Addressing Spirituality in Psychotherapy: Helping Patients With Borderline Personality Disorder and Trauma

Seventy patients with borderline personality disorder (BPD) in treatment at McLean Hospital received a group intervention to incorporate spirituality into mental health care treatment. The Spiritual Psychotherapy for Inpatient, Residential, and Intensive Treatment (SPIRIT) intervention is a hospital-based intervention grounded in a cognitive behavior therapy (CBT) framework that explores how patient spirituality and spiritual struggles relate to current distress and symptoms. Often patients diagnosed with BPD have experienced trauma and have coexisting disorders such as posttraumatic stress disorder (PTSD). We examined spiritual struggle, religiosity, spirituality, and treatment outcome for 53 patients with BPD and no PTSD and 17 patients with comorbid BPD and PTSD. We found no significant differences between those patients with PTSD and those without regarding spirituality, spiritual struggle, religiosity, or outcome. When examining suicide attempts and suicidal ideation across all patients with BPD, analysis revealed that BPD patients who attempted suicide endorsed less spirituality compared to those who did not. Those BPD patients who had current suicidal ideation reported more spiritual struggles compared to those patients who did not. The level of patient spiritual distress also related to their experience that the intervention helped them identify a link between their spiritual distress and symptoms, but it did not relate to their perceived learning strategies to reduce the distress. Limitations, research implications, and clinical implications are discussed.