An interventional study of Alliance-Focused Dialectical Behavior Therapy plus Deliberate Practice and Alliance-Focused Dialectical Behavior Therapy plus Reflective Practice in Borderline Personality Disorder and Emotion Dysregulation, sponsored by York University. Active, not recruiting at 1 site in Canada. Open to participants aged 18 Years and older, including healthy volunteers. Per ClinicalTrials.gov, last updated 2026-07-29.
Sponsored by York University · Not applicable, Interventional, and Health services research
The study evaluates the feasibility, acceptability, and effect sizes of two alliance-focused dialectical behavior therapy (DBT) training interventions to improve therapists' abilities to recognize and respond to alliance ruptures with clients with borderline personality disorder (BPD). Participants will be randomly assigned to receive either a 4-week training as usual (TAU), which include didactic training plus reflective practice (i.e., thinking about past actions to gain insight for future actions) or a 4-week didactic training plus deliberate practice training (i.e., setting individualized training goals, skills coaching, and opportunities for repeated practice with expert feedback). A pre-post design will be used to assess effect sizes for change in participants' abilities to recognize and respond to alliance ruptures. Therapist characteristics will be assessed to determine moderating effects on training outcome. Feasibility and acceptability of the training intervention will be assessed following the trainings.
Borderline personality disorder is a severe psychological disorder characterized by a pattern of emotional dysregulation, interpersonal difficulties, and impulsivity. The therapeutic alliance is the cornerstone of effective psychotherapy with clients with BPD and is positively associated with treatment retention and clinical improvement. However, the therapeutic alliance in BPD treatments can be difficult to form and maintain. BPD symptoms such as emotional instability, heightened emotional reactivity, greater susceptibility to negative emotions, and interpersonal sensitivity can impact the establishment of a strong therapeutic alliance. Additionally, when clients are emotionally dysregulated or presenting with high-risk behaviors, therapists are especially vulnerable to becoming reactive and engaging in therapy-interfering behaviors that can elicit or exacerbate alliance ruptures (i.e., tension, strain, or breakdown in the therapeutic alliance). Research suggests that therapists' abilities to effectively repair alliance ruptures when they occur is critical for positive clinical outcomes in BPD treatments.
Despite the importance of alliance rupture responsiveness in BPD treatments, many of the current methods employed in psychotherapy training do not adequately develop these therapeutic skills. Psychotherapy training typically focuses on the therapeutic relationship in an unstructured, non-systematic way, using instructional or supervision-based methods despite evidence that suggests this type of passive learning is ineffective for skill development. Recent advancements in psychotherapy training have begun to focus on improving therapists' skills in navigating alliance rupture and repair, however these trainings are often time intensive and do not sufficiently target the unique client needs and therapist challenges that emerge in BPD treatments.
The primary aim of this pilot randomized controlled trial is to evaluate the feasibility, acceptability, and effect sizes of two alliance-focused DBT training interventions to improve therapists' abilities to recognize and respond to alliance ruptures with BPD clients. Additionally, we will examine whether specific therapist characteristics moderate the impact of training. Up to eighty psychotherapists will be randomly assigned to receive either a 4-week training as usual, which includes alliance-focused training plus reflective practice or a 4-week alliance-focused training plus deliberate practice training. Both trainings include the same content but employ different training methods (i.e., deliberate practice versus reflective practice). Change in skill acquisition related to recognizing and responding to alliance ruptures will be assessed based on a set of performance tasks (interpersonal facilitative skills, process recognition, emotion recognition). Therapist characteristics of emotion regulation, empathy, emotional reactivity, and humility will be assessed by self-report to determine change in emotion regulation, humility, interpersonal reactivity, and empathy, and the moderating effects of these characteristics on training outcome. Finally, participants will be asked about the feasibility and acceptability of the training interventions.
269 studies on the registry are indexed under Borderline Personality Disorder; 67 are open to participants now.
This study's planned enrollment of 80 is above the median of 70 across 215 interventional studies indexed under Borderline Personality Disorder.
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Exclusion Criteria:
Immediately receives 4 sessions of a psychotherapy training intervention to improve ability to recognize and respond to alliance ruptures in treatments with clients with borderline personality disorder.
Behavioral: Alliance-Focused Dialectical Behavior Therapy plus Deliberate Practice
Immediately receives 4 sessions of a psychotherapy training intervention to improve ability to recognize and respond to alliance ruptures in treatments with clients with borderline personality disorder.
Behavioral: Alliance-Focused Dialectical Behavior Therapy plus Reflective Practice
The alliance-focused DBT training plus deliberate practice is a 4-session weekly intervention delivered to therapists working with individuals with borderline personality disorder or emotion dysregulation. This training intervention involves a didactic component, video analysis, and case-based learning. Deliberate practice methods (e.g., setting individualized training goals, skills coaching, feedback, and opportunities for repeated practice) will be integrated both within and between training sessions.
The alliance-focused DBT training plus reflective practice is a 4-session weekly intervention delivered to therapists working with individuals with borderline personality disorder or emotion dysregulation. Trainings will involve a didactic component, video analysis, and case-based learning. Reflective practice methods (i.e., thinking about past experiences to gain insight for future actions) will be integrated both within and between training sessions.
Facilitative Interpersonal Skills Task (FIS)
An 8-item video vignette task used to assess ability to respond effectively to challenging client interactions in therapy. Scores range from 56 to 280, with higher scores reflecting higher levels of facilitative interpersonal skills.
Time frame: Administered at baseline (pre-intervention) and at 4 weeks (post-intervention).
Process Recognition Task (PRT)
A 12-item video vignette task used to assess ability to accurately detect alliance ruptures. Scores range from 0-12, with higher scores reflecting greater accuracy of rupture detection.
Time frame: Administered at baseline (pre-intervention) and at 4 weeks (post-intervention).
Jerusalem Facial Expressions of Emotion Task (JeFEE) - Short Version
A 28-item video vignette task used to assess ability to accurately identify emotional expression. Scores range from 0 to 28, with higher scores reflecting greater accuracy of emotion recognition.
Time frame: Administered at baseline (pre-intervention) and at 4 weeks (post-intervention).
Comprehensive Intellectual Humility Scale (CIHS)
A 22-item self-report measure used to assess intellectual humility. Scores range from 22-110, with higher score indicating greater intellectual humility.
Time frame: Administered at baseline (pre-intervention) and at 4 weeks (post-intervention).
Interpersonal Reactivity Index (IRI)
A 28-item self-report measure that assesses empathy. Scores range from 28 to 140, with higher scores reflecting greater empathy.
Time frame: Administered at baseline (pre-intervention) and at 4 weeks (post-intervention).
Emotional Reactivity Scale (ERS)
A 21-item self-report measure that assesses emotional sensitivity, intensity, and persistence. Scores range from 0 to 84, with higher scores reflecting greater emotional reactivity
Time frame: Administered at baseline (pre-intervention) and at 4 weeks (post-intervention).
Difficulties in Emotion Regulation Scale (DERS)
A 36-item self-report measure that assesses difficulties with emotion regulation. Scores range from 36 to 180, with higher scores reflecting greater difficulties in regulating emotions.
Time frame: Administered at baseline (pre-intervention) and at 4 weeks (post-intervention).
Acceptability, Feasibility, and Appropriateness Scale (AFAS)
Acceptability and appropriateness will be assessed based on a post-training session satisfaction survey developed for this study. Participants will rate 5 items on a 5-point Likert scale from 1 ("Strongly Disagree") to 5 ("Strongly Agree"). The acceptability items include: "Overall, I was satisfied with the session" and "The presenters were effective in conveying the material". The appropriateness items include: "The session content was relevant to my clinical practice," "The session addressed challenges I face in my work with clients," and "The material was presented at an appropriate level of depth and complexity". A mean rating of 3.5/5 across sessions is used to operationalize acceptability and appropriateness. Feasibility will be evaluated based on attendance and homework completion rates which serve as markers for intervention engagement. The intervention was considered feasible if the majority of participants attend and complete at least 75% of the intervention and homework.
Time frame: Week 1 (after Session 1); Week 2 (after Session 2); Week 3 (after Session 3); Week 4 (after Session 4)
Plan to share: No
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This study is active, not recruiting, as verified in Jul 2026. You cannot join it, but the record below documents what was studied.
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Borderline Personality Disorder→
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