF‐DBTT + reflective practice homework or AF‐DBTT + deliberate practice homework. All trainees will attend four, weekly synchronous online training sessions. The primary outcome is pre‐post change in facilitative interpersonal skills, which will be measured by the facilitative interpersonal skills task. Secondary outcomes include emotion recognition and alliance rupture recognition. Baseline therapist characteristics including empathy, intellectual humility, emotional reactivity and emotion regulation will also be assessed as potential moderators of the training intervention. Acceptability and feasibility of the training intervention will also be assessed. Discussion Results from this study will provide future directions for the improvement of psychotherapy training and practice in BPD treatments.