Treatment compliance among patients with personality disorders receiving group psychotherapy: what are the roles of interpersonal distress and cohesion?

It is often assumed that patients with personality disorders have worse compliance in psychotherapy (i.e., attend fewer sessions) than patients without personality disorders. Such an assumption can have negative consequences for the treatment of patients with personality disorders. It also denies the presence of variability in session attendance among patients with personality disorders. Research that attempts to identify the factors that are associated with variability in session attendance among patients with personality disorders is needed. The present study examined the role of interpersonal distress as a predictor of session attendance for patients with personality disorders (n = 72) in two different forms of group psychotherapy (interpretive, supportive). The study also investigated whether patients' cohesion to their group mediated the effect of interpersonal distress on attendance. Findings indicated that interpersonal distress had a strong, direct association with attendance in supportive group therapy, but minimal association in interpretive group therapy. High levels of interpersonal distress were associated with higher attendance in supportive therapy. Furthermore, cohesion to the group accounted for about two-thirds of the effect of interpersonal distress on attendance in supportive group therapy, thus providing compelling evidence for its role as a mediator. Possible explanations and clinical implications of these findings are discussed.